Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for Medicare Part A and did not enroll for Part B when first eligible because she has insurance through her employer - Coffee Brew, Inc. She also did not enroll in Part D because she had creditable coverage. She would like to retire in June and enroll in a Medicare Advantage plan. She has been informed that her group coverage will end on her retirement effective date. How would you advise Ms. Thomas

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28-06-2022
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Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for Medicare Part A and did not enroll for Part B when first eligible because she has insurance through her employer - Coffee Brew, Inc. She also did not enroll in Part D because she had creditable coverage. She would like to retire in June and enroll in a Medicare Advantage plan. She has been informed that her group coverage will end on her retirement effective date. How would you advise Ms. Thomas

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Martebi Martebi · Answer 1 · 2022-07-04T20:22:03+02:00

In the case above, Ms. Thomas should enroll in Part B which would enable her to use the SEP for individuals changing from employer group coverage to enroll in a MA plan or MA-PD. The SEP will last until 3 months after the month her employer coverage ends.

What is the enrollment about?

If a person has missed their initial enrollment period when they were said to be first eligible for Medicare, that person can only sign up for Part A and/or Part B in course of the General Enrollment Period, and it is one that runs from January 1 to March 31 every year.

Note that if a person missed their Part B enrollment window, they will then face a late enrollment penalty if they have to enroll.

Therefore,In the case above, Ms. Thomas should enroll in Part B which would enable her to use the SEP for individuals changing from employer group coverage to enroll in a MA plan or MA-PD. The SEP will last until 3 months after the month her employer coverage ends.

See options below

a. Ms. Thomas should request continued COBRA coverage under her employer group plan. This coverage will last 18 months and provide her with time to select either a MA plan or MA-PD plan when her COBRA coverage ends. The SEP will last 6 months after the month the COBRA coverage ends.

b. Ms. Thomas should enroll in Part D to obtain prescription drug coverage under a PDP. It will not be necessary for Ms. Thomas to enroll in Part B since it offers drug coverage that duplicates most PDP plans.

c. Ms. Thomas can enroll in Part B without a late penalty at any time she is still covered by her employer group and 8 months after her last month of employer group coverage without a penalty. However, because she wants to enroll in a MA plan after retirement, she should make sure her Part B coverage is effective in time to use the Medicare Advantage/Part D special election period for individuals changing from employer group coverage to enroll in a MA plan or MA-PD. The SEP begins while she has employer group coverage and will last until 2 months after the month after the month her employer coverage ends. If she wants Part D coverage she should enroll in an MA-PD or a PDP (depending on how she decides to receive her Part A and B benefits) during this time.

d. Ms. Thomas should enroll in Part B which would enable her to use the SEP for individuals changing from employer group coverage to enroll in a MA plan or MA-PD. The SEP will last until 3 months after the month her employer coverage ends.

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