Is She Screwed This AEP?

[bigeats]

Got a prospect who turned 65 last June. She did not enroll in Part A or Part B until TODAY... with an effective date of 1/1/2012 (her company paid insurance ends at the end of December)

She originally was going to go with a Med Supp... but now is considering an MAPD.

The question is - can I enroll her in an MAPD before she gets her Medicare Card? I'm assuming she won't have it before December 7th... so would I just use her SS number followed by an "A" and use the 1/1/2012 Effective Dates for the app?

If she hadn't been dragging her feet for so many months - this wouldn't be an issue... but now, even if she wants to go with a Med Supp, she still has the same issue with the December 7th deadline regarding a standalone PDP.

Any thoughts?

 

[ksigmtsu]

Got a prospect who turned 65 last June. She did not enroll in Part A or Part B until TODAY... with an effective date of 1/1/2012 (her company paid insurance ends at the end of December)

She originally was going to go with a Med Supp... but now is considering an MAPD.

The question is - can I enroll her in an MAPD before she gets her Medicare Card? I'm assuming she won't have it before December 7th... so would I just use her SS number followed by an "A" and use the 1/1/2012 Effective Dates for the app?

If she hadn't been dragging her feet for so many months - this wouldn't be an issue... but now, even if she wants to go with a Med Supp, she still has the same issue with the December 7th deadline regarding a standalone PDP.

Any thoughts?

She should have either 63 days after 1/1/2012 or 3 months after for med supp, if im not screwing up the rules in play there.

Doesn't have to enroll during AEP.

 

[G.Gordon]

She'll have a shortened time span as mentioned above. AEP is not for her.

 

[ksigmtsu]

Also, to clarify, she can enroll the day she gets her card, since she'll be in the initial election period window, or ICEP, whichever one of them applies there, I screw that part up most of the time.
- - - - - - - - - - - - - - - - - -
G Gordon probably knows the correct wording for it and stuff, I suck at that, I do my best to remember the number of days in play.

 

[bigeats]

I tried getting the answer at Medicare.gov... but it's outdated: Enrollment Periods for Medicare Advantage and Prescription Drug Plans

I thought that she had to enroll during the seven month period which started three months before she turned 65... what am I missing here?

 

[djs]

This is a good discussion to show how screwy some of these rules get. Its hard to keep them all straight.

 

[G.Gordon]

.... and enrolled in part B.

 

[bigeats]

I found this on a tip sheet from Humana:

Initial Coverage Election Period (ICEP)

This enrollment period is for Medical type coverage, i.e. doctor’s visits & hospitalization, etc. not drug coverage. Use this enrollment period when a newly eligible beneficiary enrolls in a Medicare Advantage plan, (either MA or MAPD). Enrollment period begins three months before the individual’s entitlement to both Medicare Part A and Part B and includes the month entitlement begins, and ends three months after the month of eligibility. The total enrollment period is 7 months.

If prospect enrolls during the 3 month period prior to their Medicare effective date, the plan effective date will be the first of the month that their Medicare is effective. (Example: Medicare effective date is June 1. Prospect enrolls in a plan in March, April or May, the effective date of the plan is June 1). Otherwise, the effective date must be the first of the month following enrollment.

Special situation: (Pt. B Enrollment delayed) would occur during the three months prior to the target effective date for Part B.
____________________________________________________

So, she's in her ICEP because she just enrolled in Part B with an effective date of 1/1/2012. The trouble is that she never enrolled in Part A when she turned 65, either... so as of this moment - she has no Medicare card. Kinda hard to take advantage of that three month prior to target effective date for Part B with no Medicare card...

 

[AllGold]

Kinda hard to take advantage of that three month prior to target effective date for Part B with no Medicare card...

Yes, she needs to have Medicare before she is eligible for an MAPD or med supp. But keep in mind that only the enrollment can be early. The effective date still can't be earlier than the Medicare effective date.

She will need to be vigilant with SS to make sure there isn't an additional delay in getting her Medicare card.

Also, don't get tripped up by thinking AEP has anything to do with it. It doesn't.

 

[bigeats]

Yes, she needs to have Medicare before she is eligible for an MAPD or med supp. But keep in mind that only the enrollment can be early. The effective date still can't be earlier than the Medicare effective date.

She will need to be vigilant with SS to make sure there isn't an additional delay in getting her Medicare card.

Also, don't get tripped up by thinking AEP has anything to do with it. It doesn't.

But therein lies the rub. The way I am looking at this is that she is ELIGIBLE for enrollment for three months PRIOR to her Part B effective date. We are now in that window. The only hangup is that she does NOT have a Medicare card in her possession. From what I can tell - if Medicare does NOT get her her Medicare card PRIOR to 1/1/2012... she will NOT be eligible for ICEP.