Medicare Enrollment Periods

Investment News ran a timely article about the various Medicare enrollment periods. The alphabet soup of Medicare enrollment periods explains the initial enrollment period and special enrollment periods. It also explains succinctly how employer group health plans and Medicare interface as far as the special enrollment period.

If you have coverage through your employer or your spouse’s employer consider:

• The employer provided health plan needs to be with a group of 20 or more insurance eligible members. If the group is smaller than 20, Medicare Parts A and B must be primary and cover 80% of costs. The employer plan only covers 20%. In those cases, many folks are better served by leaving the employer plan and signing up for Medicare Part D and a supplemental plan.

• The employer coverage needs to be Medicare Part D creditable, meaning that the employer coverage includes a prescription drug benefit comparable to Medicare Part D. The employer or insurance plan can provide the Medicare creditable coverage notice. Get a copy of this letter every year when your employer coverage renews. That way no one is caught off guard down the road. If a plan has not been Medicare creditable, lifelong penalties of 12% per year are levied when the individual enrolls in Medicare Part D.

Once the person leaves a health plan and is entitled to Medicare, it is important to remember a few key factors:

• Sign up for Medicare as soon as possible. Medicare enrollment can begin three months before employer coverage ends.

• While there is an eight-month window to sign up for Medicare Parts A and B, there is no primary health coverage until Medicare enrollment is complete. Even COBRA coverage is secondary coverage to Medicare. That means Medicare Parts A and B cover 80% of costs, leaving COBRA to pay 20%. The result is that when Medicare-eligible individuals do not have Medicare Parts A or B they are left to pay 80% of their costs out-of-pocket.

• If someone misses the eight-month SEP window after leaving employment, they will have to wait an extended period to of time to enroll, have coverage gaps and pay lifelong penalties.