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

[Gary]

I applied for Medicare 8 days before the end of my IEP. Three weeks later I received a request from the WSU in Kansas City for L564 in the mail. I knew the L564 wasn't required when applying during the IEP, but I couldn't find anyone at SSA who could tell me why they wanted it, so ... I completed it anyway and took it to my local SSA office. I figured it would be faster and easier to just give it to them.

I didn't hear anything back for a few days, so last Friday (12/23) I was able to confirm that the WSU received the L564 and they said I was all set and they didn't need anything else. Shortly after that I got a phone message saying that they still don't have all the documentation they need to start my Medicare A&B. They have the 40B and the L564 (that they didn't really need), so what else could they possibly want? I am going to try to find out next week (if I can find someone their who actually knows), but this is bordering on the ridiculous. I am starting to wonder if these people are the WSU are just incompetent.

Comments, hints, suggestions?

 

[JC]

My guess is that it might have to do with the part B start date. When you apply towards the end of your IEP your medicare part B start date is delayed up to 3 months as well. The other documentation would be to apply for your part B under an SEP to get it started immediately.

 

[Gary]

My guess is that it might have to do with the part B start date. When you apply towards the end of your IEP your medicare part B start date is delayed up to 3 months as well. The other documentation would be to apply for your part B under an SEP to get it started immediately.

I think you nailed it.

So, I finally got to talk to the person handling the claim and she said she DID NOT have the L564, but she said if I faxed it over then she could start the Part B for January. Then, a couple of days later when my enrollment showed up on the SSA web site, it showed only Part A. So, I called to confirm that they got the L564, and another person said yes they did, but he said I never applied for Part B and needed to complete a 40B (I originally did the Part A and B application online). Rather than argue with him (like, why would they request the L564 if I hadn't applied for Part B?) , I just faxed it over.

Ok, so yesterday the Part B showed up as effective for January, done. And it only took 7 weeks!

Now, on to Medicare Advantage. Since I applied for Part A and B on 11/22 and Medicare Advantage enrollment closed on 12/7, how/when can I apply for Medicare Advantage? Can I get a SEP or will I have to wait until October? I've read all the rules several times and I still don't know.

 

[JC]

I think you nailed it.

So, I finally got to talk to the person handling the claim and she said she DID NOT have the L564, but she said if I faxed it over then she could start the Part B for January. Then, a couple of days later when my enrollment showed up on the SSA web site, it showed only Part A. So, I called to confirm that they got the L564, and another person said yes they did, but he said I never applied for Part B and needed to complete a 40B (I originally did the Part A and B application online). Rather than argue with him (like, why would they request the L564 if I hadn't applied for Part B?) , I just faxed it over.

Ok, so yesterday the Part B showed up as effective for January, done. And it only took 7 weeks!

Now, on to Medicare Advantage. Since I applied for Part A and B on 11/22 and Medicare Advantage enrollment closed on 12/7, how/when can I apply for Medicare Advantage? Can I get a SEP or will I have to wait until October? I've read all the rules several times and I still don't know.

You don't fall under the Annual Enrollment Period. That is for people that are already on medicare looking to change their Medicare plans. When you are new onto Medicare you have other options. These are going to really differ based on what your part A and B dates are. If they are both Jan 1 then you have until the end of April to set up a PDP or MAPD plan. If you want a Supp you have 6 months from the part B start date to enroll in a supp guaranteed.

 

[Gary]

Ah, now it makes a little more sense. Otherwise, new Part A&B enrollees would be doing a lot of waiting.
My Part A is August and Part B is January, does that change things?

 

[JC]

Ah, now it makes a little more sense. Otherwise, new Part A&B enrollees would be doing a lot of waiting.
My Part A is August and Part B is January, does that change things?

Yes. When did your prior insurance end?

 

[Gary]

Yes. When did your prior insurance end?

I am still working and still on the company GHP. Since the company is less than 20 people, Medicare will be my primary and the GHP will be secondary.

BTW, this is part of the reason I'm pushing to get this done. I also have routine medical stuff waiting until I get this settled.

 

[JC]

I am still working and still on the company GHP. Since the company is less than 20 people, Medicare will be my primary and the GHP will be secondary.

BTW, this is part of the reason I'm pushing to get this done. I also have routine medical stuff waiting until I get this settled.

As long as you have the employer coverage you shouldn't need to set up a part D or advantage plan as long as your employer coverage is creditable. If you plan on ending your employer coverage you will have a special enrollment to sign up for Part C or part D 1 month before or up to 2 months after your coverage ends.

 

[Gary]

As long as you have the employer coverage you shouldn't need to set up a part D or advantage plan as long as your employer coverage is creditable. If you plan on ending your employer coverage you will have a special enrollment to sign up for Part C or part D 1 month before or up to 2 months after your coverage ends.

I decided to go with an Advantage plan mostly to get an out-of-pocket limit. It's my understanding that there is no out-of-pocket limit with Medicare A&B, and my small-company GHP has a high out-of-pocket limit. I don't know how out-of-pocket limits work when Medicare is primary and the GHP is secondary. I'd rather let some Coordinator of Benefits person figure that out and I don't want any unpleasant surprises. Also, I have been having trouble getting proof of creditable prescription plan coverage from our group health plan (I'm still trying) and I don't want any surprises in the form of Part D penalties. And, with an Advantage plan I can get a gym membership which otherwise would cost be $500/year.

I've applied for an Advantage plan that has no additional premium, claiming my eligibility based on being "new to Medicare". If that doesn't work, I'm going to try for a SEP based on "processing delay" or "exceptional circumstances". If all that fails I can still get an Advantage plan in October, though I'll still need to get the proof of creditable prescription drug plan coverage to avoid Part D penalty. Worst case, I'll have to pay a Part D penalty, but fortunately Part D penalties are very small compared to the Part B penalties. I'll let you know how it goes.

 

[JC]

I decided to go with an Advantage plan mostly to get an out-of-pocket limit. It's my understanding that there is no out-of-pocket limit with Medicare A&B, and my small-company GHP has a high out-of-pocket limit. I don't know how out-of-pocket limits work when Medicare is primary and the GHP is secondary. I'd rather let some Coordinator of Benefits person figure that out and I don't want any unpleasant surprises. Also, I have been having trouble getting proof of creditable prescription plan coverage from our group health plan (I'm still trying) and I don't want any surprises in the form of Part D penalties. And, with an Advantage plan I can get a gym membership which otherwise would cost be $500/year.

I've applied for an Advantage plan that has no additional premium, claiming my eligibility based on being "new to Medicare". If that doesn't work, I'm going to try for a SEP based on "processing delay" or "exceptional circumstances". If all that fails I can still get an Advantage plan in October, though I'll still need to get the proof of creditable prescription drug plan coverage to avoid Part D penalty. Worst case, I'll have to pay a Part D penalty, but fortunately Part D penalties are very small compared to the Part B penalties. I'll let you know how it goes.

Applying under new to Medicare might not work because once your part B goes into effect you have to apply under an SEP. If your part A went into effect in Aug your new to Medicare enrollment would of ended the end of Nov.