Mak­ing the tran­si­tion from Mar­ket­place to Medi­care

Daily Local News (West Chester, PA) - - FIFTY PLUS -

If you buy your own health in­sur­ance, it is likely you pur­chased it on the Mar­ket­place, also known as the Ex­change (in PA.) Once you reach age 65 you are el­i­gi­ble to en­roll in Medi­care, as­sum­ing you have suf­fi­cient work his­tory. There are other ways to qual­ify for Medi­care, no­tably be­ing dis­abled for 24 months. The in­tent of this ar­ti­cle is to help you un­der­stand the tran­si­tion from Mar­ket­place to Medi­care.

The Mar­ket­place does not han­dle Medi­care, Medi­gap, Medi­care Ad­van­tage or Medi­care Pre­scrip­tion Drug Plans. You will deal with the So­cial Se­cu­rity Ad­min­is­tra­tion, Medi­care, or the is­su­ing in­sur­ance com­pany, di­rectly, for these poli­cies. You can con­sult with AP­PRISE about Medi­care Part A, Part B, Part C (Medi­care Ad­van­tage) and Part D, in­clud­ing an es­ti­mate of their cost.

Another very im­por­tant con­sid­er­a­tion is to know your Medi­care dates, es­pe­cially the Ini­tial En­roll­ment Pe­riod (IEP). This pe­riod in­cludes the three months prior to the month in which you turn 65, the month in which you turn 65, and the three months af­ter you turn 65, seven months in to­tal. For ex­am­ple, if you will turn 65 in Septem­ber, your IEP runs from June 1 through De­cem­ber 31.

Equally im­por­tant to know is that if you en­roll in Medi­care dur­ing the three months prior to turn­ing 65, your Medi­care ef­fec­tive date will be the first of the month of your 65th birthday (Septem­ber 1 in the pre­vi­ous ex­am­ple). If you en­roll in the month you turn 65, or any of the three months af­ter (Septem­ber through De­cem­ber in the ex­am­ple) your Medi­care ef­fec­tive date will be delayed. For ex­am­ple, if you wait un­til Septem­ber to en­roll, your Medi­care ef­fec­tive date will be Oc­to­ber 1. This may leave you with­out cov­er­age in Septem­ber. If you en­roll in Oc­to­ber, your Medi­care will be delayed two months and be­come ef­fec­tive De­cem­ber 1. If you en­roll in Novem­ber, your Medi­care will be delayed three months and be­come ef­fec­tive Fe­bru­ary 1. If you en­roll in De­cem­ber, your Medi­care will be delayed three months and will be­come ef­fec­tive March 1. This is true for any­one in their IEP. Not good! Speak­ing for all AP­PRISE coun­selors, please come in early to see us. A month or two prior to your IEP is not too soon.

If you fail to en­roll dur­ing your IEP, you can en­roll later, but with sev­eral risks and pos­si­ble penal­ties, the sub­ject per­haps of another ar­ti­cle. Yet another ar­ti­cle might cover those who con­tinue to work past 65 and are cov­ered by an em­ployer plan or who are cov­ered by a spouse’s plan. These folks should see a coun­selor, as well, to make sure they un­der­stand the rules. There are a lot of rules.

As you en­ter your IEP, your goal is to tran­si­tion from Mar­ket­place to Medi­care with no gap in cov­er­age. Now that you un­der­stand your Medi­care ef­fec­tive date, you will want to call the Mar­ket­place, 800318-2596, and can­cel your cov­er­age ef­fec­tive the day your Medi­care cov­er­age be­gins. For ex­am­ple, if your Medi­care cov­er­age is to be­gin Septem­ber 1, can­cel your Mar­ket­place plan ef­fec­tive Au­gust 31. You can also do this on­line at www.health­care.gov.

Can you keep your Mar­ket­place plan af­ter you en­roll in Medi­care? Yes, but it is un­likely to be in your best in­ter­ests. All Mar­ket­place sub­si­dies end when you en­roll in Medi­care Part A. Part A is con­sid­ered min­i­mum es­sen­tial cov­er­age, so there is no need to be con­cerned about fines. Keep in mind that it is un­law­ful for any­one to sell you a Mar­ket­place plan if they know that you have Medi­care. There are ex­cep­tions here that ap­ply to a small num­ber of peo­ple. If you qual­ify for Medi­care due to a chronic disease, such as end stage re­nal disease(ESRD), or you must pay for Part A (up to $411 per month), you can elect to pur­chase a Mar­ket­place plan in­stead of en­rolling in any part of Medi­care. Be sure to get some ad­vice if you are in one of these un­usual cir­cum­stances as you could be li­able for late en­roll­ment penal­ties if you sub­se­quently en­roll in Medi­care.

Re­mem­ber, once you are el­i­gi­ble for Medi­care, you will no longer be deal­ing with the Mar­ket­place. Keep in mind the dif­fer­ent Open En­roll­ment Pe­ri­ods for Mar­ket­place and Medi­care. The Mar­ket­place Open En­roll­ment Pe­riod is from Novem­ber 1, 2016, through Jan­uary 31, 2017. The Medi­care An­nual Open En­roll­ment Pe­riod is Oc­to­ber 15 through De­cem­ber 7 ev­ery year. The Medi­care Gen­eral En­roll­ment Pe­riod (GEP), mostly for those who are en­rolling late in Medi­care, is Jan­uary 1 through March 31 each year, with an ef­fec­tive date of July 1. En­roll­ment dur­ing the GEP could re­sult in a gap in your cov­er­age, and any penal­ties in­curred will stay with you for as long as you are on Medi­care.

One last piece of ad­vice from your AP­PRISE coun­selors: If you re­ceive mail from CMS (Cen­ters for Medi­care and Med­i­caid Ser­vices), or your in­sur­ance com­pany (if you have Medi­care Ad­van­tage, Medi­gap or Medi­care Pre­scrip­tion Plan), please open and read it. Fail­ure to do so re­sults in many of the prob­lems we hear about, in­clud­ing penal­ties and fines. If you need as­sis­tance with tran­si­tion­ing from Mar­ket­place to Medi­care, AP­PRISE coun­selors are avail­able to an­swer any Medi­care-re­lated ques­tions. You can con­tact a coun­selor by call­ing your lo­cal se­nior cen­ter to set up an ap­point­ment, or by leav­ing a mes­sage on the AP­PRISE Helpline at 610344-5004. You can also email us with ques­tions at ap­prisech­esco@out­look. com.

Spe­cial thanks to Ted Trevor­row; AP­PRISE Coun­selor, and En­roll­ment & Out­reach Co­or­di­na­tor/ Nav­i­ga­tor at LCH, Ken­nett Square, PA.

The Ch­ester County Depart­ment of Ag­ing, through its AP­PRISE pro­gram of trained Medi­care coun­selors, helps Medi­care ben­e­fi­cia­ries to un­der­stand the health care op­tions spe­cific to their health needs and fi­nan­cial re­sources. This is one, in a se­ries of ar­ti­cles, pre­pared by AP­PRISE vol­un­teer coun­selors to help Medi­care ben­e­fi­cia­ries nav­i­gate this com­plex sys­tem.

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