SEP for PartD?

[MedSuppPro]

I have a MedSupp with PartD lead. Potential client (age 68) has had Parts A&B and has group coverage (over 100 members) which costs over $800./month and she wants to voluntarily end group coverage September 1st. I have MedSupp carrier taken care of.

Can she voluntarily leave a Creditable Coverage situation outside of the AEP and pickup a Part D plan?

Too many rules to keep track of!

Here’s what Medicare.gov says:

The special enrollment period begins the month that you're told of the loss of creditable coverage and either ends 2 months after the loss or 2 months after you're told, whichever is later. If the coverage is lost because you didn't pay your premiums, you won't get a special enrollment period.
The effective date of your enrollment into a drug plan can be the first day of the next month, or you can choose an effective date in the future, but the date may be no more than 2 months from the end of the special enrollment period.

Basically she is deciding to not pay her premium and she needs to delay termination of group coverage January 1 for PartD with an AEP enrollment. Is this the correct answer?

 

[insurance0707]

She has a SEP. She can enroll now or within 63 days of losing coverage. There should be a box on the form (if you're writing the PDP plan yourself) that states....I am either losing coverage I had from an employer or union or leaving employer or union coverage...then list the date she's losing the coverage

 

[jdeasy]

She has a SEP. She can enroll now or within 63 days of losing coverage. There should be a box on the form (if you're writing the PDP plan yourself) that states....I am either losing coverage I had from an employer or union or leaving employer or union coverage...then list the date she's losing the coverage

That's not correct. She is not "losing" coverage. She is giving it up.

That is a very strict definition by CMS. I'm sure that some have gotten by with it by claiming that they "lost" coverage. And, if where they are leaving coverage words it that they "lost" it, then it would be fine.

The situation described is not one that qualifies as losing coverage because it's voluntary.

 

[insurance0707]

They have one section that says I'm involuntarily losing group coverage and then there is another section that lists I'm losing group coverage. She would not check involuntarily because she's choosing to end the coverage herself. She would check I'm losing group coverage. Some people just can't pay $800 - $1000 a month and are voluntarily dropping their group which does give them an SEP. I would say call Medicare on this but we know it's a 50-50 on the right answer most times

 

[bourbonlegend]

What jdeasy said is true

 

[jdeasy]

They have one section that says I'm involuntarily losing group coverage and then there is another section that lists I'm losing group coverage. She would not check involuntarily because she's choosing to end the coverage herself. She would check I'm losing group coverage. Some people just can't pay $800 - $1000 a month and are voluntarily dropping their group which does give them an SEP. I would say call Medicare on this but we know it's a 50-50 on the right answer most times

I agree with you and I wish it were that way. But, it's not. I have paddled up that creek before.

 

[insurance0707]

I googled the question. Here's one of the responses I found, it's from State Farm, it states that if you lose or drop your group coverage than you have a 63 day period to get a Part D. Here's the link

Important NoticeAbout Your Prescription Drug Coverage and Medicare

I'm sure I could find other sources but it's Friday and I'm ready to call it a week

 

[jdeasy]

I have a MedSupp with PartD lead. Potential client (age 68) has had Parts A&B and has group coverage (over 100 members) which costs over $800./month and she wants to voluntarily end group coverage September 1st. I have MedSupp carrier taken care of.

Can she voluntarily leave a Creditable Coverage situation outside of the AEP and pickup a Part D plan?

Too many rules to keep track of!

Here’s what Medicare.gov says:

The special enrollment period begins the month that you're told of the loss of creditable coverage and either ends 2 months after the loss or 2 months after you're told, whichever is later. If the coverage is lost because you didn't pay your premiums, you won't get a special enrollment period.
The effective date of your enrollment into a drug plan can be the first day of the next month, or you can choose an effective date in the future, but the date may be no more than 2 months from the end of the special enrollment period.

Basically she is deciding to not pay her premium and she needs to delay termination of group coverage January 1 for PartD with an AEP enrollment. Is this the correct answer?

Since you probably won't be able to get a pert D until AEP for Jan. 1, can the client do without RX coverage for 4 months?

 

[insurance0707]

2. You join or drop employer/union drug coverage regardless of whether it is creditable. Employer coverage may be current or former (retiree plan).

You have an SEP if...Your SEP lasts...Your coverage begins...You choose to: <LI style="MARGIN-TOP: 0.4em">enroll in an employer/union-sponsored Medicare drug plan. disenroll from a Medicare drug plan to take employer/union-sponsored drug coverage.
disenroll from employer/union-sponsored coverage (including COBRA) to enroll in a Part D plan.
Your SEP to join or disenroll from a Part D plan, or to switch plans, will be the same as the period of time when your employer would normally allow you to make changes to your employee health care coverage. It ends two months after the month in which your employer or union coverage ends.Up to three months after the month in which you submit a completed enrollment application. If your employer/union was late sending in the application, your coverage may begin retroactive to when you submitted the application.

Here's the source that I got it from....

medicareinteractive.org


You're right they don't make it real easy in the wording though depending on what source you're looking at. Your best bet is to call the insurance company for the Part D plan or call Medicare....although sometimes they don't have the correct answers either

 

[policy doctor]

Here's a sugg. Just have her apply for a Part D under iep and see what happens. I know someone who did that recently with similar scenario. Prep her for the "what if" and let it go. Or just have her sign up at the gubermint site. You don't want a headache for a stinkin' twenty, do you?