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Social Security & Medicare

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Ms. Toad

(35,731 posts)
Tue Dec 14, 2021, 05:44 PM Dec 2021

Sudden change of plans unexpectedly need Part B, while still in the initial enrollment period [View all]

I've got a complex situation here - wondering if anyone else has any experience.

I turned 65 in September and enrolled in Medicare Part A and declined part B since work insurance is good and I expected to work another 7 years.

On Oct 28, the boss everyone hates, who is on his way out the door, decided to kick me to the curb on the way out the door. Formally I'm retiring - but everyone I have told that retirement is a cover for a termination is absolutely shocked & appalled. I will be without insurance on 1/1 (with two cancer diagnoses).

Apparently, hidden in the fine print all of those folks at the state SHIP office, SS, and Medicare are supposed to be able to help me understand is a RULE:

You cannot enroll in Medicare using an SEP (Special Enrollment Period) during your Initial Enrollment Period (IEP). Your IEP starts three months before the month you reach age 65 and ends three months after the month you turn 65.


The termination - creating a 7-month SEP - was within my IEP. It took me a couple of days to get my feet under me, by which time it was November. Had I applied immediately, the earliest effective date for Part B woud be 2/1, creating a 1-month gap in coverage.

The earliest I can apply under the special enrollment period is 1/1 (because of the RULE - my IEP does not end until 12/31).

Social Security is telling me that if I apply on 1/1, the plan can be effective 1/1. That seems to be supported by this:

If you sign up while you’re still in a group health plan, during the first full month when you’re no longer in the plan, or when the covered employee stops working (whichever happens first), your coverage will begin at either time below:
On the first day of the month you enroll.
• On the first day of any of the following three months of your choice.


https://www.ssa.gov/pubs/EN-05-10012.pdf?fbclid=IwAR0k8VDq8WEOGkiKd76xyHjMcTIkygFqLvtdy2zlExSGSaymRhdAi3OLJ2s

My friend who is an insurance agent insists it cannot be effective until 2/1. I think I'm covered as to the basic Part B (my friend's assertions to the contrary). But I had also expected to enroll simultaneously in a medicare supplement plan which requires, as a prerequisite, Part B enrollment. I hope to apply yet this month, with a requested date of 1/1 (based on my request to start Part B on 1/1).

Anyone find themselves in this kind of a pickle?

Sucks to be not only terminated, but forced to go without medical coverage because the termination fell within the 3 months after my 65th birthday.

(On the good news side, I am happy to be retiring - I'm old enough that I was able to pre-empt the termination by retiring and the monthly income numbers were better than anticipated. Even though I had planned to work 7 more years, the retirement benefits would not catch up until I turn 94. Not worth the hassle. So I'm looking forward to being my own boss. I'm royally pissed about how it happened, but glad to be rid of the classism & politics around this place)
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