Problems Enrolling In Part B - What's Going On Here?

[Gary]

Yes, I see what you're saying. Since my birthday was in August and I applied for Part A&B on 11/22, they should have just started my Part B in February. Then I could apply for Part C now and this would be done (and we wouldn't need this long forum thread).

Instead, the WSU people made an error in sending me the request for an L564 that they didn't need which caused processing delays. Finally, in the first week of January, they made my Part B effective January 1, resulting in no period during which I could apply for Part C or D. If I had known the Part C rules, I could have requested that they make it effective February so I have time to apply for a Part C.

This is going to be my basis for requesting a SEP if I need it. They delayed processing of my application due to an error on the part of a WSU employee who requested an L564 that they didn't need. I also believe that I could get a SEP due to the fact that due to this error, I was a new Medicare enrollee who had no opportunity to apply for apply for Part C or Part D.

 

[JC]

Yes, I see what you're saying. Since my birthday was in August and I applied for Part A&B on 11/22, they should have just started my Part B in February. Then I could apply for Part C now and this would be done (and we wouldn't need this long forum thread).

Instead, the WSU people made an error in sending me the request for an L564 that they didn't need which caused processing delays. Finally, in the first week of January, they made my Part B effective January 1, resulting in no period during which I could apply for Part C or D. If I had known the Part C rules, I could have requested that they make it effective February so I have time to apply for a Part C.

This is going to be my basis for requesting a SEP if I need it. They delayed processing of my application due to an error on the part of a WSU employee who requested an L564 that they didn't need. I also believe that I could get a SEP due to the fact that due to this error, I was a new Medicare enrollee who had no opportunity to apply for apply for Part C or Part D.

you still have an SEP when they back date your part B premium. You have 2 months from the time you were notified of your acceptance under part B to enroll into a part C program

 

[Gary]

you still have an SEP when they back date your part B premium. You have 2 months from the time you were notified of your acceptance under part B to enroll into a part C program

Now that could save me a lot of work. I have the Advantage application in now and the provider says it pending CMS approval. So, if the CMS software is working right and they enter it in correctly, maybe they'll just approve it. And to think, this whole thing started with a WSU employee sending me an L564 that they didn't need (they eventually admitted the mistake).

Can you point me to a source for the Medicare rule about the 2 months? I searched around I couldn't find it.

JC, thanks for all the great info!

 

[Gary]

you still have an SEP when they back date your part B premium. You have 2 months from the time you were notified of your acceptance under part B to enroll into a part C program

Well, the drama continues. I received my Medicare card for Part A & B, so Part A on August 1 and Part B on January 1 is confirmed. I also just received a letter from the Medicare Advantage provider I applied to, stating that my enrollment request was denied because, as they stated, "You attempted to enroll outside of an enrollment period". So, apparently I did not get 2 months from the time I was notified of my acceptance under part B to enroll into part C. I don't want to wait until October 15, so I'm going to need a SEP.

Should I argue that I received "retroactive enrollment into Medicare", since I was notified after both my Medicare Part A&B started? That should give me a 2 month SEP. Or, should I claim that it was a federal employee error, processing delay, or exceptional circumstances? Do I request the SEP with the SSA/Medicare people, or work with a Part C/D provider?

BTW, I did manage to get a notice of creditable prescription drug coverage from my employer. I'm probably going to need that now to avoid a lifetime Part D penalty.

 

[JC]

Well, the drama continues. I received my Medicare card for Part A & B, so Part A on August 1 and Part B on January 1 is confirmed. I also just received a letter from the Medicare Advantage provider I applied to, stating that my enrollment request was denied because, as they stated, "You attempted to enroll outside of an enrollment period". So, apparently I did not get 2 months from the time I was notified of my acceptance under part B to enroll into part C. I don't want to wait until October 15, so I'm going to need a SEP.

Should I argue that I received "retroactive enrollment into Medicare", since I was notified after both my Medicare Part A&B started? That should give me a 2 month SEP. Or, should I claim that it was a federal employee error, processing delay, or exceptional circumstances? Do I request the SEP with the SSA/Medicare people, or work with a Part C/D provider?

BTW, I did manage to get a notice of creditable prescription drug coverage from my employer. I'm probably going to need that now to avoid a lifetime Part D penalty.

It's because you applied under ICEP (initial coverage electionary period) which you only have until your part b goes into effect to use that. your SEP is because your part B was back dated and you are given an SEP for 2 months from the time of notice. I can help you complete all this the right way if you like.

 

[Gary]

It's because you applied under ICEP (initial coverage electionary period) which you only have until your part b goes into effect to use that. your SEP is because your part B was back dated and you are given an SEP for 2 months from the time of notice. I can help you complete all this the right way if you like.

