LETTER TO
THE EDITOR
HIU
Volume 56, No. 9
Dear Martin,
I read, with great interest, the excellent article “Medicare’s Alphabet Soup,” that
appeared in the August HIU on page 81. There are a few items mentioned in the article that I think would benefit from some additional information or clarification.
The article correctly points out that age 65 is the magic number for eligibility
for Medicare. It should also be mentioned that it is a program for U.S. citizens
and permanent legal residents who have been here five years or more.
In addition to eligibility due to reaching age 65, one can also get Medicare if
they have been deemed by the Social Security Administration to be disabled for 24
months or if the person has ALS (Lou Gehrig’s disease), no matter what their age.
Enrollment is automatic at age 65 only if the person is receiving retirement
benefits from Social Security or Railroad Retirement Board. It is also automatic
the first month of receiving benefits for ALS or the 25th month of being disabled
per Social Security. Otherwise the person must apply. It’s fairly easy, and can even
be started by a phone call. The effective date will depend on when you apply. The
initial enrollment period is a seven-month window starting three months prior to
your birth month. If someone enrolls any time during the three months leading
up to their birth month, the effective date will be the first of the birth month.
Enrolling after that (but still within the seven-month window) will result in an
effective date from one to three months after the enrollment.
Some people will wait to enroll in Part B (perhaps because there is a cost involved) while they are on a group health plan, and that’s okay. The late enrollment penalty for Part B will be waived if the enrollee was in a group health
plan of any size (not just 20 or more employees) and enrolls within eight
months of the termination of their coverage or employment (whichever is
first). The real problem comes if the person misses this chance. They will have
to wait for the next general enrollment period (January 1 through March 31)
for a July 1 effective date.
The “one-percent” late enrollment penalty for Part D is one percent of the national average cost of Part D plans (which, for 2008, is $27) thus the penalty will
be a whopping 27 cents for each month the person is late. What is also important
here is that enrollment can’t be done at any time. If you miss the initial enrollment period (that same seven-month window for A and B) or the special enrollment period (within two months of the end of creditable group coverage), the
person will have to wait until the next annual enrollment (November 15 through
December 31) for a January 1 effective date.
One more thing: The OEP is an opportunity to make a “like kind” plan
change. It is not a time when someone can enroll in a Part D plan for the first
time. That should be done during the AEP.
There is obviously a lot of stuff about this thing called Medicare that can lead
to severe headaches if you are trying to wrap your arms around it for the first
time. I totally agree with the conclusion of the article that it requires specialized
knowledge to keep your equilibrium and avoid the landmines.
Executive Editor................ Jim Hostetler
editor@nahu.org
Managing Editor .................. Martin Carr
(703) 276-3816
mcarr@nahu.org
Associate Editor ....................Min Shepherd
(703) 276-3815
mshepherd@nahu.org
Publisher ...................... Janet Trautwein
(703) 276-3806
jtrautwein@nahu.org
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