Medicare is an area that causes a lot of confusion, not only for laymen, but also for health care providers and attorneys. Many facilities have Medicare specialists that deal with particular isolated parts of the Medicare program that affect that particular medical facility. I hope that I can give you a general idea about Medicare and its enrollment dates.
The Medicare general enrollment period for 2007 runs from January 1, 2007 through March 31, 2007. The general enrollment is an annual opportunity for individuals who are eligible for, but not enrolled in, Medicare Parts A and/or B to enroll.
Enrollment in Medicare Part A for those not entitled to premium-free Part A is necessary for individuals wishing to enroll in a private health plan under Medicare Part C (Medicare Advantage) and for lowincome individuals wishing to participate in the Medicare Savings Program. On the other hand, enrollment in Medicare Part B is voluntary. However, enrollment took on a new significance in 2006 with the advent of the Medicare Part D Prescription Drug Program. For one thing, Medicare Part D provides a route to eligibility for Part D for those who do not have Medicare Part A. For another, drugs that are covered under Part B are excluded from coverage under Part D, regardless of whether the Part D enrollee is enrolled in Part B.
It might be helpful to discuss how different parts of Medicare interact with respect to eligibility. Part A — Covers hospitalization, skilled nursing facility services, some home health and hospice, and is available to most beneficiaries premium-free beginning with their 65th birthday or when they have been receiving Social Security Disability for 24 months. For those beneficiaries who are not entitled to premium-free Part A (because their employment was not sufficiently covered by Social Security or by Railroad Retirement), they can pay a premium (for 2007 either $226/month or $410/month, depending on how many quarters of Social Security coverage the individual has) to enroll, but they must have Part B to do so. A time-limited penalty is imposed on those enrolling in Part A after their first opportunity to do so. Part A is necessary, but not sufficient to enroll in Part C (private managed care plans), and sufficient to enroll in Part D (private prescription drug plans). General enrollment for Part A is available January through March of each year, with benefits starting July 1 of that year.
Part B — Covers physicians services, outpatient therapies, durable medical equipment, long term health services, and other outpatient services. It is voluntary and available to beneficiaries at the same time they are eligible for Part A. The monthly premium, $93.50/month for most people in 2007, is generally deducted from a beneficiary’s Social Security or Railroad Retirement check. A non-timelimited penalty is imposed for late enrollment. Part B is necessary for Part A enrollment for those not entitled to premium-free Part A, is necessary but sufficient for Part C enrollment, and is sufficient to enroll in Part D. The general enrollment period is the same as for Part A.
Part C (Medicare Advantage) — Provides through private managed care plans most commonly organized as health maintenance organizations and required to cover all of the services covered under Part A and Part B. It is voluntary and available at the same time a beneficiary is first entitled to Parts A and B. A beneficiary must have both Parts A and B to be eligible to enroll in Part C. General enrollment is from November 15 through December 31 of each year, with benefits starting January 1 of the following year. Beginning in 2007, beneficiaries are able to change plans once during the first three months of the year. Part C plans can offer a prescription drug plan under Part D. There is no late enrollment penalty for Part C.
Part D — Provides through private plans offering prescription drug coverage. It is voluntary and available at the same time a beneficiary is receiving Part A or Part B. General enrollment is from November 15 through December 31 of each year. A beneficiary must have either Part A or Part B to enroll in Part D. Otherwise covered Part D drugs that are covered under Part A or Part B would not be covered under Part D, regardless of whether the beneficiary has Part A or Part B coverage.— Or— Drugs covered under Part A and Part B are not covered under Part D., regardless of whether the beneficiary has Part A or Part B coverage. A nontime- limited late enrollment penalty is determined by application of two formulas in assessing as a penalty the one that yields the highest amount.
General Enrollment Period. As noted above, January through March of each year is the Medicare general enrollment period for Parts A and B, and for those who have not enrolled in the program during the seven months surrounding their 65th birthday, when they have received Social Security Disability for 24 months or during a special enrollment period to which they may be entitled. Beneficiaries enrolling through the general enrollment period are entitled to benefits beginning the July following their enrollment.
Medicare Savings Programs (MSPs). Often people do not enroll in Part B because they cannot afford the monthly premium. For those with income below 135% of the Federal Poverty Level ($1,102.50/month in early 2007, but will increase by February or March) and few resources, Medicare Savings Programs, operated by state Medicaid programs, will pay the premium. In addition, for those with incomes below 100% of the Poverty Level (now $817.00/month; will increase in February or March), one of the MSPs called the Qualified Medicare Beneficiary Program (QMB) will pay other Medicare cost sharing and will pay the Part A premium for those without premium-free Part A. Through agreements that have been with the federal government, states are absolved from paying any penalties for late enrollment, and so is the beneficiary.
Plan to enroll early in 2007! The general enrollment period for Medicare Parts A and B ends March 31, 2007. Call 1-800-677-1116 to locate the state health insurance counseling program closest to you for assistance.
I am sorry this article has been so complicated and confusing. Please seek help by calling the above number. A good website from which much of this information was taken is www.medicareadvocacy.org. Good luck!