IEP question

[LostDollar]

LostDollar- do you think you can make life easier by saying what you read rather than telling me to carefully read the Part B application form?

Also, what a form says and reality do not always match up. I am sure I am not the only person who runs into this scenario.

Any help, from personal experience, will be greatly appreciated. Thanks

Caveat, not an agent.

Prior to making that post, from curiosity, I checked when your forum membership started.

If you have been selling Medicare all that time, you have had an opportunity to have helped hundreds of people with Part B apps. I have done one Part B app. While I was in total panic mode.

I was dumped, very unexpectedly, into Medicare world. I understood almost nothing and was in fear of making serious mistakes. I had to deal with this very specific issue, on my own for my own app. And I used the element of choosing a date on my own app.

From watching posts here, the significant issue that a number agents are not clear on is the fact that twocents posted, that there is a specific priority of enrollment period orders in the SS POMS manual. Sometimes, when he has the time and is feeling particularly generous, he will also post the specific section of the manual that covers that.

I also checked a part B app last night. Once the issue of priority of enrollment periods is resolved, ANY medicare agent worth their salt should be able to read the app instructions and answer the question you asked.

There are three enrollment periods mentioned in the app. There is only one enrollment period (and only a very specific circumstance within that enrollment period) where the medicare beneficiary has the option of choosing an enrollment date. Once you know the sequence of enrollment periods and which enrollment period you are using for your client, the answer to your question is crystal clear from the form. (and I know that from personal experience.)

What I did in my post to you is exactly the approach that a very experienced and knowledgeable agent on the forum has done with me from time to time. If he chooses to answer a question from me, sometimes he won't give me an answer. He will give me a bit of a background comment and somekind of a reference. I just consider a bit of a test. If I really want to know the answer to my question, he thinks he has given me everything I needed to know to figure it out. If I am not willing to make that effort and ask another specific directed question if there is something else I don't understand, there was no reason for him to make the additonal effort in the first place. With twocents' post above and a Part B app form, I figured the same concept could apply to a 10 year licensed insurance agent member of the senior insurance forum.

 

[LostDollar]

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdf

Page 3.

I used the second bullet under working aged/disabled.

I signed up during the first full month I no longer had coverage.

I put my desired start date under section 12, remarks.

I had no problems. I cannot speak to anyone else's experience.

Enrollment during IEP, GEP, or subsequent months of my SEP would not have allowed me to choose my month of enrollment. If my enrollment had been during a time including both IEP and the SEP, SS would have had to use the IEP and I would not have been allowed to choose my enrollment date.

 

[123insure1900]

LostDollar,

Thank you for your very uninformative (if that is a word) responses....

If you are going to beat around the bush then maybe I will too.

In most instances, small group coverage (less than 20 employees) is secondary to Medicare. However, there are often times when employees who work for small companies do not enroll in Part B because they are incorrectly advised by SSA. SSA tells them that, as long as they are actively working, there is no need to enroll in Part B. This is false when it comes to a small group and often leads to claims not being paid by the group health plan.

Is it wrong that, in 99% of these cases, these employees can quite easily pick up Part B, for the 1st of the month following the date they mail in a Part B enrollment form and request for employment information form? I mean, as a 10 year licensed insurance agent member of the senior forum, I would think I should know the answer to this question and whether this is truly an SEP for Part B. Oh wait, I do know the answer. It's not, so how are they getting Part B?

They are getting Part B because, in most instances, you and the manuals (I mean the manuals) are wrong. Manuals mean nothing. This is real life and the people processing these forms are "real" and are often wrong according to the manuals.

Bottom line is that your replies were quite unhelpful which is the reason for my random and somewhat unrelated question. I think I was looking for answers from an agent with real life experience rather than someone, like yourself, who has done this one time.

 

[Travis Price]

So, the Field Offices do make mistakes..

I had a prospect call today.. She's on Disability with only Part A because she's on her husband's private insurance. Husband is retiring in January and going to Medicare. SSA told her that she can apply in January, but wouldn't have coverage until July... Which is wrong because she'd be in a SEP for 8 months. Then she would only be able sign up during General enrollment period.

As someone that works with SSA regulations, I can tell you that policy can get messy. SSA Field Office staff are a jack of all trades, master of none. So if you have a basic issue, you can usually get the right answer. If it gets slightly complex, all bets are off.

