Trying to figure out how much my father member messed up not enrolling in Medicare (medical, plan)

[WoodchuckTX]

My father has never wanted to speak of finances and I'm not generally pushy. I've always figured he is going to end up moving in with me for retirement. He hasn't had any health insurance for a long time.

He should have enrolled in Medicare 5.5 years ago but just always intended to do so when he finally filed for Social Security, if ever.

So there is a lot of water under the bridge, I just want to see if we can avoid having it wash out completely. I never counted on any inheritance, but I would like him to be comfortable in his final decade or two (he really doesn't want to fully retire).

He turned 70 in August 2015. He enrolled in SS and Medicare in April 2016 with an effective date of Oct 2015. We checked the box for Part B. It seems clear to me that his Part A insurance was retroactive to Oct.

When will Part B be effective? What are the enrollment windows for a supplement and Part D?

He is hospitalized and there has been limited access to his mail. I'm also 3 hours away and unable to be away from my Wife for very long do to her own health issue (that started 1 week before my father's).

Are we likely going to have to turn over all of his assets to the Hospital/Doctors to eventually apply for Medicaid? I expect there to be substantial ongoing medical expenses.

Thanks for any advice/information.

[Ariadne22]

Originally Posted by WoodchuckTX

My father has never wanted to speak of finances and I'm not generally pushy. I've always figured he is going to end up moving in with me for retirement. He hasn't had any health insurance for a long time.

He should have enrolled in Medicare 5.5 years ago but just always intended to do so when he finally filed for Social Security, if ever.

So there is a lot of water under the bridge, I just want to see if we can avoid having it wash out completely. I never counted on any inheritance, but I would like him to be comfortable in his final decade or two (he really doesn't want to fully retire).

He turned 70 in August 2015. He enrolled in SS and Medicare in April 2016 with an effective date of Oct 2015. We checked the box for Part B. It seems clear to me that his Part A insurance was retroactive to Oct.

He is hospitalized and there has been limited access to his mail.

When will Part B be effective? What are the enrollment windows for a supplement and Part D?

Are we likely going to have to turn over all of his assets to the Hospital/Doctors to eventually apply for Medicaid? I expect there to be substantial ongoing medical expenses.

According to this, earliest Part B will become effective is July 1.

CMA*||* Basic Introduction to Medicare

Verify that with Social Security. Of course, your father needs Part B coverage in order to get a Medigap supplement or Advantage coverage.

However, because he missed his initial enrollment period (which can occur at either age 65, or later IF he lost creditable employer health coverage), he can apply for a supplement anytime to coincide with Part B effective date, but will need to undergo health underwriting (unless you are in a guaranteed issue state).

Chances are, if he is hospitalized now, no Medigap insurer will insure him. Although, if his ailments aren't serious, a Medigap might cover him with a waiting period and higher premium - provided he has Part B, of course.

His other, more certain option would be a Medicare Advantage plan (no health underwriting, although if he has ESRD, he will be excluded from that, as well) which, because he is enrolling in Medicare so late, won't be available to him until January 1, 2017.

Open enrollment for an Advantage plan for 2017 is October 15-December 7. Advantage plans have lower premiums, cover drugs, have copays, provider networks (HMO, as a rule), and max out-of-pockets of up to $7k/yr.

If he's ill, a Medigap supplement will be more convenient (any Medicare doctor - not just network docs) and probably, in the end, more cost-effective, but a Medigap may not be an option at this time, depending on his health.

He can enroll in Part D at any time. There will be a late enrollment penalty permanently attached to the Part D plan he chooses (as there is to Part B).

What happens to your father's assets in the event he needs Medicaid is a function of your state laws.

You need to talk to SHIP in his state of residence:

Find your State’s State Health Insurance Assistance Program (SHIP)

and a knowledgeable Medicare insurance broker - and Social Services in his county. Hopefully, there is a way to handle the gap in hospital deductibles and Part B costs before January.

[SCGamecock]

Originally Posted by Ariadne22

According to this, earliest Part B will become effective is July 1.

