Medicare Enrollment BADCs of Enrolling in Medicare

Transcription

1 Medicare Enrollment BADCs of Enrolling in Medicare Updated March 2016 Medicare Part B Enrollment Part B Enrollment Initial Enrollment Period (IEP) Special Enrollment Period (SEP) General Enrollment Period (GEP) 1

2 Initial Enrollment Period 7 months surrounding month of eligibility Delays Part B if enroll after month turn 65 IEP rules always take precedence Eligibility may begin after 65 For beneficiaries not eligible at 65 Not legal permanent resident for 5 years Initial Enrollment Period Exception People born on 1 st of month Eligible for Medicare 1 st of prior month Can actually enroll in month after IEP Coverage will be effective 3 months later Special Enrollment Period Qualifying for SEP Covered through active/current employment Since first month Medicare eligible Through end of Initial Enrollment Period With no lapse in current employer coverage for more than 8 months to be eligible Over 65 (Own or Spouse s employment) Disabled Under 65 (Own or Spouse s employment) Other Family Member s employment Large group health plan»100 or more employees 2

3 Special Enrollment Period Time Period 8 full months following loss of active employment Effective Date Enroll while employed or first month not employed Effective 1 st of month of enrollment Or 1 st day of any of following 3 months Enroll in last 7 months Begins 1 st of the following month General Enrollment Period Late Enrollment Penalty General Enrollment Period (GEP) January March (Effective July 1) Late Enrollment Penalty (LEP) 10% for every FULL 12 months Based on percentage of current premium Even if paying high income Part B premium Determining Number of Months From end of IEP to end of GEP Delaying Part B Beware of Delaying Part B in these situations Retiree Insurance/COBRA Self-Employed Small EGHP (Employer Group Health Plan) Domestic Partner VA (Veterans Administration) FQHC (Federally Qualified Health Centers) Living Outside of USA/Prison FEHB (Federal Employees Health Benefits) Medicare and Health Insurance Exchange 3

4 COBRA and Medicare Does not extend Medicare enrollment period People with COBRA when first Medicare eligible And who do NOT have Part B NOT entitled to Part B Special Enrollment Period Can only enroll in General Enrollment Period»Even if later covered under Active/Current employment Even if COBRA is free/subsidized by former employer COBRA may not continue to pay as primary If you do not enroll in Medicare when first eligible FEHB and Medicare FEHB retiree coverage can work without Medicare Cannot require Federal retirees to have Medicare Three Options for Federal Retirees FEHB and NO Medicare Part B Save Part B Premium Same FEHB Coverage FEHB and Medicare Part B FEHB plan may waive cost-sharing if enroll in Medicare May move outside of FEHB plan service area and want to have Original Medicare Medicare Part B and NO FEHB Suspend FEHB to enroll in lower premium Medicare Advantage plan Can re-enroll in FEHB during annual Open Season Medicare and Health Insurance Exchange Qualified Health Plan (QHP) and Medicare Become Medicare eligible can remain on QHP BUT will NOT qualify for Part B SEP Will lose QHP tax credits/cost-sharing reduction As of Medicare enrollment or end of IEP»Whichever is earlier QHP may not pay as primary; however, QHP must pay as primary until Medicare enrollment for those that enroll later in IEP 4

5 Medicare Part A Enrollment Part A Enrollment Premium Free Part A Collecting Social Security Part A is mandatory Not collecting Social Security Part A is voluntary Can enroll in Part A at any time Can be retroactive up to 6 months Premium Part A Same enrollment rules as Part B Late enrollment penalty (LEP) 10% LEP lasts for twice number of years delayed Qualifying for Premium-Free Part A 10 Years Work History (40 Quarters/Credits) $1,260 earns one credit (2016) May qualify under Spouse/Ex-Spouse/Deceased Current Spouse Eligible for Social Security Retirement/Disability Married at least one year Ex-Spouse Eligible for Social Security Retirement/Disability Married at least 10 years (and currently single) Deceased Spouse Married at least 9 months (and currently single) 5

6 Disenrolling From Medicare Part A If collecting Social Security, Part A is mandatory Cannot disenroll If not collecting Social Security, can disenroll Same as Part B Part B Can disenroll prior to Part B effective date Or else effective end of month following month of request Medigap Medigap Enrollment - Exception Upgrade/Downgrade with SAME Insurer May limit switch to an anniversary date At a minimum, once every 12 months AARP Medigap plans Must be AARP member (At least 50 Years Old) Disabled/ESRD under age 50 NOT eligible Medicaid/QMB Duplicates Medigap coverage Medicaid Spend-down 6

7 Medicare Part D Enrollment Initial Enrollment Period for Part D Initial Enrollment Period (IEP) for Part D Seven month period Enroll prior to month of eligibility Effective month of eligibility Enroll in month of eligibility (or last 3 months) Effective first of following month Living Outside of USA or In Prison at 65 IEP for Part D is 7 months surrounding month of eligibility Retroactive Medicare entitlement Ends 3 months after month of notice Auto-Enrollment YELLOW Notice Dual-eligible automatically enrolled in Part D plan GREEN Notice People with Extra Help Automatically enrolled in Part D plan Assigned to Benchmark Part D plan Available at $0 Premium for people with Full LIS Random assignment 7