Unlike most insurance agents, Medicare Agents have to be experts in a very complex health insurance government policies, on top of understanding private insurance underwriting niches and comparability.

Selling is actually the really easy part.

The point of this forum, really, is for agents to get insight on sometimes "dumb" questions. It's easy to say, "You can just look it up." However, sometimes SSA policy can get you stuck in a loop because things appear to contradict each other.

It's easy when your not handling clients and have a lot of time to research things, not so much when your ability to eat is based on the amount of people you see/sell.

 

[123insure1900]

@Travis Price very well said

 

[LostDollar]

Okay, so in this instance, what would the individual's Part B effective date be? Could the Part B effective date be chosen or would they end up getting stuck with a November 1st effective date since they have to use their IEP?

LostDollar,

Thank you for your very uninformative (if that is a word) responses....

If you are going to beat around the bush then maybe I will too.

In most instances, small group coverage (less than 20 employees) is secondary to Medicare. However, there are often times when employees who work for small companies do not enroll in Part B because they are incorrectly advised by SSA. SSA tells them that, as long as they are actively working, there is no need to enroll in Part B. This is false when it comes to a small group and often leads to claims not being paid by the group health plan.

Is it wrong that, in 99% of these cases, these employees can quite easily pick up Part B, for the 1st of the month following the date they mail in a Part B enrollment form and request for employment information form? I mean, as a 10 year licensed insurance agent member of the senior forum, I would think I should know the answer to this question and whether this is truly an SEP for Part B. Oh wait, I do know the answer. It's not, so how are they getting Part B?

They are getting Part B because, in most instances, you and the manuals (I mean the manuals) are wrong. Manuals mean nothing. This is real life and the people processing these forms are "real" and are often wrong according to the manuals.

Bottom line is that your replies were quite unhelpful which is the reason for my random and somewhat unrelated question. I think I was looking for answers from an agent with real life experience rather than someone, like yourself, who has done this one time.

Your original question cited above, wondered about whether a beneficiary could choose their enrollment date. That is a different kettle of fish than SSA using one of their standard procedures to assign a Part B start date to the Beneficiary.

 

[Bob L]

I'll have to admit this is all new to me, and I have been doing Medicare options for over ten years now. And I have assisted a number of folks in applying for Part B in different scenarios.

Can't be absolutely certain, but I'd almost be willing to bet my next house payment that I've had clients use their leaving-employer-coverage SEP when it fell in the latter months of their IEP and cannot recall any problems. As is the case for many government rules, it seems nonsensical that a beneficiary would lose his SEP, resulting in inferior benefits (having to go uninsured for a month or two), just because his SEP happened to also fall in the T65 IEP. But it would not be the first time.

This is one of the reasons I love this forum. Very educational.

 

[wehotex]

I'll have to admit this is all new to me, and I have been doing Medicare options for over ten years now. And I have assisted a number of folks in applying for Part B in different scenarios.

Can't be absolutely certain, but I'd almost be willing to bet my next house payment that I've had clients use their leaving-employer-coverage SEP when it fell in the latter months of their IEP and cannot recall any problems. As is the case for many government rules, it seems nonsensical that a beneficiary would lose his SEP, resulting in inferior benefits (having to go uninsured for a month or two), just because his SEP happened to also fall in the T65 IEP. But it would not be the first time.

This is one of the reasons I love this forum. Very educational.

I also used the SEP-Loss of Employer Coverage because MAPD insurance carriers would give me a hard time if Parts A and B dates weren't identical. The SEP took care of that.

 

[LostDollar]

LostDollar,
In most instances, small group coverage (less than 20 employees) is secondary to Medicare. However, there are often times when employees who work for small companies do not enroll in Part B because they are incorrectly advised by SSA. SSA tells them that, as long as they are actively working, there is no need to enroll in Part B. This is false when it comes to a small group and often leads to claims not being paid by the group health plan.
.

The SSA statement quoted in red is correct.

Your statement quoted in black is incorrect for the employee.

I think you may be confusing Part B enrollment rules with the rules for when Medicare coverage is primary and secondary to the group health plans.

 

[123insure1900]

@LostDollar

I can picture you now, in the front row of your 3rd grade class, putting your hand up begging for a teacher to choose you so you could expand on the answer to a simple math question when another student had already answered it correctly. A question like what is 2 x 2. I can see it now. You trying to prove the answer to the question or trying to prove the other student wrong. People like you just crack me up lol.