Sprycel, COBRA and the Part B LEP

[LostDollar]

Here is a paper from California Health Advocates that supports what I have been saying:

https://content.naic.org/sites/defa...rage-A False Equivalency (COBRA Dec 2019).pdf

From Page 3

(Bolding and red print is mine)

Enrollment Rules
There is no Medicare premium penalty imposed for delayed enrollment while an eligible
individual is actively employed and covered by a group health plan.5 Once active employment
ends however the former employee has an eight month special enrollment window to sign up for
Medicare Part B without incurring a late enrollment premium penalty, and 60 days to sign up for
Part D unless COBRA coverage provides equivalent prescription drug coverage as the Medicare
benefit. After this Part B special enrollment window closes an annual late enrollment premium
penalty begins to accrue and the window to enroll shrinks to an annual 3-month period, January
thru March. Benefits are delayed until July of the same year of enrollment. (I don't think the green text applies in 2023.)
Since most Medicare beneficiaries are eligible for premium free Medicare Part A no delayed
enrollment penalty for that part of Medicare is imposed.6 There is no late enrollment penalty for
Part D as long as current coverage provides equivalent prescription drug coverage as the
Medicare benefit

 

[kgmom219]

Thanks everyone! To answer some of the questions:
1. I did not think about MAPD and that’s a good point. But I don’t think it’s going to help enough financially to deal with the drama, either.
2. Part B LEP is based on loss of creditable coverage date. That’s at 8 months COBRA. So it’s the 1 year penalty amount and he has to hit an age of 134
3. No on Needy Meds, he’s IRMAA. PAP may apply though and I will look into that after Thursday.
4. Of course I will be working with him next year. Duh. That doesn’t even occur to me.

 

[somarco]

@kgmom219 IRMAA is probably a KO for PAP but never hurts to ask.

Gleevec shows as an alternative to Sprycel and has a lower cost generic (Imatinib)
[EXTERNAL LINK] - Sprycel Alternatives Compared - Drugs.com

 

[LostDollar]

2. Part B LEP is based on loss of creditable coverage date. That’s at 8 months COBRA. So it’s the 1 year penalty amount and he has to hit an age of 134

Your original post suggests to me that he is dropping employer coverage from active employment on 12/31/2022. If that is true and he then gets Medicare Part B on 02/01/2024, all the information I can find says he would not have a Part B penalty.

 

[Chazm]

Fixed it for (not four) you

If D-SNP eligible, Sprycel might be $4500 with some plans, others running $12k.

In order to go BACK to a plan G, the beneficiary must first be in a G plan. Can't get a Medigap or MA without both A & B . . . and B will be effective 1/1/2023.

Are you suggesting they can’t start a MAPD when their Medicare starts, and within the first 12 months use a trial right to get on a Supp using GI?

 

[LostDollar]

Are you suggesting they can’t start a MAPD when their Medicare starts, and within the first 12 months use a trial right to get on a Supp using GI?

Isn't that only when their Medicare starts during their T65 IEP, not when they start Medicare Part B at age 72 after dropping employer coverage?

 

[somarco]

Are you suggesting they can’t start a MAPD when their Medicare starts, and within the first 12 months use a trial right to get on a Supp using GI?

No

 

[kgmom219]

@kgmom219 IRMAA is probably a KO for PAP but never hurts to ask.

Gleevec shows as an alternative to Sprycel and has a lower cost generic (Imatinib)
[EXTERNAL LINK] - Sprycel Alternatives Compared - Drugs.com

I’ve got a guy paying top IRMAA getting PAP on Rytary