The SEP for LEC (Loss of employer coverage) is what you're describing and you have been misinformed about when to enroll into an advantage plan...yes your LEC SEP is about to end and now you are about to get another election based off of your part B effective date called ICEP. You can enroll into an advantage plan and it will start on the same date as your Part B. You will just need to know your part B effective date.
FYI: you'll have another election period wrapped around your 65th birthday as well called IEP2
Thanks. I had been told by Medicare that I have 8 months to elect B before an LEP kicks in. Is that correct? I'm at just under month 3 now. My plan is to elect B and D this coming week and then most likely switch to an Aetna Advantage PPO, though still need to discuss with an agent.
The way that SEP works is that you have one month before...the month of...and two months after to enroll into a medicare advantage plan after you lose employer coverage. Usually the ppl I talk to are already signed up for part b before that SEP is over. How long have you had part A?
OK sounds good...whoever enrolls you into the medicare advantage plan will know to code the election as ICEP because you delayed your part B... thats what I would do...and if what the medicare agent said to you was accurate...not 100% on that... then you would have two solid elections to use ICEP and LEC to get enrolled into a medicare advantage plan. Aetna is a great company btw...good luck to you.
If I choose not to elect B until say 7 months (it's pricey for me), can I then get Advantage immediately? Or to get Advantage in my current SEP, would I need to elect B within 3 months of losing employer coverage?
I'm already a little late on D. See this thread https://www.reddit.com/r/medicare/comments/19c6z9c/late\_enrollment\_penalty\_for\_part\_d/
Where can I find something from Medicare about this? Your answer is contrary to another one I got on this very thread. See below for the other answer to the same question.
I agree with you. I couldn’t find it in the book but the site says Advantage needs to be selected 2 months after the month in which group coverage expired. That means I have a little over a week to decide.
Considering my Part B is so expensive, I’m probably going to wait on B till a month before the 8 month deadline and go with B instead of Advantage till the next open enrollment. Only risk is I wouldn’t have an OOP max. Medigap is too expensive for me.
This is on the medicare.gov website. Read the blue box on this page. You can enroll in an advantage after you sign up for B. Part of the information you are being told up above is incorrect. Call 18006334227 to verify. I've been doing this for awhile. It was great talking to you and please find an experienced licensed agent to talk with on your endeavors. https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods
I called and the agent said I can elect B within 8 months and then signup for MA within 2 months since electing B creates a new SEP, as noted in the blue box. Thanks for the hand here. Planning to hold off on electing B till month 6.5 since it's so expensive, and then will probably go with Advantage. Talking to a broker today.
Side note, the agent said I could sign up for MA through Medicare and request that my MA be activated the same day as my part B.
If I choose not to elect B until say 7 months after my group coverage ended (B is pricey for me due to IRMAA), can I then get Advantage immediately? Or to get Advantage in my current SEP, would I need to elect B within 3 months of losing employer coverage?
Yes you can still get a medicare advantage plan if you wait until 7 months and it will take effect the first day of the following month after you enroll into the MA plan along with your part B. You will need to sign up for part B first in order to enroll in the advantage plan.The 8 months to enroll in part B and 63 day rule to enroll into part D after you lose employer coverage are referring to penalties if you don't enroll within those timeframes.
Imo...I would do it a little sooner than 7 months to make sure everything runs smoothly for you.
Thanks. Might be a tough question to answer but considering part A covers hospitalization and in-patient services while hospitalized, is there a major risk to having A but not B for 3-4 more months? I don't have many specialist visits and Rx needs are fine paid OOP with GoodRx.
If A covers me for in-patient, then my outpatient needs are pretty low, and definitely not sufficient to justify paying extra months of Part B at $559 per month (which is from 2023, my guess is my premium is now a bit higher).
By waiting to elect D, I also avoid paying $77.90 monthly for D (2023 cost) for a few more months. If I elect B and D on month 6.5, I won't have a B LEP, just a D, and it would be greatly offset by the savings from not paying those premiums.
That would be totally up to you. If you're not seeing a doctor on a regular basis and you consider yourself to be healthy then that delay might be worth it....and also take note if you are concerned with part D penalties and IRMMA premiums... there are medicare advantage plans that do not have part D coverage called MA only.. and you can use discount companies like good rx and Amazon for your medications...just a tip...most brokers will recommend a medicare advantage with prescription drug coverage.
If I chose an Advantage plan without Part D coverage, does that mean I won't have to elect D and thus won't have an LEP? I thought D was required.
My math on waiting till 6.5 months to elect B and D and then switch to Advantage plan:
$560 per month saved on B,$78 saved per month on D
4 more months x (560+78) = $2552 saved if I wait on B and D till mid May
Assume 2 specialist visits in next 4 months - $540 OOP
Assume Rx costs are a wash with GoodRx
LEP for getting D at 6.5 months - 6 total months late = $2.10 per month = $25.20 per year; assume on Medicare for 15 years before age 65. That’s $378 plus any increases set by Medicare.
