Health Insurance Enrollment Timelines FOR INDIVIDUALS Many people are not aware or are confused by the various time periods imposed for signing up for or changing health insurance plans. Like most issues dealing with health insurance, this can be complex. Keep in mind that Medicare is a government run healthcare program, and as such there is very little that is easy to understand or to implement. People Not Eligible For Medicare If you are not a participant in a group plan sponsored by your employer and if you qualify, you can enroll in an individual insurance plan at any time. For most plans, enrollment forms must be mailed by the 20th of the month prior to the requested effective date. These plans require applicants to answer the Standard Health Questionnaire for Washington State. If you fail the questionnaire and are denied insurance, the Washington Health Insurance Pool (WSHIP) may be an option. Though premiums for coverage with these plans are generally higher, WSHIP provides health insurance for people who are unable to obtain individual coverage. These plans provide comprehensive coverage, including a prescription drug benefit. People Eligible For Medicare (Part A – Hospital and Part B - Medical) Medicare-eligible clients face more restrictive deadlines and enrollment periods (it is a government run program after all). There is a seven month window that you can sign up for Medicare. Three months before your birth month (coverage begins on the first day of your birth month) your birth month, (coverage begins on the first of the month following, and three months after your birth month (coverage begins the first of the month following)
However, if you are 65, retired and receiving Social Security, enrollment is automatic. Coverage begins on the first day of month you turn 65. If you do not enroll at that time, you may enroll between January 1 and March 31 of any year. Your benefits will not begin until July 1 and, depending on your situation, you may have to pay a penalty (higher premium). These enrollment periods apply in most cases. You may choose to not sign up for Part B, but you must contact Social Security. As with anything, there are exceptions. Medicare Charges for Part B (Medical) Coverage. For 2009 the charge is $96.40 per month and is deducted from your Social Security check. There is no charge for Part A (Hospital) as long as you have worked 40 quarters. (If you are 65 and not collecting Social Security, you should call or visit a Social Security Office to apply). For Medicare Supplement Plans (also known as Medigap) Medigap Plans A thru L) you may apply in any month as long as you have Medicare Parts A and B. Generally, if you are a new Medicare client, you have guaranteed enrollment if you enroll during the first six months after your Medicare starts. These plans do not have any coverage for prescription drugs and the benefits are coordinated with Medicare, meaning claims are first submitted to Medicare for settlement and then to the Medigap Plan administrator for coordination of benefits. Medicare Advantage Plans (Medicare Part C) offer several enrollment periods and types of plans. With these plans you get Parts A and B through a private insurance company. Medicare Advantage plans actually transfer the administration of your Medicare benefits to the Medicare Advantage plan which eliminates much of the claims processing work for you. The plans also may include additional benefits. There are four common types of Medicare Advantage plans: Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Private-Fee-For-Service (PFFS) Medical Savings Accounts (MSA)
Medicare Advantage plan availability varies by county. You can enroll in these plans at the time you become eligible for Medicare Parts A and B. Also, each year from November 15 to December 31 is the Annual Election Period (AEP), when you may apply for or leave a Medicare Advantage Plan with or without prescription coverage. Coverage takes effect January 1 of the following year. Another period, the Open Enrollment Period (OEP), occurs from January 1 to March 31, but you cannot add or remove prescription drug coverage. You can cancel or change your Medicare Advantage Plan during the November 15 – December 31 Annual Election Period (AEP) or the January 1 – March 31 Open Enrollment Period (OEP). Again, there are exceptions. How are we doing so far? For Medicare Prescription Drug Coverage (Medicare Part D) you may enroll when you initially enroll for Medicare benefits. You may also enroll each year from November 15 to December 31. During this time, people on Medicare can join or change Part D plans. Be aware that special rules apply for Medicare Advantage plans that include Part D drug coverage. Also, under certain circumstances, you may enroll during special enrollment periods, such as if the Social Security Administration provides you with extra help for Part D costs or you move into or out of a plan’s service area. Also keep in mind that during the Annual Election Period (November 15 – December 31), you may sign up for several different Part C or D plans because of various promotions at pharmacies, information meetings, etc. There is nothing wrong with this, and it is fairly common, but remember that the last enrollment form received by Medicare is the plan you will be enrolled in and you will have to wait to make changes until the AEP (November 15 – December 31). In summary, the easiest and least complicated way to access your Medicare Benefits, and any supplemental coverage you may decide to purchase, is to enroll in these plans before you turn 65. If you find your choices are not working for you, you can change plans each year between November 15 and December 31. If you missed your initial election period, enroll as soon as you can. We are getting close to the November 15 to December 31 enrollment period for Medicare Advantage plans and Medicare stand-alone Part D plans, and though most situations are similar, there can always be exceptions. For specifics on your individual needs and to find out about other possible enrollment periods, call or make an appointment for private counseling. The Office of the Insurance Commissioner’s Statewide Health Insurance Benefits Advisors (SHIBA) HelpLine provides services free of charge to Washington state residents of all ages. You can find the HelpLine, and lots of information, at www.insurance.wa.gov then click on the SHIBA HelpLine tab on the left. You may also call 1-800-562-6900. There is also a lot if information at www.mdicare.com. Compiled by Tom Janssen, Association Benefits Corporation - www.AssociationBenefits.us |
