Many of our clients are reporting Medicare enrollment delays when first applying for Part A and B. In some cases, Medicare cards are arriving after the effective date of your clients Medicare coverage start date. If this happens, they will receive a Retroactive Entitlement letter stating their insurance is active retroactively to when they requested their start date. However, this will prevent them from being able to enroll in a plan that starts the same month as their Medicare. The good news? They will qualify for what’s known as a retroactive entitlement special election period (SEP) to enroll in a plan after they receive their card.

In the following blog we will cover

What is the Retroactive Entitlement?

The Retroactive entitlement SEP is for individuals who have not been provided the opportunity to enroll in a plan during their ICEP/IEP, perhaps due to administrative delays. These individuals will have an SEP to enroll in a plan that begins the month the individual receives the notice of Medicare entitlement retroactive determination and continues for two additional months after the month the notice is provided. The effective date for the plan would be the first of the month after the application is received by the plan sponsor. Make sure your clients save the Retroactive Entitlement letter in case the carrier comes back and asks for it!

When the SEP Applies?

Ruth is newly eligible for Medicare and turns 65 on August 4th. In July, Ruth decides to enroll in Medicare Part A and Part B to be effective August 1st. Due to an influx of Medicare enrollments, CMS doesn’t process Ruth’s application for 90 days and she doesn’t receive her Medicare card by the August 1st effective date. Because Ruth didn’t have her Medicare card in time, she missed her opportunity to enroll in a plan, but she would qualify for the retroactive entitlement SEP.

How does it work?

When Ruth finally receives her Medicare entitlement retroactive determination notice and Medicare card in October, she chooses to enroll in a Medicare Advantage plan that will become effective November 1st. Keep in mind, her Medicare Part A and B will be retroactive to the original August 1st effective date, but her Medicare Advantage plan, Part D Prescription Drug Plan or Medicare Supplement will not be effective or cover any services provided prior to November 1st.

Medicare can be confusing and trying to make sense of special election periods can make things even more difficult for your clients. Make sure you know the ins and outs of the various enrollment periods by following our blog.

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