Medicare Part B effective date 09/01 due to weird IEP rules, can he request a 05/01 date

[kev_60]

Maybe someone has some experience with this scenario. I have a client who was T-65 in Feb. 2022. Took Part A and delayed B due to having EGC. In April found out he was being retired and his EGC would end 05/01. So he went to SS to apply for Part B. I am aware of the weird rules were if you are still in IEP and you apply 2 months after the month you turn 65 your Part B for some reason normally goes into effect 3 months after, so 07/01 for him. But can he request an earlier effective date and possibly back pay his Part B premium? Or is he just stuck without coverage for 2 months ? I found it strange that they asked for the 2 forms used for delayed Part B due to having EGC when he applied. Also, I assume we could use SEP-LEGC to enroll him in an MAPD for a 07/01 effective date, assuming he cant change it.

 

[LostDollar]

Maybe someone has some experience with this scenario. I have a client who was T-65 in Feb. 2022. Took Part A and delayed B due to having EGC. In April found out he was being retired and his EGC would end 05/01. So he went to SS to apply for Part B. I am aware of the weird rules were if you are still in IEP and you apply 2 months after the month you turn 65 your Part B for some reason normally goes into effect 3 months after, so 07/01 for him. But can he request an earlier effective date and possibly back pay his Part B premium? Or is he just stuck without coverage for 2 months ? I found it strange that they asked for the 2 forms used for delayed Part B due to having EGC when he applied. Also, I assume we could use SEP-LEGC to enroll him in an MAPD for a 07/01 effective date, assuming he cant change it.

Caveat, not an agent.

IEP always takes precedence over the EGC sep for Part B so he could not make any Part B enrollment under that sep until after the IEP is ended.

I am not an agent and don't know about MA/MAPD so I can not answer that question.

If COBRA is not a choice in your scenario, agents here can give you some advice about temporary coverage options.

 

[margostl]

Maybe someone has some experience with this scenario. I have a client who was T-65 in Feb. 2022. Took Part A and delayed B due to having EGC. In April found out he was being retired and his EGC would end 05/01. So he went to SS to apply for Part B. I am aware of the weird rules were if you are still in IEP and you apply 2 months after the month you turn 65 your Part B for some reason normally goes into effect 3 months after, so 07/01 for him. But can he request an earlier effective date and possibly back pay his Part B premium? Or is he just stuck without coverage for 2 months ? I found it strange that they asked for the 2 forms used for delayed Part B due to having EGC when he applied. Also, I assume we could use SEP-LEGC to enroll him in an MAPD for a 07/01 effective date, assuming he cant change it.

He should be able to request 05/01/ part B coverage without any penalties since
group coverage ends and he has filed correctly.I just completed 1 that grp coverage ends
5/31/ filed part A in 2021 approved for B 06/01.

 

[LostDollar]

He should be able to request 05/01/ part B coverage without any penalties since
group coverage ends and he has filed correctly.I just completed 1 that grp coverage ends
5/31/ filed part A in 2021 approved for B 06/01.

Caveat, not an agent.

It is my understanding that the IEP runs out three month following the birthday month. (assuming birth date is NOT the first of the month.) For a Feb birthday, this would mean IEP runs on through MR, AP, MY.

This has been discussed here several times through the past few years. The SS POMS manual specifically states that IEP is to take precedence over the employment sep for part B enrollment if they both occur in the same time frame. NO EXCEPTIONS. If client with a FE birthday enrolled in Part B in AP, he is subject to IEP enrollment rules.

 

[kev_60]

Caveat, not an agent.

It is my understanding that the IEP runs out three month following the birthday month. (assuming birth date is NOT the first of the month.) For a Feb birthday, this would mean IEP runs on through MR, AP, MY.

This has been discussed here several times through the past few years. The SS POMS manual specifically states that IEP is to take precedence over the employment sep for part B enrollment if they both occur in the same time frame. NO EXCEPTIONS. If client with a FE birthday enrolled in Part B in AP, he is subject to IEP enrollment rules.

This is what he was told at Social Security today. It's 07/01, no exceptions. So he may look into a marketplace plan for 2 months. Dumb rule imo but what are you going to do. Thanks for the replies.

 

[LostDollar]

This is what he was told at Social Security today. It's 07/01, no exceptions. So he may look into a marketplace plan for 2 months. Dumb rule imo but what are you going to do. Thanks for the replies.

Just an FYI--I think I have this right.

I believe kgmom has posted that this rule is going to be changed in 2023-starting then I think the effective dates are supposed to be the first of the month following enrollment. You need to verify that from some source other than me. (And unfortunately, that does not help this client.)

 

[kev_60]

No, it doesn't, but it is good to know. Thanks very much. I will check that out.

 

[sshafran]

He can enroll on 6/1 (or anytime June) and request 6/1 effective date.
- His IEP ends 5/31
- June - he is in the 1st month of his SEP
- SEP - you can request coverage for current month.

https://www.ssa.gov/pubs/EN-05-10012.pdf

The language is a bit obtuse (based on the "whichever happens first" statement), and a constitutional lawyer might make the case that it would need to be July, but a SS employee can push it through for June 1, from what I've been told.

 

[sshafran]

and a constitutional lawyer might make the case that it would need to be July

...by which statement, I clearly meant LD.

 

[LostDollar]

- June - he is in the 1st month of his SEP
.

I would agree with that ONLY if he actually had 1 day of employer group coverage in the month of May. Otherwise June is the second month of the SEP because his employment ended in April.

At this point it is academic, unless you have a procedure to get the Part B application revoked, because, based on what op said, he applied for Part B in April during his IEP.