Thoughts on this enrollment table?

[jack3454]

I keep running into different scenarios that Im struggling to get the answers to right off the top. I made this table to carry with me to help remember what enrollment requirements there may be, depending on the individual.

Thoughts? Notice anything wrong, or something that you’d add/change?

Thanks.

 

[MedicareAgent]

print out the sep codes and carry them also

 

[LostDollar]

Caveat, not an agent.

Don't the answers for creditable employer group coverage depend on whether or not one is talking about Part A or Part B?

(And for Part A, the subset of whether there is, or is not, a related HSA plan?)

And in the ACA/Obamacare, does whether or not the ACA coverage is HSA eligible come into consideration?

 

[LostDollar]

And this is just me, but I would also want a second quick reference card that shows the different penalty time frames for Part A if purchased, Part B after termination of active employment, Medigap after both Part A and B are inforce, and Part D after termination of creditable coverage.

 

[rmhaire]

Don't the answers for creditable employer group coverage depend on whether or not one is talking about Part A or Part B?

More important is number of employees. That determines primary or secondary. 20 and up or 19 and under.

 

[LostDollar]

More important is number of employees. That determines primary or secondary. 20 and up or 19 and under.

Yes. I found his card quite confusing on that score.

I finally decided he was using the term creditable to relate to both PDP's and employer group size, and was ignoring group plans with less than 20 members.

If that's not the case, then there may need to be 3 lines to replace the one shown.

Although, I seem to remember a thread a few years back where someone was asking about submitting an app for someone on a small group plan using the employer sep and one or more agents posted saying go ahead and do it, they (those agents) had done it and had never had a carrier ask about the size of the group plan. I've no idea if that would still be a valid thing for an agent to try in 2024.

 

[TwoCents]

Just b/c an employer group plan is credible to delay Part B doesn't mean the drug benefit is creditable to delay Part D (PDP enrollment). I wouldn't assume anything.

 

[yorkriver1]

Note: by statute, group plans 19 and fewer employees will exclude anything that Medicare A and B would cover once the employee is 65. The employer should know this and advise the employee to enroll in Medicare. Sometimes the cost of employer insurance is higher than having even a PDP and MedSupp. re: Large groups must pay--Medicare's rationale is that larger employers will support the Medicare system's financial viability by not discriminating by avoiding to cover employees over 65. Also note: I have no opinion about the reality of the assumption. Just reporting.