Part B special enrollment for dependent of employee

[Special Agent]

i think i know the answer but this is the first time i have been asked this by a client. Client 20 year old son who is on disability and has Medicare part A was covered on fathers large group employer plan until 12/31/24 . Employer refused to complete form l564 for son which makes sense since it only has provisions for employee and spouse.. .Is there anyway the son won't pay part b premium penalty since his part A started in 2022?

 

[LostDollar]

i think i know the answer but this is the first time i have been asked this by a client. Client 20 year old son who is on disability and has Medicare part A was covered on fathers large group employer plan until 12/31/24 . Employer refused to complete form l564 for son which makes sense since it only has provisions for employee and spouse.. .Is there anyway the son won't pay part b premium penalty since his part A started in 2022?

Caveat, not an agent.

Looking at your post and form L564 and its instructions.

Wouldn't Section B, Line 6 of L564 cover your client's situation? (perhaps an EOB or two showing the employer plan actually paid some claims for son would also help with the conversation with employer HR.)

(Not sure if your comment about employee and spouse is relevant because the form is for an applicant and is being taken to the employer (Husband's or Wife's as applicable) who provided the large group health insurance coverage for the entire family.)

 

[rmhaire]

i think i know the answer but this is the first time i have been asked this by a client. Client 20 year old son who is on disability and has Medicare part A was covered on fathers large group employer plan until 12/31/24 . Employer refused to complete form l564 for son which makes sense since it only has provisions for employee and spouse.. .Is there anyway the son won't pay part b premium penalty since his part A started in 2022?

Since he's been on part A since 2022, that means he's been on SSDI since 2020. There's a 24 month wait before Medicare is available. Also he was automatically enrolled in both A and B. So someone had to have cancelled the part B.

There will be a LEP unless they find a work around on the form 1564 or if they win an appeal using form 20027. They'll need to document that he had coverage under the group plan.

The only good news is that the part B LEP will automatically end when he turns 65.

 

[Special Agent]

Since he's been on part A since 2022, that means he's been on SSDI since 2020. There's a 24 month wait before Medicare is available. Also he was automatically enrolled in both A and B. So someone had to have cancelled the part B.

There will be a LEP unless they find a work around on the form 1564 or if they win an appeal using form 20027. They'll need to document that he had coverage under the group plan.

The only good news is that the part B LEP will automatically end when he turns 65.

so it is a bit of cluster because client just called me and said SS told her that there was a pending special enrollment application that needed further documentation and shockingly they gave her an in office appointment for 4/2.Just concerned now that if they don't grant him the special enrollment period that the General Enrollment period will be over 3/31 and he may have to wait until next year.

 

[LostDollar]

I came back to this, I see where you are coming from with "spouse" comment, but I think this is applicable and should be shown to the employer too.

Page 3 instructions for L564. Section B, Line 1 (You will have to expand to see what I have bolded):

1. Is (or was) the applicant covered under an employer
group health plan?

Please check yes or no if the applicant was covered under
your group health plan offered by your company. The
applicant may be the employee or another person related
to the employee, such as a spouse or family member with
disabilities.

https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms-l564e.pdf

 

[rmhaire]

so it is a bit of cluster because client just called me and said SS told her that there was a pending special enrollment application that needed further documentation and shockingly they gave her an in office appointment for 4/2.Just concerned now that if they don't grant him the special enrollment period that the General Enrollment period will be over 3/31 and he may have to wait until next year.

OEP isn't going to be a factor here.

My question is who filed the special enrollment application.

 

[Special Agent]

I came back to this, I see where you are coming from with "spouse" comment, but I think this is applicable and should be shown to the employer too.

Page 3 instructions for L564. Section B, Line 1 (You will have to expand to see what I have bolded):

https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms-l564e.pdf

 

[LostDollar]

so it is a bit of cluster because client just called me and said SS told her that there was a pending special enrollment application that needed further documentation and shockingly they gave her an in office appointment for 4/2.Just concerned now that if they don't grant him the special enrollment period that the General Enrollment period will be over 3/31 and he may have to wait until next year.

Caveat, not an agent.

In the event client is unable to get employer cooperation for L564, this page from SS POMS manual shows some other acceptable documents to prove health coverage. Client could work on digging up a little of this info to take with them for the SSA appt.

SSA - POMS: HI 00805.295 - Evidence of GHP or LGHP Coverage Based on Current Employment Status

Evidence of GHP or LGHP Coverage Based on Current Employment Status

secure.ssa.gov

Rereading some more, read section D of poms info and have client have documentation to prove that as well.

 

[Special Agent]

ahhh.... i missed this paragraph on instructions it does say family member so their employer should have filled this out for covered dependent. learned something new today.will tell client to complete first section to foolproof it for HR dept.

"WHAT IS THE PURPOSE OF THIS FORM?In order to apply for Medicare in a Special Enrollment Period, you must have or had group health plan coveragewithin the last 8 months through your or your spouse's current employment. People with disabilities must have large group health plan coverage based on your, your spouse's or family member's current employment.

 

[Special Agent]

OEP isn't going to be a factor here.

My question is who filed the special enrollment application.

His mother but she wasn't sure it was a special enrollment period when i asked .it was in febuary so it could have been GEP now i know it was a SEP