SSDI + Medicare T65 No Drug Plan

[somarco]

Prospect on SSDI + Medicare for 18 years. A & B only. No Rx plan. Turns 65 March, 2017.


Join a Medicare Prescription Drug Plan when you're first eligible.

You won't have to pay a penalty, even if you've never had prescription drug coverage before.

https://www.medicare.gov/part-d/costs/penalty/ways-to-avoid-part-d-late-enrollment-penalty.html

Technically he was first eligible for Medicare 18 years ago. Did not buy a drug plan when they were initially offered.

Can he buy a plan now without penalty?

And there is this.

A person enrolled in a Medicare drug plan may owe a late
enrollment penalty if he or she goes without Part D or creditable prescription
drug coverage for any continuous period of 63 days or more after the end of his
or her Initial Enrollment Period for Part D coverage

https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11222-P.pdf

Does Part D get a "reboot" in the same way as Medigap does?

He only has A & B but has applied for a Medigap plan to be effective the month in which he turns 65.

 

[TDFnCali]

Prospect on SSDI + Medicare for 18 years. A & B only. No Rx plan. Turns 65 March, 2017.


Join a Medicare Prescription Drug Plan when you're first eligible.


https://www.medicare.gov/part-d/costs/penalty/ways-to-avoid-part-d-late-enrollment-penalty.html

Technically he was first eligible for Medicare 18 years ago. Did not buy a drug plan when they were initially offered.

Can he buy a plan now without penalty?

And there is this.


https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11222-P.pdf

Does Part D get a "reboot" in the same way as Medigap does?

He only has A & B but has applied for a Medigap plan to be effective the month in which he turns 65.

I was told its "rebooted" at 65, but havent had any exp with this to see if its true though.

 

[somarco]

Same here, and I have not run into this before. Perhaps someone who trains agents might know the answer and will be willing to share.

 

[agentjhc]

I was told its "rebooted" at 65, but havent had any exp with this to see if its true though.

My understanding as well.

 

[kgmom219]

Just a question: what are the options?

Stay on MAPD?

Go to Med Supp without Part D?

I would apply ASAP and see what happens, so you have time to recover if it gets rejected. My 2 cents.

 

[somarco]

He's not on MA now. Doesn't want MA. Has docs (specialist) and wants to keep them. Girlfriend in SC has MA and doesn't like it. He wants her to change to Medigap during next AEP.

 

[kgmom219]

He's not on MA now. Doesn't want MA. Has docs (specialist) and wants to keep them. Girlfriend in SC has MA and doesn't like it. He wants her to change to Medigap during next AEP.

I'm on board with the anti-MA reasoning. I just don't think you are going to get the answer without applying for Part D.

Assuming 3/1 or later, apply ASAP and see what happens. The rejection has to come within 10 working days. If they say no, appeal and figure out Plan B.

 

[yogooglethis]

I was told its "rebooted" at 65, but havent had any exp with this to see if its true though.

Yes definitely gets a reboot- and i have seen it and covered it.

 

[MBSC]

Yes, gets a reboot at age 65.

MEDICARE PRESCRIPTION DRUG BENEFIT MANUAL
CHAPTER 4 - Creditable Coverage Period Determinations and the Late Enrollment Penalty
Section 10.1.3 - End of the Subsequent Part D IEP

An individual who is entitled to Medicare prior to turning age 65 (e.g., those who were entitled based on disability), will have a new or subsequent Part D IEP when they become entitled to Medicare based on age. If an enrollee attains age 65 while enrolled in a Part D plan and has been paying an LEP, his/her LEP will end on the day before his/her subsequent IEP begins, which is three months prior to the month s/he attains age 65.

The Part D plan sponsor shall have a process in place for identifying members who are attaining age 65 or who have recently attained age 65.

Example
Mrs. Brown was initially eligible for Medicare based on a disability, but never enrolled in a Part D plan. She will turn 65 on May 19 and her new (or subsequent) IEP will begin on February 1 and continue through August 30. If she enrolls in a Part D plan during this subsequent IEP, she will not be subject to an LEP.

Note: If, in this example above, Mrs. Brown was already enrolled in a Part D plan when she attained age 65, her current plan must take appropriate actions to have the LEP removed effective on the date that her IEP begins, which is February 1. See §30.4.3 for more information.

Reference: https://www.cms.gov/Medicare/Eligib...criptionDrugBenefitManualChapter4_Dec2009.pdf

 

[99murph]

T65 gets anyone a "new" IEP, without penalty