Caregivers can play a significant role in ensuring that Medicare beneficiaries get the best out of their plans. As they work in close proximity with patients, caregivers are in a position to ascertain their health needs, medical benefits, and how they feel about their current plan.
By helping patients review their existing Medicare plans, caregivers can help advise them about any changes that they may want to make during the prescribed Medicare enrollment periods. They can also do a comparative study of the plans available in the area to see which one suits their patient best. Due to changing health conditions, beneficiaries can add plans that perhaps only include drug coverage or switch to a private Medicare Advantage Plan. These can offer further benefits that include vision and dental coverage as well as prescription medication coverage that they may find useful.
The information below is to help caregivers educate their patients about a few of the different Medicare enrollment periods that apply depending on the type of plan a person already holds or wants to use.
If you are a caregiver, regardless of relation, you need to understand the Medicare beneficiary’s healthcare needs, including prescription drug needs, medical preferences and who acts as their medical advisor or durable power of attorney on their behalf.
To fully understand, you need to narrow down their current health insurance coverage and determine if they are covered by Medicare, Part A or B, Medicare Advantage, or a supplemental plan and if they have drug coverage. Typically, most of this information you can find on their Medicare and/or their supplemental insurance card.
You may need to have the following information regarding the beneficiary:
- Social Security number
- Type of Medicare coverage and the Medicare number
- All insurance plans with policy numbers and coverage information
- Contact information for health-care professionals
- List of current prescriptions, dosages, and over-the-counter drugs
- Current health conditions, treatments, and symptoms
- Health history, allergies, and food restrictions
- Emergency contacts
- Living will, medical power of attorney, financial information
When is Medicare Enrollment?
Most people who are U.S. citizens or have lived legally in the country for five consecutive years become eligible to apply for Medicare. In some cases, automatic enrollment happens if they worked for a minimum of 10 years or 40 quarters and paid Medicare taxes if they are already receiving specific benefits, or suffer from certain major illnesses.
Initial Enrollment Period – In cases where automatic enrollment doesn’t apply, a person needs to apply for Medicare Parts A & B during the Initial Enrollment Period (IEP) when they first qualify to apply. While Medicare Part B premiums usually need to be paid monthly, costs of Medicare Part A premiums will depend on whether a person has worked for 10 years or 40 quarters and paid Medicare taxes during that period.
General Enrollment Period – This is a period that usually spans from January 1 to March 31 annually where a person can sign up for Original Medicare Parts A & B, in case they didn’t get enrolled automatically. If a person isn’t eligible to forego Medicare Part A premiums and misses their IEP sign up period, they may have to pay a penalty for Medicare Part A when enrolling during the General Enrollment Period (GEP). Penalties could also incur if they apply for Medicare Part B in the GEP instead of in the IEP.
Medicare Supplement Open Enrollment Period – If a person has Original Medicare (Parts A & B) and also wants to be covered by a Medicare Supplement (Medigap), they usually have a 6 month Open Enrollment Period to do so. This period generally starts when they turn 65 years of age and are beneficiaries of Medicare Part B.
What is the Special Enrollment Period?
In certain situations, a person may qualify to enroll in Medicare during a Special Enrollment Period (SEP) which is not part of their Initial Enrollment Period (IEP) and General Enrollment Period (GEP).
To qualify for a SEP for Medicare Part B, a person has to be 65 years of age or older and covered by their own or a spouse’s employer’s group health plan. When a spouse’s health plan covers a person, typically they will not, pay a late enrollment penalty for Medicare part B and can wait to enroll in the GEP.
In the case of Medicare Part A, many people automatically become eligible for premium-free insurance if they have worked for a minimum of 10 years or 40 quarters and paid taxes towards it. In case a person has worked for a shorter period or has delayed enrolling at the age of 65 because they have insurance coverage from their employer, they can sign up during the SEP.
Typically, the SEP refers to any time that a person chooses to enroll while they are still covered by employer health insurance. Alternatively, the SEP is an 8 month period that begins after a person’s group health insurance ends or when their employment ends, whichever comes first. In situations where group health insurance provided by the employer ends during an IEP, the SEP usually does not exist.
Any person benefiting from Social Security disability benefits, who is enrolled in group health insurance—either through their employer or a family member’s employer—can also take advantage of the SEP.
What are Late Enrollment Penalties?
