Is She Screwed This AEP?

[bigeats]

She will have a Special Election Period for aging into Medicare, I wouldn't just assume you know her claim number and her effective dates until she has confirmation from Medicare.

We're waiting for it to show up online. When she called SS, she was on hold for 20 minutes before she got disconnected. Needless to say, she wasn't interested in calling back.

When I told her what this so-called "personal" information was all about - she was ticked off that the gubmint worker didn't just come out and say "I'll need your name, DOB, SS#, address and phone number to verify with your agent on the line... is that ok?"

She would have given permission - and all would be well... but that would be too easy...

 

[bigeats]

Well she got her letter from Medicare.

She's screwed.

Her Part A effective date is June 2011. That's cool.

Her Part B effective date is JULY 2012.

WTF???

 

[SportsNut]

Well she got her letter from Medicare.

She's screwed.

Her Part A effective date is June 2011. That's cool.

Her Part B effective date is JULY 2012.

WTF???

M'care didn't take into acct that she had credible covg and has still been working and is just now requesting Part B to become effective. M'care has classified her a late enrollee w/o prior credible covg, in which case the enrollment period is within the first three months of the year with an effective date of Part B being July 1 of that year... or 2012 in this case.

She needs to contact M'care back and emphatically let them know that she has had cred covg... and she may need to provide verification of such from HR or her current health insurer, and then her Part B should become effective on Jan 1, 2012.

**Disclaimer: This is providing that you have the facts straight, and that I have understood exactly what has been written in the previous posts... of course I have just skimmed through this thread quickly and not absorbed every gorey detail either...

____________________________________________________________________________

As it stands now she would be eligible for MAPD or other supplemental covg on GI, eff July 1st.

 

[wehotex]

Well she got her letter from Medicare.

She's screwed.

Her Part A effective date is June 2011. That's cool.

Her Part B effective date is JULY 2012.

WTF???

If she was still working, why didn't they make her Medicare Part b with a Jan 01 eff date? That would make her elig for SEP- Loss of Group Coverage. It's not ICEP, because the eff dates of A & B aren't identical.
But I think that they distinguish between having group insurance, "not working" v "actively working". The latter must pay the 10% penalty per year for each year where they did not take the Part B when initially offered. I'm not sure what Part B effective date they give them. But the 7-1-11 eff date sounds right.

 

[bigeats]

Well she spoke to Social Security... and apparently they had her fill out the wrong form online. They are sending her the correct form (which will require her employer's autograph indicating loss of coverage) and when she returns that - she can expect her Medicare card in around 45 days.

While they told her that her coverage will be effective as of Jan 1st - they would NOT provide her with ANY documentation of that claim... and, needless to say, she is understandably skeptical.

So... she will have coverage (if you believe the gubmint worker) but will be without any proof of such coverage until around the end of January.

 

[ksigmtsu]

This is why, in basically all circumstances, it is in your best interest to tell the person to go directly to the local SS office and do this in person, AFTER explaining what they need to tell the worker there.

The phone staff at SS are not trained, they're screen readers. They literally have a script that involves them clicking the correct link on the screen based on answer given. Same with the 1800 medicare people.

I accidently got one of their scripts one time, its quite funny.

The local staff usually knows what they're doing.

 

[bigeats]

Speaking of scripts... I just used a generic CMS voice signature script - and I couldn't believe how stupid it was. No one apparently proofed it - in some cases, it repeated information three times or more. It was painful to take this old lady through it... but I had to. Unfortunately, it looks like it might be all for naught as I can no longer log into the Agent Data Entry for seniors on BCBS' website. F#$K.

 

[Colby214]

It is always best to go to the SS office, if possible. The card is not necessary. SS office can provide the beneficiary with a "Letter of Entitlement" which verifies they are in the system, and provides exact NAME, Medicare # and effective dates. Regarding a previous post, SS# with a "B" always belongs to a living spouse, never the beneficiary.

 

[bobdehncke]

Got a prospect who turned 65 last June. She did not enroll in Part A or Part B until TODAY... with an effective date of 1/1/2012 (her company paid insurance ends at the end of December)

She originally was going to go with a Med Supp... but now is considering an MAPD.

The question is - can I enroll her in an MAPD before she gets her Medicare Card? I'm assuming she won't have it before December 7th... so would I just use her SS number followed by an "A" and use the 1/1/2012 Effective Dates for the app?

If she hadn't been dragging her feet for so many months - this wouldn't be an issue... but now, even if she wants to go with a Med Supp, she still has the same issue with the December 7th deadline regarding a standalone PDP.

Any thoughts?

Because she had group coverage, all she needs to do is get a letter from her HR department that shows that she had coverage. Have her take that letter with her down to the local SS office (she actually has 63 days to get coverage before the penalty would apply). The local SS office will then give her the proper 1-1-12 effective date for her part "B" coverage. You have up until midnight of Dec. 31, 2011 to enroll her and get it sent in for a 1-1-12 effective policy. Also, if you are with her when she calls SS you will be able to verify the effective dates (make sure that you write down the name of the person whom you spoke with at SS and if they give it to you, their badge number or their extension). This will guarantee you that policy will be issued exactly how you want it to be.

A good thing to remember when dealing with someone coming off of a group policy whether it is voluntary or unvoluntary, is that they have a 63 day window, you don't need to worry about enrollment periods like AEP is the person's 63 day window is still open. When it comes to marking down the type of enrollment period you are using, just put down SEP group.

Hope that helps!

 

[bigeats]

Thanks Colby and Bob -

That's what we're going to do... when she gets this form from SS and signed off by her employer, she'll go to the local SS office.

I appreciate all the replies!