Tuesday, December 8, 2015

IBM Medicare one.exchange.com 2016 other enrollment periods

Yesterday was the last day of the Medicare Fall Open Enrollment which is the time to make changes to Medicare health insurance for 2016 coverage.  In addition to this time, some people will be able to modify their choices during 2016.

  • Medicare Advantage Disenrollment Period: January 1 - February 14, 2016

If you have a Medicare Advantage insurance plan, you are allowed to disenroll from the plan and use original Medicare during this period of time.  Some people use this option because they did not realize they were automatically enrolled in a new Medicare Advantage plan because their old plan terminated.  They will often realize the change when they go to the doctor in January and are told the doctor does not accept their current plan.  It's possible this might happen to some  IBMers who were automatically enrolled in the individual Aetna plan because the IBM group Aetna plan terminated.
Although it is a nice option it can get complicated.  If you had a Medicare Advantage plan that did not include an Rx insurance plan, you cannot switch to a new Rx plan.  If you want to buy a Medicare Supplemental plan to have secondary insurance for original Medicare, the rules governing that purchase are determined by your state.  Finally, if you have something called a Medicare Medical Savings Account plan you cannot switch.  If you are able to switch, original Medicare will be effective the beginning of the next month.

  • Medicare General Enrollment Period:January 1 - March 31, 2016

If you miss the initial sign up window for Medicare after you turned 65 and are not working (which is 3 months before through 3 months after your birthday), then you must wait for the General Enrollment Period (GEP) to sign up unless you can prove you were misinformed by a Medicare employee. There will likely be penalties assigned for every year you did not use Medicare and definitely be penalties for every month you did not buy Rx insurance.  That's irritating all by itself but then add to that your insurance coverage will not begin until July 1st of 2016. The most frequent cause for making this kind of mistake is for people who are over 65 and get laid off.  They buy the COBRA insurance and think they are covered by COBRA (per an earlier post, they really are not covered).  When COBRA ends it is usually after their Special Enrollment Period (SEP) to enroll in Medicare which is 8 months.  At that point, they must wait for the Medicare GEP to enroll.

  • Unique Special Enrollment Periods: Any time during 2016 if you are eligible

As I just described, when you stop working and are over 65 you have 8 months to enroll in Medicare insurance.  There are other ways you are also be eligible for an SEP.  Just to name a few:

  • If you move from one state to another
  • If you have a state pharmaceutical assistance program which includes a one time SEP
  • If you go into or come out of a nursing home
  • If you can prove marketing fraud for the insurance plan you currently have 

Hopefully, none of the above applies and you will have a happy Medicare 2016 year!


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