I've been doing Social Security work since 1978 so it's not often I get a question that I haven't heard before but here's a new one on me. Let me explain some background first. There's a 24 month waiting period for Medicare after Social Security Disability Insurance Benefits begin and that waiting period only begins after the five month waiting period for cash benefits to start. Yes, it's brutal. As long as the waiting periods are, many cases are delayed long enough that the claimant is entitled to back Medicare benefits. To get Medicare Part B, the part that pays for outpatient medical treatment, you have to pay monthly premiums. What happens in cases with retroactive Medicare entitlement is that the Medicare Part B doesn't go back unless you pay the back premiums. The question is can you take the retroactive Part B for only part of the time period for which you're eligible for it? This claimant's case had gone on for a very long time. The period of retroactive Medicare entitlement is about 30 months. The claimant had health care insurance until about nine months ago. She feels she won't get much value out of retroactive Medicare Part B until her health care insurance ended so she only wants the retroactive Medicare Part B for the last nine months instead of the entire 30 month time period. The difference in retroactive Part B premiums is over $2,000 so this isn't an academic question. Does anyone have experience with this question?
For someone under age 65 who becomes entitled to Medicare based on disability, entitlement begins with the 25th month of disability benefit entitlement. For these individuals, the IEP begins 3 months before the 25th month of disability benefit entitlement, includes the 25th month, and ends three months after.
ReplyDeleteSeems to me if someone does not take Part B during the IEP, then that person would need to enroll in a subsequent general enrollment period (Jan - March of each year) to get Part B. That might incur penalties.
They (pc) basically auto-grant Equitable relief. They send a letter from the PC; most cases are ALJ reversals and Payment center has control anyways. They grant HI with the IEP and then allow the claimant to choose retro SMI to that point or if they want it today. So be on the look out for that letter.
ReplyDeleteNo. An intermediate date is not allowed.
ReplyDeletehttps://secure.ssa.gov/poms.nsf/lnx/0600805195
But see: https://secure.ssa.gov/poms.nsf/lnx/0600805275
ReplyDeleteHI 00805.275 Special Enrollment Period (SEP) Enrollments
A. Policy for when enrollment can occur
Beginning 03/95, individuals who are age 65 or over, or disabled, can enroll (or re-enroll) in (SMI) and Premium HI:
during any month (including a partial month) in which they are enrolled in a group health plan (GHP) or a large group health plan (LGHP) based on current employment status; (For the definition of LGHP see HI 00805.266A); or
in any of the 8 consecutive months following the last month, during any part of which, the individual was enrolled in the GHP based on current employment status.
My experience is that they will only charge six months premiums because that is cost effective. I would call local office handling claims.
ReplyDeleteThere are many election periods.
Initial Enrollment Period (IEP).
Annual Coordinated Election Period (AEP) each year from November 15 through December 31 each year.
General Enrollment Period (GEP) for Medicare beneficiaries not on Part B who did not sign up when they first became eligible .January 1 through March 31 each year. Effective on July 1 of the same year. May have late penalty.
The Open Enrollment Period (OEP) for people on Medicare to disenroll from existing plans.
Special Enrollment Period (SEP) Special Enrollment Periods for people who move, who delay enrolling in Part B, or have other insurance. They have an SEP that runs for eight months from the time they (or their spouse) retire or they lose their health insurance. Part B coverage starts the month after the election is made, and no late premium penalty is assessed. http://www.cms.gov/HealthPlansGenInfo/Downloads/mc86c02.pdf.
You get equitable relief that allows you to choose either the first month of eligibility to Medicare (25th month of entitlement) or month the award is processed without any penalty for late enrollment. You cannot pick an intermediate month.
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