My Brain Is Like Sybil

[justsayinisall]

I have a client that is self-employed and purchases "group" coverage (him and his wife).

He's 68 and she just turned 65. They went to their local SS office to start Medicare and they told him that he has to use the GEP and start Medicare B 7/1/2019. She, of course, can start on time.

Wouldn't he be able to start B whenever he wanted and use SEP losing or replacing employer coverage?

Also, his Medicare A started when he turned 65. What will his election period be for RX in July? I know I don't want to start him on an RX plan now because it could end his current insurance. I'm also assuming he's IEP for a supp plan?

Thanks in advance for any help!

 

[TwoCents]

His individual coverage (not through the marketplace, right?) wouldn't be considered coverage (usually has to be from an active employer group) that would give him a Part B special enrollment period. Assuming he keeps it up through 6/30/19 and is creditable for Part D, then he would get a special election period for dropping it to pick up a PDP. His ICEP for Medicare Advantage would be 4/1 to 6/30.

 

[rousemark]

Just glanced the post and saw "group insurance" and Sybil in the thread title.. Thought you were going to say he had group coverage for all his personalities..

 

[vic120]

His individual coverage (not through the marketplace, right?) wouldn't be considered coverage (usually has to be from an active employer group) that would give him a Part B special enrollment period. Assuming he keeps it up through 6/30/19 and is creditable for Part D, then he would get a special election period for dropping it to pick up a PDP. His ICEP for Medicare Advantage would be 4/1 to 6/30.

Only if the group is less than 50 he still needs to get part B when eligible or late enrollment

 

[TwoCents]

Only if the group is less than 50 he still needs to get part B when eligible or late enrollment

Good call out.

 

[kstein]

But...nowhere on the l564 form do they ask about group size so I'm sure he could get in without a penalty. I had 2 of these in the last 6 mo go through fine

 

[LostDollar]

Even though someone at his SocSec office now knows it is a small plan?
and
Even though he signs the form as the company official?

 

[kstein]

I'd say that you should have a very sloppy signature...

 

[TwoCents]

I'd say that you should have a very sloppy signature...

Gather round for an ethics lesson, folks. Not saying the rule is fair, but it is what it is.

 

[LostDollar]

Would I be asking a dumb question to ask:
I wonder why the insurance carrier paid his claims as primary insuror for 3 years?