Friday, November 18, 2022

How Long Does It Take For Medicare To Become Effective

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Retiree Coverage From Your Employer


You possibly could have some type of decent retiree health coverage from your employer, but this type of coverage is becoming increasingly rare.

However, if you did retire as some type of government or union retiree, theres a chance you have a decent healthcare plan as their retiree. Check with your employers benefits department at the same time they fill out their part of the L564 form.

Keep in mind, even though you may have a decent health plan through your former employer, you do still need to get Part A & Part B, regardless.

If youre in the majority of folks that dont have retiree coverage, youll need to pick up some type of supplemental plan. Youre going to be best off working with an independent agent, like me, who can help you shop the dozens of plans in your area and find one that works best for you and your situation.

Your two options to get insurance not through your former employer are either a

You Are Also Eligible For Medicaid

There are Medicare plans specifically designed for people who are eligible for both Medicaid and Medicare. Dual Special Needs Plan are a special kind of Medicare Advantage Plan that combine Parts A, B and D Medicaid, and extra benefits such as dental and vision.

Your Medicare coverage choices need to fit your health needs, lifestyle and budget. You will have a chance to review your coverage, and make changes each year during the Medicare Annual Enrollment Period, Oct. 15 Dec. 7.

Sign Up for Your Medicare GuideYou’ll get timely emails with important information to help you navigate your Medicare Initial Enrollment Period as smoothly as possible.

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Thank you for signing up! You’ll receive an email with a link to your free Medicare information guide shortly.

When Does Medicare Advantage Coverage Start

The date your Medicare Advantage plan starts depends on the enrollment period and your eligibility. Those turning 65 and enrolling in Medicare, can select an advantage plan 3-month before the effective date.

When you pre-enroll in your plan, you save yourself from scrambling. Medicare is one thing you dont want to procrastinate on. Many people change plans during the Annual Enrollment Period if you make a change during this period, your policy will begin on January 1st of the following year.

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Medicare Enrollment: Special Enrollment Periods

In some cases, you might be able to enroll in Medicare, or get other Medicare coverage, outside of the regular enrollment periods. Please note that this table doesnt include every situation that might qualify you for a Special Enrollment Period.

Your situation with Original Medicare Medicare Enrollment Period
You want to enroll in Medicare Part A and/or Part B. Your employer- or union-based coverage is ending. Your Special Enrollment Period generally lasts 8 months. It starts at one of these times, whichever happens first.

The month after employment ends

The month after employment-based health insurance ends

Your SEP Period is usually 2 full months after the month of the triggering events.

When Does Medicare Coverage Start If You Sign Up For A Medicare Advantage Plan

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If you sign up during your Medicare Initial Enrollment Period, your Medicare Advantage coverage usually starts at the same time your Original Medicare coverage would start, as described above. For example, if you enroll in Medicare Advantage during the three-month period before you turn 65, your plan would start coverage the first day of your birthday month.

If you sign up for a Medicare Advantage plan during the Annual Election Period , your plan coverage usually starts January 1 of the next year. The same is true if you change plans.

If you switch from one Medicare Advantage plan to another during the Medicare Advantage Open Enrollment Period , generally your new coverage starts the first of the month after the plan gets your request.

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When Can You Sign Up Outside Of The Initial And General Enrollment Periods

You could qualify for a Special Enrollment Period and avoid the penalty for enrolling late. SEPs are typically granted if you or your spouse are still working when you turn 65 and you have group health insurance through an employer or union.

In that case, youre allowed to enroll in Part B at any time you have qualified group health coverage and youve turned 65. Once you no longer have coverage, you can enroll during the eight-month SEP period that starts the month after you lose the job or the coverage, whichever comes first.

Theres A Push For Change

If the rules governing the transition to Medicare sound complicated, rest assured that experts agree. Moving into Medicare from other kinds of health insurance can be so complicated that it should be a required chapter in Retirement 101, Mr. Moeller said.

The only government warning about the risks associated with late enrollment comes in the form of a very brief notice near the end of the annual Social Security Administration statement of benefits.

The Medicare Rights Center and other advocacy groups have proposed legislation that would require the federal government to notify people approaching eligibility about enrollment rules, and how Medicare works with other types of insurance. The legislation the Beneficiary Enrollment Notification and Eligibility Simplification Act, also would eliminate coverage gaps now experienced by enrollees during the Initial Enrollment Period and General Enrollment Period. The legislation was introduced in Congress last year, and will be reintroduced this year.

In the meantime, Mr. Baker proposes a simple rule of thumb to help people approaching Medicare eligibility to avoid costly errors.

If you are eligible for Medicare, you should really consider it to be your default, primary coverage. If you are going to decline Medicare, think very carefully and take the time to really understand all the rules.

