SEP Question

[sbg_ben]

I have a potential client who is asking me for advice on signing up for Medicare. Here is the situation..

He currently has employer group coverage for him and his wife. They DO NOT have prescription coverage through the group, it is available as a separate benefit and they have opted out of it.

The group cost around $400 per month for both of them to stay covered. It's a BCBS PPO with a $1500 ded, $4000 oopm per person.

I'm thinking of telling him to enroll in Part A only, keep the group plan, enroll in a standalone part D plan as a placeholder so that he doesn't get hit with a Part D LEP when he goes to retire.

The question: When he does retire, does he get a SEP to enroll into a MAPD or PDP plan if his employer plan does not include prescription drug coverage?

Obviously he will get that SEP to add Part B so I'm not worried about that part or adding a gap plan if he goes that route.

 

[straightnochaser]

ICEP

 

[sbg_ben]

ICEP

Thank you. I was getting stuck on the fact that the person had no Rx coverage because that is unusual; it may be the 1st time in 8 years I've run into that.


I found this info but not directly on the medicare website, can you confirm this is correct? It makes sense but I don't recall seeing it worded this way exactly.
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Some people choose not to enroll in Medicare Part B during their IEP. This could be because they have health coverage from their own or their spouses' group health plan through their employer.

If you enroll in Part B at a later date rather than during the IEP, your ICEP begins three months before your Part B coverage is due to start. It runs until the last day of the month before your Part B coverage begins.
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[Fisher]

If you enroll in Part B at a later date rather than during the IEP, your ICEP begins three months before your Part B coverage is due to start. It runs until the last day of the month before your Part B coverage begins.
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That is correct. The application for enrollment to whatever Medicare plan he's switching to at that point MUST happen before his Part B becomes effective.

 

[straightnochaser]

That is correct. The application for enrollment to whatever Medicare plan he's switching to at that point MUST happen before his Part B becomes effective.

That hasn't been correct since Jan 1st 2025. ICEP for delayed Part B enrollment runs 60 days PAST Part B start date.

 

[Fisher]

That hasn't been correct since Jan 1st 2025. ICEP for delayed Part B enrollment runs 60 days PAST Part B start date.

Cite your source on that, please. A quick Google query disagrees - [EXTERNAL LINK] - Google Search

And I am A-OK with learning something I didn't know.

 

[Medicare bro]

I have a potential client who is asking me for advice on signing up for Medicare. Here is the situation..

He currently has employer group coverage for him and his wife. They DO NOT have prescription coverage through the group, it is available as a separate benefit and they have opted out of it.

The group cost around $400 per month for both of them to stay covered. It's a BCBS PPO with a $1500 ded, $4000 oopm per person.

I'm thinking of telling him to enroll in Part A only, keep the group plan, enroll in a standalone part D plan as a placeholder so that he doesn't get hit with a Part D LEP when he goes to retire.

The question: When he does retire, does he get a SEP to enroll into a MAPD or PDP plan if his employer plan does not include prescription drug coverage?

Obviously he will get that SEP to add Part B so I'm not worried about that part or adding a gap plan if he goes that route.

Wait are both eligible for Medicare? Why would he stay on that coverage when he get better coverage for $370?

 

[straightnochaser]

Cite your source on that, please. A quick Google query disagrees - [EXTERNAL LINK] - Google Search

And I am A-OK with learning something I didn't know.

This is all I could find but CMS did send some guidance on it last year, I would need to dig through my emails but I'm not home.

MAPD Help Desk: Important Technical Information Regarding use of MARx Election Type Code "I-INITIAL COVERAGE ELECTION PERIOD (ICEP)" as of January 1, 2025 - Cornerstone - Senior Marketing

RELEASED BY CMS FEB 4, 2025: This memorandum is a follow up to a prior MAPD plan update titled, “MAPD Help Desk: Important MARx Election Type Code and Special Election […]

cornerstoneseniormarketing.com

 

[sbg_ben]

Wait are both eligible for Medicare? Why would he stay on that coverage when he get better coverage for $370?

It depends on if they want to ultimately end up with a medigap plan or an advantage plan. If they both go with gap plans they would be well over the $370 by a lot.

If they wanted to go with an advantage plan, that would change it a bit. The wife isn't t65 until Nov though so even if they did go advantage he would be better off keeping the group coverage at least until then. We can revisit it when his wife ages in.

 

[sbg_ben]

That hasn't been correct since Jan 1st 2025. ICEP for delayed Part B enrollment runs 60 days PAST Part B start date.

I hope you are right on this. Now that I think about it, this screwed me up one time about a year ago.