Thanks, I think we're almost there. I spoke to the Medicare Advantage provide that I applied to, and they said I need to request the SEP from Medicare. This seems like a pretty clear case for a SEP.

 

[Gary]

Thanks, I think we're almost there. I spoke to the Medicare Advantage provide that I applied to, and they said I need to request the SEP from Medicare. This seems like a pretty clear case for a SEP.

It's because you applied under ICEP (initial coverage electionary period) which you only have until your part b goes into effect to use that. your SEP is because your part B was back dated and you are given an SEP for 2 months from the time of notice. I can help you complete all this the right way if you like.

The Medicare Advantage provider I had applied to previously (and got rejected) told me that I need to request the SEP from Medicare. So, I called Medicare. They said I can't really request a SEP, that it doesn't work that way. He said either I have one or I don't. When I explained the situation with the dates and all, he said I clearly have a SEP for retroactive notification of entitlement. OK, good.

Then he transferred me to someone else at Medicare to enroll me in the plan I wanted. I didn't really understand that, but it sounded easy so I went with it (but now I'm not not sure if that was a good idea or not). The next guy asked a lot of questions, agreed that I do have a SEP, and said he would submit the application. It sounded like this was going back to the provider, but this time with the info related to the SEP. He also said that my Medicare account showed a Part D starting eligibility date of December 1, which he said he really didn't understand. However, he said that the December 1 starting eligibility date for Part D would still give me until the end of February to get enrolled in a Part C or D. He also said he didn't understand why the provider gave me the rejection on the first enrollment. I suspect it's because all I gave them was the Part A date of August 1 and the Part B date of January 1, so they rejected it based on the Part B date being already passed.

I don't understand the sequence of all this. It sounds like different people (the individual, someone at Medicare, or a sales agent) can submit the application to the provider. Then maybe the provider decides if you have an enrollment period, or do they ask Medicare? Who really determines if an applicant really has a valid SEP? Do the providers do that themselves or do they ask Medicare for that determination?

 

[JC]

The Medicare Advantage provider I had applied to previously (and got rejected) told me that I need to request the SEP from Medicare. So, I called Medicare. They said I can't really request a SEP, that it doesn't work that way. He said either I have one or I don't. When I explained the situation with the dates and all, he said I clearly have a SEP for retroactive notification of entitlement. OK, good.

Then he transferred me to someone else at Medicare to enroll me in the plan I wanted. I didn't really understand that, but it sounded easy so I went with it (but now I'm not not sure if that was a good idea or not). The next guy asked a lot of questions, agreed that I do have a SEP, and said he would submit the application. It sounded like this was going back to the provider, but this time with the info related to the SEP. He also said that my Medicare account showed a Part D starting eligibility date of December 1, which he said he really didn't understand. However, he said that the December 1 starting eligibility date for Part D would still give me until the end of February to get enrolled in a Part C or D. He also said he didn't understand why the provider gave me the rejection on the first enrollment. I suspect it's because all I gave them was the Part A date of August 1 and the Part B date of January 1, so they rejected it based on the Part B date being already passed.

I don't understand the sequence of all this. It sounds like different people (the individual, someone at Medicare, or a sales agent) can submit the application to the provider. Then maybe the provider decides if you have an enrollment period, or do they ask Medicare? Who really determines if an applicant really has a valid SEP? Do the providers do that themselves or do they ask Medicare for that determination?

On each application you have to select the "Reason" you are eligible to apply at this time. Because you selected New to Medicare and the eligibility dates for that election period had passed it automatically declined you. Once it is submitted with the right eligibility it will go through. No one at Medicare or the Health Insurance is going to spend the time to make sure that application was submitted correctly. This is where a licensed agent is most useful. It sounds like everything has been resubmitted using the correct Reason code and shouldn't have any more problems

 

[Gary]

On each application you have to select the "Reason" you are eligible to apply at this time. Because you selected New to Medicare and the eligibility dates for that election period had passed it automatically declined you. Once it is submitted with the right eligibility it will go through. No one at Medicare or the Health Insurance is going to spend the time to make sure that application was submitted correctly. This is where a licensed agent is most useful. It sounds like everything has been resubmitted using the correct Reason code and shouldn't have any more problems

Thanks for all the help. I'll let you know what happens next.

If knew what I know now when I started, I would have done this much differently.
I'm going to really kick myself if I find out that licensed agents don't charge an additional fee.

 

[JC]

Thanks for all the help. I'll let you know what happens next.

If knew what I know now when I started, I would have done this much differently.
I'm going to really kick myself if I find out that licensed agents don't charge an additional fee.

Nope Licensed agents are not allowed to charge you. We are paid through the insurance companies.