Eligibility & Enrollment Pt 3

A person may sign up for Medicare under these new provisions, while they are still covered by an EGHP while choosing to start coverage this month or for one of the following 3 months.

Example:

Mary turned 65 in 2013, but continued to work and was looked after by an EGHP. In April 2015, she applied for monthly social security benefits and Medicare as she wanted to retire on 30 June 2015. She may choose to start Medicare either in April 2015 or in one of the following three months. She chooses to start reporting in July 2015, as she is currently working under her EGHP.

Mary could have opted to postpone her decision to apply for Medicare until July 2015, the 1st full month in which EGHP did not cover her. This would also result in Medicare coverage taking effect on 1 July 2015, the first day of the month when it was no longer covered by the EGHP. However, should Mary delay her decision to apply for Medicare till August 2015, its reporting would have only been effective in September 2015. This is because registration with Medicare occurs in the seven months following the first full month in which a person is no longer covered by health insurance, EGHP performs coverage from the first day of the month following the month of registration.

In order to avoid any gaps in coverage, it is advisable to register either in the 3 months before or in the month in which your employment ends. It is important to note that the amendments to the law have not changed the fact that the special registration deadline is only available to persons who are staffed by an EGHP by virtue of law or their own or one of their employees.

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It can have serious consequences for people who do not enroll for Medicare during their regular enrollment period. The Part B premium will be charged a supplement of 10% per annum for each year that an individual does not sign up.

More seriously, non-enrollment during the first or special enrollment period may result in the person being unable to enroll in Medicare Part B by the general enrollment period in the first three months of a year. The coverage of Part B would then start in July of this year. As a result, it may take several months for an individual who has no Part B Medicare insurance cover to be prone to expensive medical expenses out of pocket.

It is important to know that a person entitled to social benefits or a retirement pension can enroll in Part A at any time and receive up to six months retroactively without penalty. Only for part B the scope of the enrollment period and a markup applies. Exceptions are persons who are not entitled to Part A but who decide to pay the premium and voluntarily participate. They are subject to the registration restrictions and the mark-up.

Complaints:

The decision to deny Medicare permission or cover for any reason can be appealed to the Social Security Administration or the Railroad Retirement Board.