Special Enrollment / Late Penalty Question

[North American]

Most of the language I can find related to the Special Enrollment is about "employer's" coverage. If someone has an individual health policy and enrolls in Part B after their general enrollment, will they be treated the same as if they were in a group? Or will they be penalized for enrolling late?

 

[G.Gordon]

Interesting case. Most individual health plans I'm aware of cancel the first day of the month they turn 65. If he had creditable drug coverage in that plan, he is not getting the part B penalty then I'd assume that he'd not get the part D penalty either.

I don't have a sourse for that opinion, but it would make sense on the way things work.

 

[jdeasy]

Most of the language I can find related to the Special Enrollment is about "employer's" coverage. If someone has an individual health policy and enrolls in Part B after their general enrollment, will they be treated the same as if they were in a group? Or will they be penalized for enrolling late?

Are you asking about the penalty for enrolling in part B other than when first elidgible or about part D or both?

As for group or individual, it doesn't matter. What matters is if it was creditable coverage.

 

[North American]

Only asking about Part B after first eligible.

How would one go about proving that it was creditable?

 

[G.Gordon]

Have him call the plan that he had.

 

[jdeasy]

Only asking about Part B after first eligible.

How would one go about proving that it was creditable?

If he had creditable coverage and that's why he didn't take part B and he has been continuously enrolled in that creditable coverage, he can get part B at the first of the next month following the loss of coverage and will not have a penalty.

If he did not have creditable coverage or was not continuously enrolled, he cannot enoll in pat b until Jan 1 and it will be effective starting July 1 and he will have a 10% per penalty dating back to when he first could have gotten B.

As Gordon said, call the plan to see what they say about the coverage being creditable and have them send a letter to the client. That letter will be needed by CMS anyway, you might as well go ahead and get it.

 

[DS4]

. Most individual health plans I'm aware of cancel the first day of the month they turn 65.

Since 1997, HIPAA requires guaranteed renewal in the individual market. Prior to HIPAA, eligibility for Medicare triggered a CX on your IFP.

 

[North American]

Very helpful. Thanks.

 

[supersupps]

Sounds like karen.. super genius might be sure she has her e and o in place.

 

[houcoogster]

What happens when someone's part D plan gets canceled and they forgot to enroll in another plan before Jan 1.
Do they have to wait until next year?
Do they have to pay a penalty?