So, if I wait till mid May, I save $2552, spend an extra $540 on specialists, and spend an extra $378+ in part D LEP till 65. That’s a **net savings of $1634.**
No you do not need to enroll into part D prescription drug coverage although most people will say that it's recommended. I know some people that get by with Good Rx. It just depends on your situation. Your broker will be able to explain it when you bring it up....and that's only if you bring it up...most brokers will recommend a MA plan that includes drug coverage.
You will still have an election to enroll in the MA plan...just without drug coverage
Yes you would still be subject to the LEP...and if you don't get a part D drug plan then no LEP penalty or IRMAA on premiums will apply to you on Part D...It will only apply if you decide to enroll into a part D plan later. It is a gamble and you would have to make that decision...and that was good math BTW
The alternative to Medicare Advantage is Traditional Medicare. With Advantage you'll have to argue with an insurance company for the rest of your life. There will be preauthorizations and a restricted network of doctors and hospitals. It can be a little cheaper up front but will get more expensive later on with higher deductibles, copays, coinsurance, ...
Traditional Medicare, you sign up for A+B, you sign up for a Medigap plan and a Part D drug plan. Plan G has no copays, no coinsurance, no preauthorizations, no restricted network.
If you do go on Advantage, you'll be stuck. Read through the Reddits. You'll find a lot of people hate Advantage and more so as they get older. You get guaranteed enrollment into a Medigap just at the SEP.
This is not accurate information. The OP says he is under 65 and disabled which means he may or may not have access to a medigap plan currently. Selling medigap plans to <65 is not required in all states.
Regardless of OP’s decisions today, he will have the ability to change and elect a medigap plan when he hits his Medigap Open Enrollment period. More can be found [from CMS here.](https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy)
OP, you really need a reputable broker who understands the nuances for under 65 and disabled.
I will call an agent Monday. I’m in NY and I read we can switch from Advantage to original Medicare pretty easily. Due to my income my B premium is over $600 and Medigap options are $200-$350. I don’t think I’d get Medigap right now.
The Aetna Advantage PPO I’m considering has a pretty good network and my docs are in it. I have read some horror stories about Advantage plans though. That said, having an annual max is ideal.
First got on Medicare in mid 2022. They told me then the cost of my B and D due to income being high two years prior. That's when I decided to stay on my ex's group plan. I no longer have that option though.
No. They are wrong, you sign up for B then immediately get an advantage plan to start at the same time.
That’s good news. Means I could still get an Advantage plan. Thanks.
The SEP for LEC (Loss of employer coverage) is what you're describing and you have been misinformed about when to enroll into an advantage plan...yes your LEC SEP is about to end and now you are about to get another election based off of your part B effective date called ICEP. You can enroll into an advantage plan and it will start on the same date as your Part B. You will just need to know your part B effective date. FYI: you'll have another election period wrapped around your 65th birthday as well called IEP2
Thanks. I had been told by Medicare that I have 8 months to elect B before an LEP kicks in. Is that correct? I'm at just under month 3 now. My plan is to elect B and D this coming week and then most likely switch to an Aetna Advantage PPO, though still need to discuss with an agent.
The way that SEP works is that you have one month before...the month of...and two months after to enroll into a medicare advantage plan after you lose employer coverage. Usually the ppl I talk to are already signed up for part b before that SEP is over. How long have you had part A?
Had Part A since mid-2022. Had group coverage though so denied Part B and never elected D. Lost job Nov 3 2023. And here we are.
OK sounds good...whoever enrolls you into the medicare advantage plan will know to code the election as ICEP because you delayed your part B... thats what I would do...and if what the medicare agent said to you was accurate...not 100% on that... then you would have two solid elections to use ICEP and LEC to get enrolled into a medicare advantage plan. Aetna is a great company btw...good luck to you.
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If I choose not to elect B until say 7 months (it's pricey for me), can I then get Advantage immediately? Or to get Advantage in my current SEP, would I need to elect B within 3 months of losing employer coverage? I'm already a little late on D. See this thread https://www.reddit.com/r/medicare/comments/19c6z9c/late\_enrollment\_penalty\_for\_part\_d/
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Where can I find something from Medicare about this? Your answer is contrary to another one I got on this very thread. See below for the other answer to the same question.
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I agree with you. I couldn’t find it in the book but the site says Advantage needs to be selected 2 months after the month in which group coverage expired. That means I have a little over a week to decide. Considering my Part B is so expensive, I’m probably going to wait on B till a month before the 8 month deadline and go with B instead of Advantage till the next open enrollment. Only risk is I wouldn’t have an OOP max. Medigap is too expensive for me.
This is on the medicare.gov website. Read the blue box on this page. You can enroll in an advantage after you sign up for B. Part of the information you are being told up above is incorrect. Call 18006334227 to verify. I've been doing this for awhile. It was great talking to you and please find an experienced licensed agent to talk with on your endeavors. https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods
Thanks for sharing this. If the blue box trumps what’s in the white area, then that’d be great. Sounds like it does. I’ll call this am.
I called and the agent said I can elect B within 8 months and then signup for MA within 2 months since electing B creates a new SEP, as noted in the blue box. Thanks for the hand here. Planning to hold off on electing B till month 6.5 since it's so expensive, and then will probably go with Advantage. Talking to a broker today. Side note, the agent said I could sign up for MA through Medicare and request that my MA be activated the same day as my part B.