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Check Status Of Medicare Application

There are various ways to receive Medicare coverage.

If you already collect Social Security benefits before age 65, youll be automatically enrolled in Medicare Part A hospital insurance and Medicare Part B medical insurance when you turn 65.

Otherwise, you need to sign up for this coverage on your own.

Once your application is submitted, you can check on its status by:

To check the status of your Medicare application on the Social Security website, you will need to enter your Social Security number and the confirmation number you received when you filed your application.

Your application status will show:

  • The date your application was received
  • Any requests for additional documents
  • The address of the Social Security office processing your application
  • Whether a decision has been made about your application

Once your application is processed, you will receive a notification letter in the mail to inform you of whether your application was approved.

If you need help, or are unable to check your application status online, call the Social Security Administration at 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday.

Is There A Special Enrollment Period For Extra Help

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When you qualify for Extra Help, you also qualify for a continuous SEP. You can drop, join or switch plans one time during each period January through March, April through June, and July through September.

You cant make changes from October through December with this Special Enrollment Period. When making a change, the new policy will go into effect on the first day of the next month.

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How Long Do I Have To Enroll After A Qualifying Event

  • For most Qualifying Events, the law says you have 60 days to submit an application, beginning with the date you lost qualifying health coverage, but
  • In reality, you have less than 60 days if you want to avoid a gap in coverage.
  • O.K., but How long? I would suggest you have only two weeks to submit your application during a Special Enrollment Period or SEP. Confused? Let me explain below.

    When Does Medicare Coverage Start If You Sign Up For A Medicare Supplement Insurance Plan

    Details of your coverage start date might vary. Call your Medicare Supplement insurance plan for information.

    If you would like to learn more about your Medicare coverage options in your area, youre welcome to use the plan finder tool on this page. Just enter your zip code and click the button.

    New To Medicare?

    Becoming eligible for Medicare can be daunting. But dont worry, were here to help you understand Medicare in 15 minutes or less.

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    Delaying Medicare Due To Work: Special Enrollment Period

    If you didn’t enroll in Medicare because you were still working, and you were covered under a group health plan based on employment, you have a Special Enrollment Period during which you can sign up for Part A and/or Part B. While you or your spouse are still working and you’re still covered under a group health plan, you can sign up anytime.

    After your or your spouse’s employment ends, your Special Enrollment Period lasts eight months, starting the month after the employment or group health plan ends . However, you have only two months after the employment or group health plan ends to sign up for a Medicare Advantage plan or Part D prescription drug plan . You can enroll in a Medicare Advantage plan starting three months before your Medicare Part B enrollment is due to take effect up to the day before your Part B coverage startsbut again, enrollment must take place within two months of your employment or group health plan ending.


    Judy’s last day of work is July 1 and her group health plan ends July 31. She has eight months, until April 30, to sign up for Part B without a penalty. But if she wants to join a Medicare Advantage plan, she needs to do so by September 30 . Instead, on June 15, Judy signs up for Part B coverage to begin on August 1, so that she won’t have a gap in coverage. She has only until July 31 to add a Medicare Advantage plan . Her Medicare Advantage plan will start August 1.

    When Medicare Coverage Ends

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    1. If the beneficiary has Medicare only because of ESRD, Medicare coverage will end when one of the following conditions is met:

    • 12 months after the month the beneficiary stops dialysis treatments, or
    • 36 months after the month the beneficiary had a kidney transplant.

    There is a separate 30-month coordination period each time the beneficiary enrolls in Medicare based on kidney failure. For example, if the beneficiary gets a kidney transplant that continues to work for 36 months, Medicare coverage will end. If after 36 months the beneficiary enrolls in Medicare again because they start dialysis or get another transplant, the Medicare coverage will start right away. There will be no 3-month waiting period before Medicare begins to pay.

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    Dont Register For Medicare Alone

    If youre uncomfortable with applying for Medicare alone, we can help! Our services are completely free for you. If you would like an agent by your side when applying, contact us. We can walk you through setting up all your coverage, including Medicare, Medigap, Part D, and more.

    Plus, when you use us to apply, you get unlimited support from our Client Service Team. That means if you have any issues with claims or appeals, we can help at no additional cost. You can compare rates online or give us a call today at the number above.

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    When Your Coverage Starts

    The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always starts on the first of the month.

    If you qualify for Premium-free Part A: Your Part A coverage starts the month you turn 65.

