IEP question

[Travis Price]

LD, you're out of your depth here.

As someone that works with SSA with disability, I can tell you unequivocally that Field Office staff only know very general information about the multitude of programs they oversee.

I've had FO personnel tell mentally ill people applying for Disability that I'm a fraudulent call because we do not sign letters. So I then have to do extra work to establish that I'm a legit contact.

Of as I noted above, an SSA person tell a prospect that they have to wait for January with a coverage start date in July for Part B because they're losing their spouses insurance in two months.

You can read and pull policy all you want. They're right, but it doesn't mean that's how it's explained to people interacting with FO.

 

[LostDollar]

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.

LD, you're out of your depth here.

.

OP is the one out of his depth.

He created an example in which he said that each time a SS employee told an employee they could continue working and not apply for Part B if they were covered by a GHP (small group plan), the SS employee was giving incorrect advice. As far as SS is concerned, that is correct advice in relation to the employee's ability to obtain Part B coverage in the future.

And that then relates to his second paragraph above where he says that situation is not a SEP.

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?

It is a SEP, so he is the one that is wrong. The SS employees are following POMS.

Claims payments are a different issue, relating to primary and secondary insurer rules. I'm not sure you can fault an SS employee for not discussing primary secondary coverage rules when the question appears to relate to the ability to obtain penalty free Part B in the future.

 

[Travis Price]

I think there is an argument for what you're saying, as people the general public rarely knows how to articulate what they're really asking when speaking to a government employee.

I don't read the question the way you're presenting it, but if the person doesn't indicate they're in a smaller group, the SSA person wouldn't necessarily register they were and the general guidance of POMS would be parroted.

However, POMS is almost never as clear cut as it seems in application. And SSA FO staff aren't really experts at anything, they're generalists over everything.

Now, if you talk to a person from a specialized office, like CMS or Disability, you usually get a more specialized answer for your situation.

 

[LostDollar]

As far as using the SEP to enroll in Part B, POMS specifically applies the same rule to GHP and LGHP.

Edit
After your comment ran through my mind a few more times, if in regard to general guidance you mean just talking in terms of Part B enrollment and not expanding the discussion to primary/secondary coverage issues, I can see that.

I angered OP so he went away from his original question and created another situation in which he said SSA employees were allowing a SEP when one did not exist, in order to bolster an argument about SSA employees making errors.

I won't argue that SS employees never make mistakes, but OP's example is not an example of incorrect application of SEP rules.

OP should also understand that if a SSA employee does something that does not follow the POMS manual, it does not make the manual incorrect. Unless he can demonstrate that the manual does not follow federal code, which I suspect is unlikely, it just means the document was processed incorrectly.

end edit.

 

[123insure1900]

@LostDollar

You definitely did not anger me.

I am fairly certain you are incorrect in trying to correct my original statement about an individual NOT TECHNICALY qualifying for a legit Part B SEP (due to loss of group coverage) if that individual or his or her spouse is actively working for a small group (less than 20 for 65 and older and less than 100 for under 65).

 

[LostDollar]

@LostDollar

You definitely did not anger me.

I am fairly certain you are incorrect in trying to correct my original statement about an individual NOT TECHNICALY qualifying for a legit Part B SEP (due to loss of group coverage) if that individual or his or her spouse is actively working for a small group (less than 20 for 65 and older and less than 100 for under 65).

Medicare and you (2021) pp 17-18 provides the answer to both of the concerns you raised.

Toward the bottom of page 17, under the heading of Special Enrollment Period:
It indicates that the key for Part B enrollment using the SEP is group health plan coverage based on current employment. (no distinction between GHP and LGHP.)

At the end of the first paragraph at the top of page 18:

This period does not apply if .....(stuff about ESRD)....., or you're still in your Initial Enrollment Period.

 

[TwoCents]

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.

I have to point out that most of this conversation thread is about SEP vs IEP for Original Medicare which is a different animal than using the SEP-LEC for an MAPD. But thanks for playing; here's a year's supply of virtual turtle wax.