Already posted on r/Medicare but posting her as well because there is a lot more activity on this sub. And I have asked co-workers about this, every one of them has told me that this isn’t a valid enrollment period, but I’ve found Medicare publications stating that it is an enrollment period.
Applicant is under 65 and already enrolled with Medicare due to disability. The 65th birthday is coming up. I’ve been told that this should entitle the applicant to a second open enrollment period 3 months before, the month of and 3 months after the 65th birthday. I have found publications from Medicare referencing this.
https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf
The chart on page 3 states:
You’re already eligible for Medicare because of a disability, and you turn 65.
■ Sign up for a Medicare Advantage Plan (with or without drug coverage) or a Medicare drug plan.■ Switch from your current Medicare Advantage or Medicare drug plan to another plan.
■ Drop a Medicare Advantage or Medicare drug plan completely.
During the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
Also this publication from CMS is an older document, but still section C clearly states that they should be entitled to an open enrollment upon aging in. And since this document is specifically for Medigap plans, it makes it seem like not only do they get an enrollment period, but it seems to be with Guaranteed Issue.
https://www.cms.gov/Medicare/Health-Plans/Medigap/Downloads/mdgp0203.pdf
However, every time I see an application come in fitting this circumstance, it gets denied. The reasoning is that member isn’t “New to Medicare” as they are already on Medicare, so they need a valid SEP. And this enrollment scenario isn’t a valid SEP.
So it’s really bothering me to figure this out. Does anyone here know if this is a valid enrollment period or not?
submitted by /u/fartmitten
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Already posted on r/Medicare but posting her as well because there is a lot more activity on this sub. And I have asked co-workers about this, every one of them has told me that this isn’t a valid enrollment period, but I’ve found Medicare publications stating that it is an enrollment period. Applicant is under 65 and already enrolled with Medicare due to disability. The 65th birthday is coming up. I’ve been told that this should entitle the applicant to a second open enrollment period 3 months before, the month of and 3 months after the 65th birthday. I have found publications from Medicare referencing this. https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf The chart on page 3 states: You’re already eligible for Medicare because of a disability, and you turn 65. ■ Sign up for a Medicare Advantage Plan (with or without drug coverage) or a Medicare drug plan. ■ Switch from your current Medicare Advantage or Medicare drug plan to another plan. ■ Drop a Medicare Advantage or Medicare drug plan completely. During the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. Also this publication from CMS is an older document, but still section C clearly states that they should be entitled to an open enrollment upon aging in. And since this document is specifically for Medigap plans, it makes it seem like not only do they get an enrollment period, but it seems to be with Guaranteed Issue. https://www.cms.gov/Medicare/Health-Plans/Medigap/Downloads/mdgp0203.pdf However, every time I see an application come in fitting this circumstance, it gets denied. The reasoning is that member isn’t “New to Medicare” as they are already on Medicare, so they need a valid SEP. And this enrollment scenario isn’t a valid SEP. So it’s really bothering me to figure this out. Does anyone here know if this is a valid enrollment period or not?
submitted by /u/fartmitten [link] [comments]Read Morer/HealthInsurance