Social Security & Medicare

Ms. Toad

(34,130 posts) Tue Dec 14, 2021, 06:44 PM Dec 2021

Sudden change of plans unexpectedly need Part B, while still in the initial enrollment period

I've got a complex situation here - wondering if anyone else has any experience.

I turned 65 in September and enrolled in Medicare Part A and declined part B since work insurance is good and I expected to work another 7 years.

On Oct 28, the boss everyone hates, who is on his way out the door, decided to kick me to the curb on the way out the door. Formally I'm retiring - but everyone I have told that retirement is a cover for a termination is absolutely shocked & appalled. I will be without insurance on 1/1 (with two cancer diagnoses).

Apparently, hidden in the fine print all of those folks at the state SHIP office, SS, and Medicare are supposed to be able to help me understand is a RULE:

You cannot enroll in Medicare using an SEP (Special Enrollment Period) during your Initial Enrollment Period (IEP). Your IEP starts three months before the month you reach age 65 and ends three months after the month you turn 65.

The termination - creating a 7-month SEP - was within my IEP. It took me a couple of days to get my feet under me, by which time it was November. Had I applied immediately, the earliest effective date for Part B woud be 2/1, creating a 1-month gap in coverage.

The earliest I can apply under the special enrollment period is 1/1 (because of the RULE - my IEP does not end until 12/31).

Social Security is telling me that if I apply on 1/1, the plan can be effective 1/1. That seems to be supported by this:

If you sign up while you’re still in a group health plan, during the first full month when you’re no longer in the plan, or when the covered employee stops working (whichever happens first), your coverage will begin at either time below:
• On the first day of the month you enroll.
• On the first day of any of the following three months of your choice.

https://www.ssa.gov/pubs/EN-05-10012.pdf?fbclid=IwAR0k8VDq8WEOGkiKd76xyHjMcTIkygFqLvtdy2zlExSGSaymRhdAi3OLJ2s

My friend who is an insurance agent insists it cannot be effective until 2/1. I think I'm covered as to the basic Part B (my friend's assertions to the contrary). But I had also expected to enroll simultaneously in a medicare supplement plan which requires, as a prerequisite, Part B enrollment. I hope to apply yet this month, with a requested date of 1/1 (based on my request to start Part B on 1/1).

Anyone find themselves in this kind of a pickle?

Sucks to be not only terminated, but forced to go without medical coverage because the termination fell within the 3 months after my 65th birthday.

(On the good news side, I am happy to be retiring - I'm old enough that I was able to pre-empt the termination by retiring and the monthly income numbers were better than anticipated. Even though I had planned to work 7 more years, the retirement benefits would not catch up until I turn 94. Not worth the hassle. So I'm looking forward to being my own boss. I'm royally pissed about how it happened, but glad to be rid of the classism & politics around this place)

5 replies

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Sudden change of plans unexpectedly need Part B, while still in the initial enrollment period (Original Post) Ms. Toad Dec 2021 OP

You gotta call Stephanie Abt Sucha NastyWoman Dec 2021 #1

I was just hoping for someone who had also fallen into this hole - Ms. Toad Dec 2021 #4

I have found that talking to Social Security and Medicare by phone is a very good way enough Dec 2021 #2

Unfortunately, I've already spoken with them multple times. Ms. Toad Dec 2021 #3

Damn! So sorry to hear that. Hope you can resolve this some way. enough Dec 2021 #5

Sucha NastyWoman

(2,759 posts)

1. You gotta call Stephanie Abt

Reply to Ms. Toad (Original post)

Tue Dec 14, 2021, 07:20 PM

Dec 2021

you have a really technical question there, and you need someone who really knows her stuff

https://www.abtinsuranceagency.com/

She has a bunch of YouTube videos about different subjects for Medicare and keeps them up to dare

Ms. Toad

(34,130 posts)

4. I was just hoping for someone who had also fallen into this hole -

Reply to Sucha NastyWoman (Reply #1)

Tue Dec 14, 2021, 08:38 PM

Dec 2021

Or - at a minumum - had applied for Part B during an SEP and had it effective the 1st day of the month of application.

Thanks for the reference, but I'm largely allergic to insurance agents unless I know them well and have solid reasons to trust them with this 35+ year decision (given the longevity in my family).

FYI - Her site does have the correct rule about SEP v. IEP. But it has the same blanket statement made by my friend (the agent) about when coverage starts (the month after you apply). The Part B SEP application, another document from SS, and the woman I spoke with at SS last night suggest there is more flexibility than that. That added flexibility is critical for me, since I need it to start in the month in which I apply - since I am prohibited from applying until the month I need it to start.

enough

(13,270 posts)

2. I have found that talking to Social Security and Medicare by phone is a very good way

Reply to Ms. Toad (Original post)

Tue Dec 14, 2021, 07:32 PM

Dec 2021

to get specific detailed information on issues like this. Also, they really seem to want to help, not to to make things difficult. Make the call and you will probably get an appointment to talk to someone at a specific time. Be ready with all your details and they will probably be able to clarify for you and make it happen.

Good luck to you.

Ms. Toad

(34,130 posts)

3. Unfortunately, I've already spoken with them multple times.

Reply to enough (Reply #2)

Tue Dec 14, 2021, 08:19 PM

Dec 2021

As well as the state SHP person.

After approximately 3.5 hours total on hold over 5 phone calls),

I spoke with:

Two brainless script readers.

Two people who got half the rule right (and the remaining critical half wrong)

One person who finally recited the critical half of the rule (which I later confirmed to be correct). She was able to find my application (filed 3 weeks ago). It had been rejected (althogh no one had bothered to notify me). The muttering I heard while she reviewed the rejection matched what she had told me prior to finding my application.

Unfortuntately, I will have to wait until sometime in January or February to know if she is correct as to the rest. (I can't file the application until 1/1- and it takes up to 60 days to process it. Once it is processed I'll find out whether she is correct as to the rest of the information she gave me.)

The last person I spoke wth at SS was worth her weight in gold. The state SHIP person earlier pointed me in the right direction. Althogh she was wrong as to a critical detail - I won't hold it against her because the rest of what she said was spot on,

enough

(13,270 posts)

5. Damn! So sorry to hear that. Hope you can resolve this some way.

Reply to Ms. Toad (Reply #3)

Thu Dec 16, 2021, 07:43 PM

Dec 2021

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