It is usually advisable for a person to apply for Medicare as soon as they are qualified to avoid paying a penalty. Typically, many people automatically qualify for premium-free Medicare Part A if they have worked the required number of years and submitted the taxes due. If a person isn’t eligible for free Medicare Part A and decides not to apply for it when they are qualified to enroll for Medicare, they can face a penalty with their premiums when they apply later. This penalty is usually calculated as 10% of the monthly premium and is usually paid for a period that is twice the amount of time they didn’t sign up for Medicare Part A.
This late enrollment fee also applies to Medicare Part B and can be levied if they don’t sign up in time. Again, this penalty is added to their monthly premium and may have to be paid for the entire duration of Medicare Part B coverage. In cases where a person opts out of Medicare Part B and chooses to sign up again in the future, they may still have to face a penalty. However, if a person is eligible for a SEP, a late enrollment penalty may not apply.
Medicare Part D, which has to do with prescription drug coverage, also has a late enrollment penalty component that applies if a person doesn’t enroll during the IEP. The amount of the penalty determined by multiplying 1% of the “national base beneficiary premium” by the amount of time they did not have Medicare Part D coverage, despite being eligible.
There are certain circumstances, however, that exclude people from paying this penalty as per Medicare rules.
When is the Annual Enrollment Period?
The Annual Enrollment Period refers to a specific time during which a person can make certain changes to their Medicare plans. This is usually between October 15 to December 7 every year. Individually, you can switch from Original Medicare (Parts A & B) to a Medicare Advantage Plan or vice versa; switch between Medicare Advantage Plans; apply for Medicare Part D drug coverage for the first time; switch between drug coverage plans or drop a drug coverage plan altogether.
To disenroll and switch to Original Medicare, the Medicare Advantage Disenrollment Period is also applicable. Furthermore, if there are specific situations that are beyond the enrollee’s control, they are allowed to make changes to their plans during a Special Election Period.
What is the Initial Coverage Election Period?
Also known as the ICEP, this applies to the period when a person first qualifies to apply for a Medicare Advantage Plan or Medicare Part C, which is Medicare insurance offered by private parties. To be eligible for the ICEP, a person needs to have enrolled in Medicare Parts A & B and must be staying permanently in the service area of the plan. Typically, they must not suffer from end-stage renal disease, although there are exceptions to this rule. People requiring Special Needs Plans need to meet extra qualifications to be eligible.
The ICEP often coincides with the IEP—a 7 month duration that begins 3 months before a person becomes eligible for Original Medicare if a person becomes a Medicare enrollee during this time, the ICEP and IEP overlap and last 7 months.
In cases where a person doesn’t enroll in Medicare Part B, the ICEP becomes applicable only after they enroll in Medicare Part B. This is because both Medicare Parts A & B are requirements to qualify for Medicare Part C. In this scenario, the ICEP spans 3 months that begin before the start date of Medicare Part B.
If a person misses the ICEP but is still eligible to enroll in Medicare Part C, they may be able to do so during the Annual Election Period or Special Election Period.
What is the Medicare Advantage Disenrollment Period?
For various reasons, a person can choose to switch to Original Medicare coverage during the disenrollment period, between January 1 and February 14 every year. Once the person requests to disenroll from the plan, it is typically considered effective from the first of the next month. However, they must be careful to check the exact disenrollment effective date. Specific Medicare Advantage Plans require enrollees to use the healthcare providers listed in the plan to provide coverage for services rendered. In case this is not followed, the plan may choose not to cover the costs incurred.
An important point to note is unlike the Annual Election Period or the Initial Coverage Election Period; the Medicare Advantage Disenrollment Period doesn’t allow enrollees to join new plans or change plans. All they can do is cancel Medicare Advantage and renew the Original Medicare. The disenrollment period, however, allows people to join an independent Medicare prescription drug plan that does not need to be clubbed with another plan if they leave the Medicare Advantage Plan.
Certain circumstances call for a Special Election Period under which a person can disenroll from a Medical Advantage plan outside of the Medicare Advantage Disenrollment period and move to a new one. This includes situations like no longer living in a plan’s service area and other criteria outlined by Medicare.
As a caregiver, if you have questions regarding Medicare, you can contact the State Health Insurance Assitance Program in your state for free guidance.
Each Medicare enrollee’s needs are different. As a caregiver, once you understand their needs or existing Medicare plan, you can guide them in choosing the right enrollment period to apply or make changes to their Medicare plans and optimize their health care benefits. Remember the rules and guidelines with Medicare often changes, make sure to check the Medicare website www.medicare.gov/ or by calling 1-800-MEDICARE to verify specific plan information.