Medicare Disability beneficiary Turning 65 question

Aug 9, 2019

  1. LostDollar
    Offline

    LostDollar Guru

    Posts:
    2,980
    Likes Received:
    649
    State:
    Kansas
    Do you have a CMS reference for that?

    If turning 65 resets the clock on things Medicare, it seems like the clock would reset here too, and the beneficiary would become an "age-in" first time MA consumer.
     
  2. TwoCents
    Offline

    TwoCents Guru

    Posts:
    460
    Likes Received:
    167
    The elections for the 2nd IEP and SEP-65 get confused all the time. #16 has to do with the 2nd IEP. That document from the Medicare Rights Center doesn't even take into account SEP-65.

    And of course I have CMS documentation to back that up.

    IEP-2 is available to anyone who started Medicare prior to Age 65. I think we all can agree that the person can pick up an MAPD/MA/PDP at this time. The person can also disenroll from a current plan and return to Original Medicare.

    Technically, SEP-65 is a disenrollment election only to leave an MA/MAPD and there is a coordinating PDP election.

    From Chapter 2 (Pay close attention to that last sentence!!):

    30.4.5 - SEPs for Beneficiaries Age 65 (SEP65)
    MA eligible individuals who elect an MA plan (other than an MSA plan) during the initial enrollment period (IEP) for Part B surrounding their 65th birthday have an SEP. This “SEP65” allows the individual to disenroll from this MA plan and elect the Original Medicare plan any time during the 12-month period that begins on the effective date of coverage in the MA plan.
    The IEP for Part B is established by Medicare and begins 3 months before and ends 3 months after the month of the individual’s 65th birthday. Individuals entitled to Medicare prior to age 65 are not eligible for the SEP65.

    From Chapter 3:
    A. SEP for MA-PD enrollee using the MA SEP65 - MA eligible individuals who elect an MA plan during the initial coverage election period (ICEP) surrounding their 65th birthday have an SEP called the “SEP65.” The SEP65 allows the individual to disenroll from the MA plan and elect the Original Medicare plan any time during the 12-month period that begins on the effective date of coverage in the MA plan. If the individual using the SEP65 is disenrolling from an MA-PD plan, he or she may (but is not required to) use this Part D SEP to enroll in a PDP plan. This SEP must be used at the same time the SEP65 is used.
     
  3. vic120
    Offline

    vic120 Guru

    Posts:
    3,266
    Likes Received:
    1,054
    State:
    Tennessee
    I am missing something I am reading the document, 30.4.5 except I don't see the part that says Individuals entitled to Medicare prior to age 65 are not eligible for the SEP65.

    To Copy and Paste
    30.4.5 - SEPs for Beneficiaries Age 65 (SEP65) (Rev. 66, Issued: 08-05-05, Effective: 08-05-05) Beginning January 1, 2006, MA eligible individuals who elect an MA plan during the initial enrollment period (IEP) surrounding their 65th birthday have an SEP. This “SEP65” allows the individual to disenroll from the MA plan and elect the Original Medicare plan any time during the 12-month period that begins on the effective date of coverage in the MA plan. The IEP is established by Medicare and begins 3 months before and ends 3 months after the month of the individual’s 65th birthday. 30.5 - Effective Date of Coverage

    Unless you are saying because it says IEP and not IEP 2, I don't know that makes a difference, I am 80 % sure I used this before in this situation and it worked, IEP 2 is still an IEP not a SEP
     
    Last edited: Aug 12, 2019
    vic120, Aug 12, 2019
    #23
  4. TwoCents
    Offline

    TwoCents Guru

    Posts:
    460
    Likes Received:
    167
    You literally cut it off right where it says, "Individuals entitled to Medicare prior to age 65 are not eligible for the SEP65."

    So to summarize -- SEP65 and coordinating Part D election are for the plan vanillas who start Part A and Part B when they turn 65. IEP2 is for those who start Medicare prior to Age 65 then get a redo at 65. They are completely separate elections/SEPs, but in a way even out the playing field for the 2 populations.
     

    Attached Files:

  5. vic120
    Offline

    vic120 Guru

    Posts:
    3,266
    Likes Received:
    1,054
    State:
    Tennessee

    Why am I not seeing that on the document I didn't cut it off it was the next piece

    30.4.5 - SEPs for Beneficiaries Age 65 (SEP65) (Rev. 66, Issued: 08-05-05, Effective: 08-05-05) Beginning January 1, 2006, MA eligible individuals who elect an MA plan during the initial enrollment period (IEP) surrounding their 65th birthday have an SEP. This “SEP65” allows the individual to disenroll from the MA plan and elect the Original Medicare plan any time during the 12-month period that begins on the effective date of coverage in the MA plan. The IEP is established by Medicare and begins 3 months before and ends 3 months after the month of the individual’s 65th birthday.

    30.5 - Effective Date of Coverage (Rev. 66, Issued: 08-05-05, Effective: 08-05-05) With the exception of some SEPs and when election periods overlap, generally beneficiaries may not request their effective date. Furthermore, except for EGHP elections, the effective dateis generally not prior to the receipt of a complete election by the MA organization. An enrollment cannot be effective prior to the date the beneficiary or their legal representative signed the enrollment form or completed the enrollment election. Section 40.2 includes procedures for handling situations when a beneficiary chooses an enrollment effective date that is not allowable based on the requirements outlined in this section. To determine the proper effective date, the MA organization must determine which election period applies to each individual before the enrollment may be transmitted to CMS. The election period may be determined by reviewing information suc
     

    Attached Files:

    vic120, Aug 12, 2019
    #25
  6. TwoCents
    Offline

    TwoCents Guru

    Posts:
    460
    Likes Received:
    167
    You seem to be referencing an outdated version. On pg 1 (cover page) the last updated date should be 7/31/18 for Chapter 2. That would be for 2019. The 2020 version hasn't been released yet just as an FYI.
     
  7. vic120
    Offline

    vic120 Guru

    Posts:
    3,266
    Likes Received:
    1,054
    State:
    Tennessee

    Maybe that's why I probably did it before it has changed since then
     
    vic120, Aug 12, 2019
    #27
Loading...