Medicare and SSDI - The Definitive Thread

Oct 11, 2016

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  1. somarco
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    somarco That Medicare Expert Guy

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    Looking for information for under age 65, SSDI and Medicare. General information not specific to a particular case. Just trying to get this all in one place.

    If you can contribute it will help a lot of us, not just me. And as they told us in school, please show your work. Links, especially to Mcare.gov, will help.

    If on SSDI does Medicare A and B start at the same time or can you get one before the other?

    I am assuming they do not have to start at the same time since I recently talked with a lady whose Part A started in June, 2015 and B in July, 2016. Not really sure why there were two different effective dates and she didn't know either.

    For purposes of establishing your initial enrollment period, does it begin when you get Part A or both if your start dates are staggered?

    I know you must have A and B to get an MA or Medigap plan, and you only need A or B to get a PDP. If you have different start dates for A and B (like the situation above) when does you penalty free sign up start for the PDP? I will assume when A started but maybe it starts over again when your B begins (but I doubt it).

    Assuming no prior creditable drug coverage, how long do you have before you must sign up for PDP and avoid the LEP? Links will help on this.

    Finally, I understand when you turn 65 everything resets and you can sign up for a new MA or Medigap plan and a new PDP. If you paid penalties before, those are wiped out and you start again.

    6 months from your "new" Part B to sign up for Medigap. I have mixed information for the PDP. Some notes say 63 days, others 3 (or 4) months from the start of Part B (which includes the month B was effective. And different notes say 6 months PDP sign up + 63 days.

    Thanks!
     
    somarco, Oct 11, 2016
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  2. TN_agent
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    TN_agent Guru

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    https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html

    According to that, PDP LEP Starts when you have gone more than 63 days without creditable drug coverage after your IEP ends.

    IEP for PDP being 3 months before Part A effective date (OR Part B, not both), the month Part A begins, and 3 months after.

    Your example of your lady if I am reading correctly (if not LIS/SLMB, etc, which would waive Part D LEP), she would accrue Part D LEP from December 2015-until Part D enrollment. I think, not sure about that month. If she enrolled in MAPD for 7/1/2016 using her ICEP, that would cap her LEP with enrollment in MAPD. If she did not use the ICEP SEP, she is SOL until 1-1-2017, she would need to use AEP for 1/1/2017 coverage.

    Based on everything I have read, LEP for PDP does NOT start over again when your Part B starts up (unless that coincides with your T65 election period).

    I think that is the most acronyms I have ever use in one post. :twitchy:
     
    TN_agent, Oct 11, 2016
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  3. goillini52
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    goillini52 MAGA...Eat More Bacon & BUILD THAT WALL!!!

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    Here you go Bob, it's in the 1st link. They're automatically enrolled in A and B. I'm sure that at 65 they have 7 months...3 months before, the month they turn 65 and 3 months after to sign up for a PDP plan.

    https://www.medicare.gov/people-lik...g-up-for-part-b-disability.html#collapse-3179
     
  4. Fisher
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    Fisher Guru

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    I have never heard of an existing LEP being wiped out. Evidence please?
     
    Fisher, Oct 11, 2016
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  5. Todd King
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    Todd King IMO/FMO Owner

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    You can't penalize someone who is turning 65 for being late. Once they turn 65 it's like they've never been with Medicare before, even if they have.
     
  6. somarco
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    somarco That Medicare Expert Guy

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    Unless I read it wrong, WCMason posted that here.
    http://www.insurance-forums.net/forum/senior-insurance-forum/avoiding-pdp-lep-2017-a-t83888.html
    #3

    She gets a second IEP and all the options available to her that any age-in gets, including OE on med sup, choosing a new Rx, and all previous penalties go away.


    Why does that sound like a Seinfeld routine?
     
    somarco, Oct 11, 2016
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  7. Fisher
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    Fisher Guru

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    I called Medicare and they concur - the LEP would indeed go away at the new IEP.

    Good deal, learn something new every day. Thanks.
     
    Fisher, Oct 11, 2016
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  8. LostDollar
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    LostDollar Guru

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    When trying to think about Medicare and ask questions of Medicare sales people, I have gotten all tangled up in assorted groups of adjectives used with the word period.

