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Additional Counties in CA Added to the Special Election Period for Medicare!

Additional counties in California will have a Special Election Period (SEP) available for Medicare beneficiaries affected by the California wildfires.  *FEMA declared an emergency or major disaster for the following counties:

New counties added as of Dec. 8, 2017*:

-Los Angeles
-Riverside
-San Diego
-Santa Barbara
-Ventura

Counties previously issued with an SEP:

-Butte
-Lake
-Mendocino
-Napa
-Nevada
-Orange
-Solano
-Sonoma
-Yuba

Special Election Period Overview

The wildfires in California have caused and continue to cause disruption. The Centers for Medicare & Medicaid Services (CMS) has extended a SEP to Medicare beneficiaries affected by the fires. The SEP runs from the start of the incident through Dec. 31, 2017.

Who is eligible?

Any beneficiary who resides in, or resided in, an area for which the Federal Emergency Management Agency (FEMA) declared an emergency or major disaster (see www.fema.gov/disasters) is eligible for the SEP, if the beneficiary was unable to enroll in a plan during another qualifying election period. In addition, beneficiaries who do not live in the impacted areas but receive assistance from someone living in one of the affected areas also qualify for this SEP.

What does this mean for Medicare beneficiaries?

Eligible beneficiaries who were unable to make a plan selection during the Annual Enrollment Period (AEP) have until Dec. 31, 2017, to enroll in a 2018 plan. Eligible beneficiaries who wish to change their health and/or prescription drug plan, but were unable to do so during the Annual Enrollment Period (Oct. 15, 2017-Dec. 7, 2017), will now have until Dec. 31, 2017, to enroll in a 2018 plan. Enrollments taken between Dec. 8 and Dec. 31, 2017, are effective Jan. 1, 2018.
Eligible beneficiaries who were eligible for a different SEP, or aged into Medicare, but were unable to enroll during the allotted time period, will have their election period extended. Eligible beneficiaries who had/have a qualifying election period (e.g., aged into Medicare, are aging into Medicare or are qualified for a different SEP) but were unable to enroll in a plan during the allotted time, have until Dec. 31, 2017, to enroll. Enrollments received are effective the first day of the following month. For example, if a beneficiary aged into Medicare and had until Aug. 31, 2017, to enroll but was unable to complete the enrollment process, the beneficiary can enroll now. If the beneficiary enrolls Oct. 28, 2017, the beneficiary’s plan will be effective Nov. 1, 2017.

What is needed as proof the beneficiary was affected by an affected area?

If the beneficiary is unable to provide proof that they reside in an affected area, the beneficiary just needs to verbally attest that they lived/live in an area impacted by the wildfires.

MEDICARE ISSUES A SPECIAL ELECTION PERIOD FOR THOSE AFFECTED BY CA WILDFIRES

The Centers for Medicare & Medicaid Services (CMS) has extended a Special Election Period (SEP) to Medicare beneficiaries affected by the wildfires in CA. The SEP runs till Dec. 31, 2017.

Who is eligible?

Any beneficiary who resides in, or resided in, an area for which the Federal Emergency Management Agency (FEMA) has declared an emergency or major disaster (see www.fema.gov/disasters or the list below*) is eligible for the SEP, if the beneficiary was unable to enroll in a plan during another qualifying election period. In addition, beneficiaries who do not live in the impacted areas but receive assistance from someone living in one of the affected areas also qualify for this SEP.

*FEMA declared an emergency or major disaster for the following counties:

  • Butte
  • Lake
  • Mendocino
  • Napa
  • Nevada
  • Orange
  • Solano
  • Sonoma
  • Yuba

What does this mean for beneficiaries?

Normally, Medicare beneficiaries only have till December 7th to make changes to their Part C (Medicare Advantage) or Part D (Drug) plans.  Eligible beneficiaries who are unable to make a plan selection during the Annual Enrollment Period (AEP) have until Dec. 31, 2017, to enroll in a 2018 Plan.  Enrollments taken between Dec. 8th and Dec. 31st 2017, will be effective Jan. 1st 2018.

Verifications

  • Individuals must show proof that the beneficiary resided in an affected area (e.g., driver’s license or utility bill reflecting the beneficiary’s address).
  • If the beneficiary is unable to provide proof, ask the beneficiary if they attest that they lived/live in an area impacted by the wildfires.
  • Once eligibility is verified, the application can proceed.
  • Only paper applications can be used. Use the SEP election type code on the application, and write in ‘Weather Related Emergency’ or ‘Fire’.