8 Reassignment Reassignment Due to Plan Termination PDP or MA-PD ALL Extra Help recipients will be reassigned Whether CMS or beneficiary chose plan Will be assigned to a benchmark Part D plan if offered by same sponsor or if not Will be reassigned to random benchmark plan Non-Extra Help recipients will NOT be reassigned Special Enrollment Period (SEP) December 8 End of February Effective 1 st of following month Reassignment Reassignment Due to Premium Change - PDP FULL Extra Help auto or facilitated enrolled NOT in a MA-PD and did NOT elect a Part D plan If Part D premium continues to be below LIS subsidy will remain in plan If Part D plan premium is above subsidy Will be assigned to another benchmark plan if offered by same sponsor or if not Will be reassigned to random benchmark plan Plans may waive the monthly beneficiary premium for a subsidy eligible individual if de minimis (within $2) If premium is waived, will not be reassigned Medicare Part C (Medicare Advantage) Enrollment 8

9 Medicare Advantage Eligibility Must have BOTH Part A and Part B Must live in service area of plan Must NOT have ESRD (End Stage Renal Disease) ESRD Exceptions Develop ESRD while enrolled in plan Can remain in plan or Enroll in another plan with same organization Plan non-renewal/termination Initial Coverage Election Period Initial Coverage Election Period (ICEP) Newly eligible for Medicare Advantage can enroll in plan Begins 3 months before first entitlement To BOTH Part A and Part B Ends later of: Last day of Part B Initial Enrollment Period Last day before enrollment in both Part A & B Special Enrollment Period Retroactive Medicare Entitlement Determination Not able to enroll during ICEP Special Enrollment Period Begins month notice received Continues for two additional full months Effective 1 st of the following month 9

10 Annual Coordinated Election Period Annual Coordinated Election Period (AEP) October 15 December 7 Enroll, disenroll, or switch Medicare Health Plan choice and/or Part D Enrollment effective January 1 Last choice made during AEP will be effective Officially Also Known As (AKA) Fall Open Enrollment Open Enrollment Period for Medicare Advantage AND Medicare Prescription Drug Coverage Medicare Advantage Disenrollment Period Medicare Advantage Disenrollment Period (MADP) January 1 February 14 Switch from Medicare Advantage (with or without Part D) to Original Medicare One time effective first of following month May elect to enroll in stand-alone Part D plan At any time during the MADP Medicare Part C/D Special Enrollment Periods 10

11 Special Enrollment Periods Extra Help/LIS Available for all levels of Extra Help Can change plans at any time Effective first of following month SPAP (EPIC) Available for all SPAP (EPIC) members One election every calendar year Can enroll or switch plans No longer eligible for SPAP (EPIC) Can switch Part D plans Special Enrollment Periods SEP65 Aged beneficiary enrolls in Medicare Advantage plan (with Part D) during Initial Coverage Election Period surrounding their 65 th birthday 12 months from effective date to return to Original Medicare Can enroll in stand-alone Part D plan (PDP) at same time Drop Medigap for first time to enroll in MA-PD plan 12 months to return to Original Medicare One-time chance to enroll in PDP SEP begins month of MA disenrollment plus two months Special Enrollment Periods Changes in Residence Living Outside of USA or Incarcerated New Medicare health or Part D plans available as result of permanent move Lasts for two months following month of move SEP for Institutionalized Individuals Moves into, resides in or moves out of Facility list includes Skilled Nursing Facility Up to two months after month of discharge 11

12 Special Enrollment Period SEP EGHP (EGHP) Employer/Union Group Health Plan Includes Retiree Coverage and COBRA SEP to enroll in Part D (or to Disenroll) Used when employer/union allows changes Ends 2 months after month EGHP ends Special Enrollment Period SEP for Disenrollment from Part D To Enroll in or Maintain Creditable Coverage Individuals may disenroll from a Part D plan Including PDPs and MA-PDs To enroll in or maintain creditable drug coverage Such as TriCare or VA coverage Effective 1 st of the following month Special Enrollment Period Using the SEP No need to disenroll from current plan Just enroll in new plan SEP ends When Part D plan is effective OR when SEP time frame ends SEP is NOT 63 days 63-day period related to late enrollment penalty 12

13 Late Enrollment Penalty (LEP) Gap in creditable coverage and/or Part D more than 63 days Begins end of IEP or May 15, 2006 whichever later 1% per full month without Part D or creditable coverage (Starting with June 2006 or first full month after end of IEP) Based on base beneficiary premium EXCEPTION: LEP does not apply to any beneficiaries with Extra Help (Full or Partial) LEP ends when beneficiary eligible for Extra Help 13