    This document covers three of them:
    IEP; SEP; GEP. There is a fourth, but I don't have a link for it, so I am not mentioning it here.

    https://www.cms.gov/Outreach-and-Ed...care-Part-A-and-Part-B-Enrollment-Periods.pdf

    the two things I found most useful in this document are:
    If one is within an IEP, it is not possible to substitute into another type of enrollment period, but it is possible to substitute between SEP's and GEP's if the dates place one in both. Also it shows the sequence between them if there are conflicts.
     
    Last edited: Oct 11, 2016
  9. goillini52
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    goillini52 MAGA...Eat More Bacon & BUILD THAT WALL!!!

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    https://www.mymedicarematters.org/enrollment/when-can-i-enroll/

    "Special Enrollment for Parts A and B

    You may have waited to sign up for Medicare Part A (hospital service) and/or Part B (outpatient medical services) if you were working for an employer with more than 20 employees when you turned 65, and had healthcare coverage through your job or union, or through your spouse’s job.

    You can get a Special Enrollment Period to sign up for Parts A and/or B:
    •Any time you are still covered by the employer or union group health plan through you or your spouse’s current or active employment, OR
    •During the 8 months following the month the employer or union group health plan coverage ends, or when the employment ends (whichever is first)."


    I see you deleted your 8 month question while I was posting.
     
  10. LostDollar
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    LostDollar Guru

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    Yes. I remarked that I didn't think the link I posted covered that, I reread it again and decided maybe it did, so deleted the remark.

    Thank you for posting this because I think it is much clearer on that particular issue than the training document.

    ----------

    This link :
    https://www.medicare.gov/people-lik...b-automatically-disability.html#collapse-3100

    Suggests, for under 65 on SSDI, that part A and B enrollment are both simultaneous and automatic. It also notes
    That the timing of Medicare is relative to the start of SSDI
    That the specific start of Medicare in relation to SSDI depends on the nature of the disability.

    Did the lady have group health coverage due to a spouse when the disabled lady got part A?

    (Doing some additional reading-if this is the same person in another thread, wouldn't GHP account for different dates-and can you use credible coverage from GHP to cut PDP penalty to a couple of months?)

    ----------

    With a combination of my current knowledge level and reading comprehension, these links would take me a very long time to work with and really understand.

    Scanning them suggests to me that they are relevant to the situation.
    In scanning, in the special enrollment periods document, I did see one or two situations addressing different Pt A and B enrollment dates-not sure if they are relevant here. Also the very last one was a special circumstances request for an SEP-maybe that would be useful here.

    https://www.medicareinteractive.org...-drug-plans/when-to-enroll-in-medicare-part-d

    https://www.medicareinteractive.org/pdf/SEP-Chart.pdf

    I figured some of you will be able to know pretty quickly whether these things are relevant and useful.

    (somarco-if this stuff is not relevant to the thread, please pm me and I will delete the post.)

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    Here is another piece of information I find interesting. It helps clarify confusion in my mind about the "8 months" and conflicting information about its starting date.

    "Originally, the special enrollment period (SEP) began on the first day of the first month in which the employee was no longer covered by the EGHP, and ended seven months later. However, effective March 1, 1995, individuals covered under an EGHP can enroll in Medicare while still covered by the EGHP. Additionally, the period during which enrollment may occur, after EGHP coverage ends, was extended from seven to eight months.*"

    Found in this:
    CMA*||* Eligibility & Enrollment

    ----------

    I saw something that suggested the following idea to me. I decided not to post the link because it involved some old (2006) KS legislation that popped up during a search. A more general and more current reference would be more appropriate for what you are looking for.

    I think actual enrollment in plan A may not be required. I think it may be that the IEP for PDP hooks to the ELIGIBILITY date for Medicare part A. And that this would be 1 of 3 seven month periods. Two SSDI periods depending on the type of disability and the turning 65 period.

    See: Who ie eligible for Medicare Part D?

    https://q1medicare.com/PartD-HowPartDComparestoMedicare-AandB.php

    And AARP
    Medicare Part D Enrollment, How To Sign Up For Medicare Part D - AARP
     
    Last edited: Oct 12, 2016
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