    Part B : Coverage starts based on the month you sign up:

    If you sign up:

    1 month after you turn 65

    2 months after you sign up

    2 or 3 months after you turn 65

    3 months after you sign up

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    The Basics On Signing Up

    Medicare enrollment in Part A and Part B is automatic if you have claimed Social Security benefits before your 65th birthday your Medicare card will arrive in the mail and coverage begins the first day of the month in which you turn 65. There is no premium charged for Part A in most cases, and you may be able to turn down Part B at that point without incurring late-enrollment penalties if you are still working and receive your primary insurance through work.

    If you have not yet applied for Social Security, signing up for Medicare requires proactive steps to avoid problems.

    Medicare offers an Initial Enrollment Period around your 65th birthday. If you miss that window, you will be subject to a late enrollment surcharge equal to 10 percent of the standard Part B premium for each 12 months of delay a penalty that continues forever. That can really add up. In 2017, 1.3 percent of Part B enrollees paid penalties , according to the Congressional Research Service. On average, their total premiums were 31 percent higher than what they would have been.

    Medicares prescription drug program comes with a much less onerous late enrollment penalty, equal to 1 percent of the national base beneficiary premium for each month of delay. In 2019, the base monthly premium is $33.19, so a seven-month delay would tack $2.32 onto your plans premium.

    Late enrollment also exposes you to significant gaps while waiting for Medicare coverage.

    When Does Medicare Start For Me

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    For Original Medicare, Part A and Part B, a simple way to determine your exact Medicare effective date is to refer to the lower right corner of your Medicare card or to refer to your letter from either the Social Security Administration or the Railroad Retirement Board.

    If you have any questions about when your Medicare coverage starts, you can contact Social Security at 1-800-772-1213, Monday through Friday, from 7AM to 7PM. For TTY services, call 1-800-325-0778.

    If you worked for a railroad, you can call the Railroad Retirement Board at 1-877-772-5772, Monday through Friday, from 9AM to 3:30PM. For TTY services, call 751-4701.

    If you enroll into a Medicare Advantage or Medicare Prescription Drug Plan, the date your coverage starts can vary, depending on when you enroll and which election period you qualify for. For questions about your effective date on these types of Medicare plan options, you can contact the Medicare health or prescription drug plan directly or refer to mail you may have received from them.


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    During A Special Enrollment Period

    This SEP is available only if you have health insurance from an employer for which you or your spouse actively works. It allows you to delay enrolling in Part B until the employment or the coverage ends whichever occurs first.

    The SEP actually lasts throughout the time you have coverage from current employment and for up to eight months after it ends. If you enroll at any point during this time frame, your Medicare coverage will begin on the first day of the following month, and you will not be liable for late penalties regardless of how old you are when you finally sign up.

    Be aware that an IEP always trumps an SEP if the two should happen to overlap. For example, if your IEP ends on Aug. 31, and you retire on the same date, you will not be entitled to an SEP. Therefore, if you delayed enrollment until after Aug. 31, you would not be able to sign up until the following general enrollment period and your coverage would not begin until July 1 so you would be left for almost a year without coverage. Even if you signed up during the final months of your IEP, your coverage would still be delayed by two or three months. But, to continue this example, if you retired on Sept. 1, under the rules of the SEP, you could enroll in August and receive Medicare starting Sept. 1 with no loss of coverage.

    Two other Medicare enrollment scenarios have different rules.

    Two States With Different Special Enrollment Period Effective Dates

    There are two states Massachusetts and Rhode Island where the exchanges allow people to enroll as late as the 23rd of the month and still have a first-of-the-following month effective date. So May 17 enrollment in one of those states would result in a June 1 effective date .

    Washington used to have a 23rd-of-the-month deadline as well, but they changed that in 2017, and now use the same 15th of the month enrollment deadline thats used in most other states.

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    Is There A Special Enrollment Period When Dual Eligible For Medicare And Medicaid

    When eligible for Medicare and Medicaid, you can choose to change plans, whether it be switching, joining, or dropping plans. Changing plans is an option because dual-eligibility and low-income subsidy qualify you for a Special Enrollment Period.

    You can do this once throughout the following dates:

    Those getting extra help can make changes once during the above time frames.

    Enrolled in an SPAP Program

    You can choose to join a Medicare plan once during the calendar year.

    Enrolled in an SPAP Program and you lose eligibility

    You can choose to join a new Medicare plan. You can do this either the month that you lose your eligibility or when you get the notification.

    Suffer from a severe condition

    If theres a Special Needs Plan and you have a severely disabling condition, you can join into a Medicare Chronic Care SNP at any time.

    Errors by a Federal Employee

    If you join a plan or decide to not participate because of a mistake by a federal employee, you have a few options.

    You can choose to:

    • enter a new Medicare plan
    • switch from your current policy to a new one
    • drop your Advantage plan and return to Medicare
    • or drop your drug coverage.

    These changes can take a full two months after the month you get notification of the error.

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