Election Period Coding

[Alhambra]

My question is if a 70 year old guy signs up for MA for the first time, could you qualify his election under SEP65?

Thanks

 

[Josh]

SEP65? Now you're making this up. There is no special election period for "first time on MA".

 

[Alhambra]

There is SEP65, but it needs to be around 65 years of age, beginning 3 months before and ending 3 months after.

I've posted here because I've a client that I like to enroll into a MA (with part-d) Program, and I was hoping it would be answered by nice friendly professionals of the industry.

A 70 year old with no chronic issues, has only Medicare, has not moving residences, has not been institutionalized, or switched from another MA plan, would that person have any ways to enroll at this time, middle of June?

SEP65? Now you're making this up. There is no special election period for "first time on MA".

 

[ksigmtsu]

I think hes asking if he gets an initial enrollment period for just starting medicare. The answer to that is yes if he had medical coverage, although I'm not sure what the exact SEP code is. You need a copy of the evidence of creditable coverage from his old insurance company. I think the election period lasts 63 days in that instance, without looking it up.
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Never mind. No. You have to wait till AEP unless he's QMB subsidy or dual eligible.

 

[Alhambra]

Here's a link as to how to get people certified as QMB.
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Never mind. No. You have to wait till AEP unless he's QMB subsidy or dual eligible.

Yes, QMB Subsidy is my only solution with someone who does not have Medicaid.

 

[Josh]

"SEP65" is only for folks aging into Medicare when they turn 65, so they'd have to be precisely. It would also be referred to as their ICEP, "SEP65" seems more like a term a carrier is using to create new terminology to make things easier by actually using the number 65 in it.
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I think hes asking if he gets an initial enrollment period for just starting medicare. The answer to that is yes if he had medical coverage, although I'm not sure what the exact SEP code is. You need a copy of the evidence of creditable coverage from his old insurance company. I think the election period lasts 63 days in that instance, without looking it up.

It's not just losing coverage, it has to be losing employer/retiree benefits and I believe the coverage would have to be terminated at the employers request, not the employee. The new plan would have to be elected within 63 days of the employer coverage being terminated.
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Alhambra:

1. Where did you see the "SEP65"? That's cracking me up.

2. You seem to be all over the place. Let's start a new life insurance website, opened a retail location, really confused about Medicare Advantage (SEP65 terminology aside), knocking Medicare Advantage HMO's when it's clear you don't understand them (or the industry). Do you have a primary focus or are you just trying to sell something to anyone that says "Oh, you sell insurance, I need to get some (health, Medicare, life, etc) coverage. Can you help me?"

 

[ksigmtsu]

It's not just losing coverage, it has to be losing employer/retiree benefits and I believe the coverage would have to be terminated at the employers request, not the employee. The new plan would have to be elected within 63 days of the employer coverage being terminated.

99% of the time when I get to enroll based on a initial election period with creditable coverage certificate, it's because the person chose to retire and lost their coverage. I guess in some logic that would be at the employers request, but usually they initiated it themselves.

 

[jdeasy]

MPS is correct. There is no such thing as an SEP65. It's ICEP for MA/MAPD and it's IEP for PDP.

There is an SEP for a person just getting Medicare B for the first time if they didn't get it at age 65 because they had creditable coverage.

If this person has had Medicare A and B since age 65 and just now wants to get an MA plan, he has no SEP for procrastination. He would have one if he qualifies for for an LIS/SLMB or QMB. Barring that, he has to wait for AEP.

 

[Josh]

99% of the time when I get to enroll based on a initial election period with creditable coverage certificate, it's because the person chose to retire and lost their coverage. I guess in some logic that would be at the employers request, but usually they initiated it themselves.

There is a key difference there. They didn't choose to drop the coverage, they chose to retire. Based on everything I recall and what I've looked at in the last 10 minutes, the employer has to actually drop the coverage. How does CMS verify this? Well that's up for debate. But for it to follow the guidelines of eligibility the employer would need to actually drop them. One source is here:
Special Election Periods (SEPs) | California Health Advocates

I don't have an updated reference sheet handy, but the employer does need to actually drop them, they can't make the voluntary decision to leave and have a SEP, the would only be able to use the standard enrollment periods (or another SEP).

 

[MrMack]

I've posted here because I've a client that I like to enroll into a MA (with part-d) Program, and I was hoping it would be answered by nice friendly professionals of the industry.

A 70 year old with no chronic issues, has only Medicare, has not moving residences, has not been institutionalized, or switched from another MA plan, would that person have any ways to enroll at this time, middle of June?

[/quote]

He would have to wait until the Annual Enrollment Period. It is from Nov. 15 to Dec. 31. The plan would start Jan. 1 and he would be subject to the Part D Late Enrollment Penalty if he does not have credible coverage now.