Part B Coming Off Group

[Bob_The_Insurance_Guy]

Met a gentleman yesterday, who was on his group plan, covered as a retiree. He's had Part A Medicare for several years now, but never picked up Part B.

His group coverage ended December of 2009.

He's got a Medicare Supplement F, and was told by his doctor's office yesterday that he doesn't have Part B, and therefore showing the Med Supp card is no good.

A few observations on my part:

1. he, or his current agent, should have notified Medicare when the group coverage ended, letting them know he now wants Part B, effective January 1
2. his Medicare Supplement app should have been denied, since he does not have Part B
3. since it has been more than 63 days since group coverage ended, he may be penalized if he gets Part B now (effective April 1)

How far off the track am I. Feedback appreciated. If you need more info let me know.

 

[Russ]

Unless I'm mistaken, if he applies now for Medicare part B... his part B won't be effective until July 1st, 2010. He's got until March 31st, 2010 to sign up for part B.....unless the below statements apply...

EDIT>>>Looking in the Medicare & You 2010 handbook, it says "you can sign up for part B anytime while you have group health plan coverage based on current employment or during the 8-month period that begins the month after the employment ends, or the group health plan coverage ends, whichever happens first. If you have COBRA coverage, you must enroll during the 8-month period that begins the month after the employment ends." That's under the SEP.

When did his employment end?

 

[G.Gordon]

It's not the issue of when his employment ends; it is an issue of when the group plan ended and the OP said that was 12/09.


To the OP:

You're not off track at all. Have him call the SS office and talk to them about this and get back to you as soon as possible. There are so many places this guy was failed or so many suggestions by others he ignored. It's hard to tell at this point. More than likely he was told by his benefits administrator that he needed part B, he had to be asked by the agent "When will your part B be started?"... you have to see the car. That's why I won't fill out a supplement application without seeing the red white and blue card... not one single ink mark until that card comes out.

 

[Russ]

It's not the issue of when his employment ends; it is an issue of when the group plan ended and the OP said that was 12/09.

It is as far as his effective date for Medicare part B.
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If he retired from his job February 1st, 2009(as an example), then he wouldn't qualify for an SEP(8-month period), because it's been over 8 months since that happened and it happened first, BEFORE his group coverage ran out. He could still sign up for part B of Medicare under the General Enrollment Period...being effective for part B July 1st, 2010 and pay a penalty.

If he retired July 2009 or after that date, then he would qualify for an SEP(within the 8-month period after the month his employment ends). He should be effective on part B of Medicare April 1st, 2010.

 

[G.Gordon]

The law you quoted does not apply to him. He was covered under a group retiree plan that acted as his primary so he had no need for Part B until it was ending... 12/31/09. Most likely he can enroll in Part B effective 4/1/10 if he gets down to the social security office ASAP.

 

[Russ]

The law you quoted does not apply to him. He was covered under a group retiree plan that acted as his primary so he had no need for Part B until it was ending... 12/31/09. Most likely he can enroll in Part B effective 4/1/10 if he gets down to the social security office ASAP.

The SEP makes no mention of it being "retiree" group coverage...it just says "group coverage".

Based on what I've read and pondered over for the last hour I'll ask my original question again....when did he retire? The Special Enrollment Period is for 8 months after the month that he retired OR his group health plan coverage ends, whichever happens first.

 

[G.Gordon]

I'll beg to differ on actual experience... not something that may or may not be talking about this person's situation.

I've had folks come in my office with notices that thier group retiree plans are being discontinued, some more than 10 years after they retired. They enrolled in part B and I helped with the rest.

I've had folks that have made the decision to leave their group retiree benefits due to coverage or the cost of paying for thier share. They were able to enroll in part B at that time for the first of the next month.

Page 22; 2010 Medicare and YOU.

"Special Enrollment Period: You can sign up for part B anytime while you have group health plan coverage based on employment (in the context of the previous sentences where it talks about being on a spouses or family member working). So it does leave one to possibly believe what you're saying, but in real practice that I've seen if someone has "other" coverage that acts as primary... YOU CAN SIGN UP ANY TIME... you want to exit that plan.


This also brings to mind another situation: I had a guy from eastern MO call me. Wants to exit the wife's primary plan. Does not have part B. Called SS and enrolled part B, called wife's benefits office to get out of her plan, they wouldn't let him since he's outside their election period, he called SS back to reverse his enrollment. He'll have to wait until this fall when his wife's company has an election period that will allow him to exit.
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To further explain: I believe that paragraph explains more of when you can enroll and NOT have a penalty than making it clear of exactly under which/all circumstances one can enroll.

 

[Russ]

G.Gordon...I understand what you're saying..."To further explain: I believe that paragraph explains more of when you can enroll and NOT have a penalty than making it clear of exactly under which/all circumstances one can enroll.".......

It can be mind-boggling....lol....I gotta get to work.......

 

[cadylou]

Russ - G. Gordon is right - it's got nothing to do with when you actually retire but with when you leave the group plan provided by the employer - at least that's been my experience. I have plenty of retirees who were on their group plans for years after retiring who leave that plan for a variety of reasons and then get part B and a supp with no problem creating a SEP at that time.

 

[Russ]

Russ - G. Gordon is right - it's got nothing to do with when you actually retire but with when you leave the group plan provided by the employer - at least that's been my experience. I have plenty of retirees who were on their group plans for years after retiring who leave that plan for a variety of reasons and then get part B and a supp with no problem creating a SEP at that time.

That's not what's listed in the Medicare and You 2010 guide. If I'm wrong then I stand corrected.