If you are not sure if you fall under these guidelines, give us a call and we can check for you – 323.455.4961.

medicare

Avoiding Medicare Part B Penalty, Part 1 – Medicare Eligible and Covered Under an Employer Group Plan

Welcome and thank you for reading my very first blog!  I’m extremely honored and grateful you chose to spend a few minutes of your time with me.   My goal is to bring something valuable to your life that will put you in a better health and wealth position AND make confusing subjects, easier to understand.  One of the most disheartening parts of our job as an independent insurance agent is to give bad news to a client and not being able to do anything about it.  From our vast experience, I’d like to use this blog to help you avoid some of the ‘gotchas’, pitfalls and crazy rules that could get you in a pickle later.    

If you hadn’t noticed, Medicare can be very confusing.  There are some really quirky rules in Medicare and this is one of the craziest.  It’s relatively easy to enroll into Medicare when you turn 65 and your situation is pretty straight forward.  However, if you have something out of the ordinary, you need to know the rules so you won’t get penalized in the future.  This has popped up a few times in my career so it’s good to realize it’s a problem in case you know of anyone that fits the situation. You don’t have to know ALL the rules, you just have to be aware it could be a problem and know where to seek guidance.  Unfortunately, many of Social Security’s own staff do not understand this rule.  It has to do when do you apply for Part B if you are covered under an employer group plan.  The rule (from Medicare.gov) is you can delay Part B (and avoid the penalty) if:

  • You have insurance through an employer or union.
  • You or your spouse (or family member if you’re disabled) are still working.

Notice the 2nd part of the rule…’still working‘.  That’s the part most people miss.  But wait…there’s more!  In addition to being penalized, you cannot apply for Part B at just anytime of the year unless you have a ‘special circumstance’.  This situation does NOT fall under one of their ‘special circumstances’ and therefore you can ONLY apply during the Part B Open Enrollment which is from January 1 – March 31st.  But wait…there’s even more!!  Your Part B won’t become effective until July 1st!

Here are a couple of stories that illustrate the problem:

  1.  Betty retires at age 60, her spouse, Bob, is 65.  Part of her School District’s contract with the union covers her for insurance till she turns 65.  That’s normally a great benefit, UNLESS your spouse is eligible for Medicare!  In this case, Bob delays Part B because he is still covered under the group plan.  When she turns 65, they both go into their local Social Security to apply for Part B where they are informed Bob will have to pay a penalty because he did NOT obtain Part B when she ‘stopped working’. The Part B penalty is 10% for each year he didn’t have the Part B = 50% of the current Part B premium!  For 2017, the Part B premium is $134, therefore, he pays an additional $67/month…FOREVER!  AND it will increase as the Part B premiums increase.

AVOIDING THE PENALTY:  When Betty retired at age 60, Bob should have applied for his Part B at that time. 

  1. Susan, age 64, has an accident at work and goes onto worker’s compensation.  When she turns 65 (even though she isn’t technically working), her company continues to keep her on the employer group plan.  At that time, she goes to her local Social Security office where she meets with an agent and is upfront, informing the agent that she is out on disability but still covered under her group plan.  The Social Security agent tells her that she can delay her Part B.  After 2 years of being on disability, the employer group plan stops.  She goes back to the Social Security office and they inform her that she will be penalized 20% for 2 years of not having Part B when she was eligible.  The good news is she kept VERY good notes, recorded the date/time and name of the agent.  This is IMPORTANT because everything is video recorded at the SS office and they can look back at the recordings to verify her story.  Because it was a Social Security agent that misinformed her, she is currently appealing through Medicare (we’ll discuss appeals in another blog).  My thought is she will have the penalty reversed because she kept good notes and SS misinformed her.

AVOIDING THE PENALTY:  When Betty turned age 65, she should have applied for his Part B at that time. 

So think about it, if Bob or Susan tried to apply for their Part B on April 1st, they have to wait till January 1st of the NEXT year AND they won’t have coverage till July 1st of the NEXT year.  Yikes!  That means they will have to go without doctor/out patient medical coverage for 1 year and 3 months or have to purchase an individual plan at exorbitant rates because they are over age 65 (ESPECIALLY during ObamaCare).   In my opinion, this is insane and should be changed!

In summary, keep excellent notes when you speak with Social Security or Medicare.  Record the date, time and everyone’s name you speak with!   I also suggest asking different agents the same question to see if their answers coincide.  If possible, obtain something in writing.  AND hold onto to that info FOREVER!

https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-3156

 

Debbie Hoffman is an independent insurance broker specializing in Medicare and individual/family health plans, contracted with over 40 companies and Medicare certified with 13 carriers.  Located in the Los Angeles area, she is contracted in many states throughout the country.  She prides herself on educating her clients, being their advocate and exceeding their expectations.  She accepts only the insurance company commissions so there are no extra charges for her assistance and guidance.  From ObamaCare through MediCare…Debbie cares.

debbie@debbiehoffman.com    323.455.4961