Ask the Medicare Specialist

QUESTION:

From John: I’m already 65 and retiring in April of next year. Do I have to enroll in Medicare Part B and make my plan selection during the Annual Election Period that starts in October?

ANSWER:

You do not. This is a question I get quite often, especially closer to the Annual Election Period (AEP) which runs from October 15th through December 7th. Let’s talk about the different election periods, which one John will use to enroll in a Medicare plan, and when and how he and others get Part B. The election period people are probably most familiar with is AEP which is a “free for all” as I like to characterize it. During this 53-days, Medicare beneficiaries can make any change they want; move from one Advantage Plan to another, from an Advantage Plan to a Supplement, from a Supplement to an Advantage Plan, or add/drop Part D. Be advised that most who choose to move from an Advantage Plan HMO or PPO to a Supplement have to go through what is known as Medical Underwriting, a series of questions one has to answer regarding their current and previous health issues, procedures, medications, etc. In most states, including Pennsylvania, Supplement companies can discriminate on who they accept into their plans based on the answers to the questions and other information one agrees to allow companies to access which includes what is known as a Medical Information Bureau (MIB). I would describe an MIB as being the medical history equivalent of a credit report. Anytime a claim is made with a health insurance company, the code used for the claim is reported to one’s MIB, which insurance companies review to help determine if they are going to accept the applicant. There are a couple exceptions where people do not have to disclose any medical information or answer questions and Supplement companies must accept them into a plan regardless of the existence of pre-existing conditions. This is known as Guarantee Issue (GI). The most common qualifiers of GI, but one that very few people know about, are those who enrolled in an Advantage Plan when they first went on Part B and have had it less than a year. John will use what is known as an Initial Election Period (IEP). It can be used anytime during the year when one goes on Medicare Part B for the first time. It’s also used when someone is turning 65. In this case the beneficiary doesn’t need to do anything if they’re already collecting Social Security and will automatically receive their Medicare card in the mail about 100 days before the first day of the month they “age in.” There are no forms or applications to fill out. Those who aren’t collecting Social Security at age 65 must apply for Parts A and/or B. This is best to do online at Socialsecurity.gov. It’s a pretty easy process, however an account must be set up prior to doing so. People who work past age 65, like John, must get a “Request for Employment Information” form filled out and signed by their employer to attest they’ve had health insurance since their 65th birthday. This allows one to choose any month for part B to start while avoiding what is known as the Part B and Part D “Late Enrollment Penalty,” which can be quite costly. Unfortunately, those in this situation can’t enroll online. It must be done either in person at a local Social Security office, which aren’t open for face to face meetings right now unfortunately. This means the process must be done via phone and mail. It can be a tedious process and as long as Social Security offices remain closed to the public, I suggest starting it as soon as possible, which can be as early as 90 days before the first of the month one wants their Part B to start. For example, if John wants an April 1st effective date, he can apply as early as January 1st. My agency can provide you with the “Request for Employment Information” form. People who get Part B for the first time when turning 65 or due to retiring after age 65 can buy any Supplement plan they want without going through Medical Underwriting, the most important perk of IEP in my opinion. Please keep in mind that Advantage Plans never take preexisting medical conditions into account. The Center for Medicare and Medicaid (CMS) regulations state they must accept anyone who has both Medicare Parts A and B. And in 2021, for the first time, that will even include those who have End Stage Renal Disease. There are also what are known as Special Election Periods (SEP’s) that are triggered by certain events. Many people who are awarded an SEP also get Guaranteed Issue (GI) if they want to choose a Supplement. This would include people who lost insurance from an employer or Medicaid, or those whose previous Medicare Advantage Plan is being discontinued, which happens from time to time. Moving from one Medicare region to another, which doesn’t necessarily have to be state to state, also triggers an SEP. However, this isn’t one that would provide GI. People who have PACE, PACENET, Medicaid, or “Extra Help” actually have year-round SEP’s, although not GI. There are other instances where an SEP could be awarded as well. You can reach out to myself or another of our licensed agents with questions regarding SEP’s and all their intricacies. There is one other election period available to everyone that is date specific and can be very valuable for some people. However, due to CMS regulations, I’m not allowed to mention it by name in the column or other advertisements. Please feel free to reach out regarding today’s topic or any other Medicare questions. You can log on to our website to read previous columns, listen and subscribe to our podcasts, and watch my webcasts.