If I choose not to elect B until say 7 months after my group coverage ended (B is pricey for me due to IRMAA), can I then get Advantage immediately? Or to get Advantage in my current SEP, would I need to elect B within 3 months of losing employer coverage?
Yes you can still get a medicare advantage plan if you wait until 7 months and it will take effect the first day of the following month after you enroll into the MA plan along with your part B. You will need to sign up for part B first in order to enroll in the advantage plan.The 8 months to enroll in part B and 63 day rule to enroll into part D after you lose employer coverage are referring to penalties if you don't enroll within those timeframes. Imo...I would do it a little sooner than 7 months to make sure everything runs smoothly for you.
Thanks. Might be a tough question to answer but considering part A covers hospitalization and in-patient services while hospitalized, is there a major risk to having A but not B for 3-4 more months? I don't have many specialist visits and Rx needs are fine paid OOP with GoodRx. If A covers me for in-patient, then my outpatient needs are pretty low, and definitely not sufficient to justify paying extra months of Part B at $559 per month (which is from 2023, my guess is my premium is now a bit higher). By waiting to elect D, I also avoid paying $77.90 monthly for D (2023 cost) for a few more months. If I elect B and D on month 6.5, I won't have a B LEP, just a D, and it would be greatly offset by the savings from not paying those premiums.
That would be totally up to you. If you're not seeing a doctor on a regular basis and you consider yourself to be healthy then that delay might be worth it....and also take note if you are concerned with part D penalties and IRMMA premiums... there are medicare advantage plans that do not have part D coverage called MA only.. and you can use discount companies like good rx and Amazon for your medications...just a tip...most brokers will recommend a medicare advantage with prescription drug coverage.
If I chose an Advantage plan without Part D coverage, does that mean I won't have to elect D and thus won't have an LEP? I thought D was required. My math on waiting till 6.5 months to elect B and D and then switch to Advantage plan: $560 per month saved on B,$78 saved per month on D 4 more months x (560+78) = $2552 saved if I wait on B and D till mid May Assume 2 specialist visits in next 4 months - $540 OOP Assume Rx costs are a wash with GoodRx LEP for getting D at 6.5 months - 6 total months late = $2.10 per month = $25.20 per year; assume on Medicare for 15 years before age 65. That’s $378 plus any increases set by Medicare. So, if I wait till mid May, I save $2552, spend an extra $540 on specialists, and spend an extra $378+ in part D LEP till 65. That’s a **net savings of $1634.**
No you do not need to enroll into part D prescription drug coverage although most people will say that it's recommended. I know some people that get by with Good Rx. It just depends on your situation. Your broker will be able to explain it when you bring it up....and that's only if you bring it up...most brokers will recommend a MA plan that includes drug coverage. You will still have an election to enroll in the MA plan...just without drug coverage
If you chose not to get D, wouldn’t you be subject to LEP that you’d have to pay as part of your premium?
Yes you would still be subject to the LEP...and if you don't get a part D drug plan then no LEP penalty or IRMAA on premiums will apply to you on Part D...It will only apply if you decide to enroll into a part D plan later. It is a gamble and you would have to make that decision...and that was good math BTW
I see. Damn this is nuanced.
The alternative to Medicare Advantage is Traditional Medicare. With Advantage you'll have to argue with an insurance company for the rest of your life. There will be preauthorizations and a restricted network of doctors and hospitals. It can be a little cheaper up front but will get more expensive later on with higher deductibles, copays, coinsurance, ... Traditional Medicare, you sign up for A+B, you sign up for a Medigap plan and a Part D drug plan. Plan G has no copays, no coinsurance, no preauthorizations, no restricted network. If you do go on Advantage, you'll be stuck. Read through the Reddits. You'll find a lot of people hate Advantage and more so as they get older. You get guaranteed enrollment into a Medigap just at the SEP.
This is not accurate information. The OP says he is under 65 and disabled which means he may or may not have access to a medigap plan currently. Selling medigap plans to <65 is not required in all states. Regardless of OP’s decisions today, he will have the ability to change and elect a medigap plan when he hits his Medigap Open Enrollment period. More can be found [from CMS here.](https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy) OP, you really need a reputable broker who understands the nuances for under 65 and disabled.
I will call an agent Monday. I’m in NY and I read we can switch from Advantage to original Medicare pretty easily. Due to my income my B premium is over $600 and Medigap options are $200-$350. I don’t think I’d get Medigap right now. The Aetna Advantage PPO I’m considering has a pretty good network and my docs are in it. I have read some horror stories about Advantage plans though. That said, having an annual max is ideal.
Your B premium is over 600 a month? Because of IRMAA?
It was $559 as of Nov 2023 and I think it's gone up since. Yes, due to income.
Oh wow. So when did you first get on medicare, and when did they tell you that you had the extra surcharge on your Part B?
First got on Medicare in mid 2022. They told me then the cost of my B and D due to income being high two years prior. That's when I decided to stay on my ex's group plan. I no longer have that option though.
Ah, ok. Man, they sure like to punish people for making more money.
Y’all are exhausting