CMA*||* Basic Introduction to Medicare

Verify that with Social Security. Of course, your father needs Part B coverage in order to get a Medigap supplement or Advantage coverage.

However, because he missed his initial enrollment period (which can occur at either age 65, or later IF he lost creditable employer health coverage), unless you are in a guaranteed issue state, he can apply for a supplement anytime to coincide with Part B effective date, but will need to undergo health underwriting.

The Medigap initial enrollment period (open enrollment) begins when you enroll in Part B and lasts for 6 months. You can be over age 65. During this time period, Medigap is guaranteed issue without underwriting regardless of the state.

Part B General Enrollment is January-March of each year with an effective date of July 1. If you checked the Part B box in April 2016, then it sounds like Part B enrollment will occur January, 2017 with an effective date of July 1, 2017 if you did not qualify for a Part B Special Enrollment Period.

I'm 65 or older: Your Medigap open enrollment period begins when you enroll in Part B and can't be changed or repeated.

Reference: https://www.medicare.gov/supplement-...#collapse-2509

It’s best to buy Medicare supplement insurance during your six-month open enrollment period. Your open enrollment period begins when you enroll in Medicare Part B. During this time, companies can’t refuse to sell you a policy because of your health history or condition. If you wait until after your open enrollment period, you might not be able to buy a policy if you have a preexisting condition.

Reference: Medicare Supplement Insurance Handbook

The best time to buy a Medigap Policy is during the 6-month period that begins on the first day of the month in which you are enrolled in Part B. Your option to buy a Medigap policy may be limited after this initial enrollment period.

Reference: Tennesse Medicare Assistance - Medicare Info - Supplemental Insurance

[Ariadne22]

Originally Posted by SCGamecock

The Medigap initial enrollment period (open enrollment) begins when you enroll in Part B and lasts for 6 months. You can be over age 65. During this time period, Medigap is guaranteed issue without underwriting regardless of the state.

Part B General Enrollment is January-March of each year with an effective date of July 1. If you checked the Part B box in April 2016, then it sounds like Part B enrollment will occur January, 2017 with an effective date of July 1, 2017 if you did not qualify for a Part B Special Enrollment Period.

Thanks for that important correction. So, it appears he can purchase a Medigap w/o underwriting - a good thing - when Part B becomes effective - which is a great fail-safe for people who've delayed Part B enrollment for years. I had read the language you quote, but still conflated Part B late-enrollment penalty (which he will incur) with Part B initial enrollment period for which he is still eligible - two separate and distinct issues. So, OP's dad has caught a break. Thanks for reminding me think.

[WoodchuckTX]

so the biggest puzzle I had was the enrolling in April bit. So he is going to have to wait 14 months to get part B now.

[Ariadne22]

Originally Posted by WoodchuckTX

so the biggest puzzle I had was the enrolling in April bit. So he is going to have to wait 14 months to get part B now.

Unfortunately, since he missed the March 31, 2016 enrollment cutoff, based on a literal reading of the following, it would appear the answer is YES - he will not have Part B coverage until July 1, 2017:

Between January 1–March 31 each year

If you didn't sign up for Part A and/or Part B (for which you must pay premiums) when you were first eligible, and you aren’t eligible for a Special Enrollment Period (see below), you can sign up during the General Enrollment Period between January 1–March 31 each year.

Your coverage will start July 1.

https://www.medicare.gov/sign-up-cha...s-a-and-b.html

Failure to Enroll

There can be serious implication for individuals who fail to enroll in Medicare during their proper enrollment period. There is the surcharge of 10% per year assessed on the Part B premium for each year that an individual fails to enroll.

What can be more serious, is that failure to enroll during the initial or special enrollment period will result in the individual not being allowed to enroll in Medicare Part B until the general enrollment period during the first three months of each year. Coverage for Part B benefits then would not begin until July of that year.

CMA*||* Basic Introduction to Medicare

Again, discuss the above with Social Security and Social Services. There may be a way around this very long delay.