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I've searched around and have not found a definitive answer to this.
Client got Part A about a year ago and elected not to enroll in Part B due to the fact that she was still working at age 65 and was covered by a great employer plan.
Her employer plan ended 12/31/13 and she enrolled in Part B some time in 2/14, during her eight-month SEP. It became effective 3/1/14. However, for some reason, she did not choose to enroll in any Part C or D plan, or a Med supp, for that matter.
I would think that her SEP for losing employer coverage ended 2/28/14. She has called me desperately wanting to enroll in a BCBS MAPD, to be effective 7/1/14. She believes she has an initial enrollment period of three months before to three months after the month she got her Part B, which would end 6/30/14, i.e., next Monday night. She has talked to Medicare about this several times, and most of the time they tell her she has an SEP that ends 6/30/14. (Note they are not saying ICEP or IEP.)
My thought initially was that she blew her employer coverage SEP by not enrolling by 2/28/14. (She could still get a Med supp, since she has an open enrollment for six months after getting Part B, even if subsequent to getting Part A, but she cannot afford the premium. She needs a zero-premium MAPD.)
I have gone through the last several years believing that if a beneficiary gets Part A and some time goes by, and there is no other SEP in place, such as leaving employer coverage, the act of enrolling in Part B in itself does not generate an SEP, ICEP, or IEP, and that it would be necessary to apply for Part B and exercise an employer plan SEP within the two months after loss of coverage.
Now, however, I discovered that in this CMS document:
http://www.medicare.gov/Pubs/pdf/11219.pdf
... at the bottom of page 3, it says thusly:
If this describes you...
You HAVE Medicare Part A coverage, and you enroll in Medicare Part B during the Part B General Enrollment Period (January 1–March 31).
You can...
Sign up for a Medicare Advantage Plan (with or without prescription drug coverage) or a Medicare Prescription Drug Plan.
At this time...
Between April 1–June 30.
Now I've seen this before, but I thought that it only pertained to someone using the GEP and getting their Part B on July 1, as a result. But the language does not exclusively say that. It seems to say that if you do all this in the first three months of the year you get extra time to make a MAPD election.
I called Humana's agent help line and the lady said no, she's burned her SEP and is locked out until AEP. When I called 800-MEDICAR, the lady with the foreign accent said the same thing. But when the client calls, they pull her file and say she has an SEP.
So it appears that I should go see her and take the app before Monday night comes and goes, if perchance she does have an election. The abovereferenced publication clearly says at the top of the page "Initial Enrollment Periods," not special election periods. The client insists on calling it an SEP on the application so we don't blow it and miss the SEP.
So my question for you gurus out there is this: How do you mark the app, as an IEP or SEP? And if SEP, what code, the one for losing employer coverage or something else? Sorry for writing a novel about this, but I wanted to get all the details out for you folks to see.
Client got Part A about a year ago and elected not to enroll in Part B due to the fact that she was still working at age 65 and was covered by a great employer plan.
Her employer plan ended 12/31/13 and she enrolled in Part B some time in 2/14, during her eight-month SEP. It became effective 3/1/14. However, for some reason, she did not choose to enroll in any Part C or D plan, or a Med supp, for that matter.
I would think that her SEP for losing employer coverage ended 2/28/14. She has called me desperately wanting to enroll in a BCBS MAPD, to be effective 7/1/14. She believes she has an initial enrollment period of three months before to three months after the month she got her Part B, which would end 6/30/14, i.e., next Monday night. She has talked to Medicare about this several times, and most of the time they tell her she has an SEP that ends 6/30/14. (Note they are not saying ICEP or IEP.)
My thought initially was that she blew her employer coverage SEP by not enrolling by 2/28/14. (She could still get a Med supp, since she has an open enrollment for six months after getting Part B, even if subsequent to getting Part A, but she cannot afford the premium. She needs a zero-premium MAPD.)
I have gone through the last several years believing that if a beneficiary gets Part A and some time goes by, and there is no other SEP in place, such as leaving employer coverage, the act of enrolling in Part B in itself does not generate an SEP, ICEP, or IEP, and that it would be necessary to apply for Part B and exercise an employer plan SEP within the two months after loss of coverage.
Now, however, I discovered that in this CMS document:
http://www.medicare.gov/Pubs/pdf/11219.pdf
... at the bottom of page 3, it says thusly:
If this describes you...
You HAVE Medicare Part A coverage, and you enroll in Medicare Part B during the Part B General Enrollment Period (January 1–March 31).
You can...
Sign up for a Medicare Advantage Plan (with or without prescription drug coverage) or a Medicare Prescription Drug Plan.
At this time...
Between April 1–June 30.
Now I've seen this before, but I thought that it only pertained to someone using the GEP and getting their Part B on July 1, as a result. But the language does not exclusively say that. It seems to say that if you do all this in the first three months of the year you get extra time to make a MAPD election.
I called Humana's agent help line and the lady said no, she's burned her SEP and is locked out until AEP. When I called 800-MEDICAR, the lady with the foreign accent said the same thing. But when the client calls, they pull her file and say she has an SEP.
So it appears that I should go see her and take the app before Monday night comes and goes, if perchance she does have an election. The abovereferenced publication clearly says at the top of the page "Initial Enrollment Periods," not special election periods. The client insists on calling it an SEP on the application so we don't blow it and miss the SEP.
So my question for you gurus out there is this: How do you mark the app, as an IEP or SEP? And if SEP, what code, the one for losing employer coverage or something else? Sorry for writing a novel about this, but I wanted to get all the details out for you folks to see.
