Help Requested, T65 November, COBRA in Play for Couple

Oct 28, 2016

  1. yorkriver1
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    yorkriver1 Guru

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    I thought I read that entitled to Medicare (A) means you are actually signed up, not just T65 (with 40 quarters, etc)

    A referral today:

    Married couple, the spouse on employer coverage quit last summer, went on COBRA for self/spouse.

    former employee's T65 DOB: late November this year. So, could get Medicare for 11/1/16. Not.signed.up.yet.

    I just read on DOL that a COBRA plan could drop a covered individual when they become "entitled" to Medicare. I recall that the language for eligibility for PDP is "entitled to Medicare A, or enrolled in Medicare B". In that situation "entitled" means they have Medicare A in force.

    Why this matters. We are 3 days from 11/1/16. If entitled means, T65 in November, therefore can sign up for 11/1/16, then there could be trouble and a possible coverage gap. If entitled means actually covered by Medicare A, then waiting a month won't hurt.
    They don't know whether the former employee's spouse will lose coverage when the former employee drops COBRA. (I understand COBRA as a contintuing option for the spouse, due to Medicare eligibility as a valid qualifying event for the former employee to drop off COBRA)--and, it's a worrisome situation if COBRA could be ended as of 11/1/16, when the former employee could/should have signed up.
    I recall seeing posts indicating Medicare could probably be backdated to 11/1/16.

    The close date on getting signed up for Medicare concerns me for the former employee getting enrolled in a PDP and Med/Supp quickly, possibly by 11/1/16, if COBRA has to end then.

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    I may have answer. Looks like COBRA can be kept after T65, but must enroll in Part A & B within the 7 month window, in this case November and the following 3 months, to avoid Medicare delay + penalty.

    Spouse should be able to keep COBRA if desired, for the original 18 month period, due to each person's eligibility, not dependent on spouse T65.

    With that in mind, then the question is whether the spouse needs to keep COBRA until 12/31/16, and can use open enrollment for ACA based individual health coverage, or is there a SEP due to spouse T65. Probably best to keep to end of year anyway due to calendar year deductible/MOOP.
     
  2. LostDollar
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    LostDollar Guru

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  3. yorkriver1
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    yorkriver1 Guru

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    ACA open enrollment is the major time to get out of COBRA once it has been elected, assuming there are better deals in individual plans.

    The information on Healthcare.gov is not as clear as it could be. ACA compliant plans open enrollment is: 11/1/16 to 1/31/17. It's OK to leave COBRA then, and only then, unless COBRA has run out, or there are qualifying events, AKA: special election period.

    Qualifying events for SEP's are spelled out on HC.gov.
     
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