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Medicare Special Enrollment Period Problems

Today’s video is only relevant if you worked at age 65 and beyond and maintained active group coverage through your work or a spouse’s work and deferred enrolling in Medicare Part B. As discussed in the previous video on Medicare’s Special Enrollment Period (SEP), one must prove one had active group coverage in order to enroll in Medicare Part B through a SEP. The Part D process is more kind and forgiving as explained below.

As discussed in the previous video on the SEP, uploading the CMS-L564 forms, which former employers complete, to the portal, https://secure.ssa.gov/mpboa/medicare-part-b-online-application, is the most common way TODAY to meet the SEP requirements. The most common error we see in this process is a Human Resources, Benefits or other official not completing the CMS-L564 form correctly. The form is simple BUT the question “give the date the applicant’s (group) coverage began” is occasionally interpreted as when the coverage began through the most recent insurance company. The government is actually looking for when the group coverage initially began so proofread this form carefully. Remember, the CMS-L564 form’s purpose is to show that one had ongoing, active group coverage since turning 65. The insurance company the coverage was through is not relevant.

Prior to the pandemic, Social Security did not make a portal available and required a CMS-L564 with an original signature so the form could not be faxed or scanned in and emailed. Prior to March of 2020, we recommended clients hand-deliver the CMS-L564 and CMS-40B to the local Social Security office because we had never experienced those forms being lost when hand-delivered. Unfortunately, we had experienced the forms being lost or misplaced in many offices all over the country including Seattle, Philadelphia, Manhattan, and Naples that had been mailed with tracking and signatures required. Hence, whether or not you use the portal or choose to mail or fax your information to your local office, you should follow-up with your local Social Security office if your Part B enrollment isn’t appearing on your mymedicare.gov portal within two weeks or so after using the portal or faxing or sending the forms with tracking to your local Social Security office.

We can’t say if Social Security will start to open local offices any time soon. That’s possible but it is also possible that use of the portal may continue to be an option when offices re-open.

Our clients have occasionally had other SEP headaches. One former employer refused to complete a CMS-L564 for a former employee. Other clients have had former employers who went out of business. The lesson here is that if you are working at age 65 or beyond, keep proof of your active group coverage such as annual enrollment confirmation.

The process for enrolling in Part D through a SEP is more straightforward. You must select your Part D plan and enroll either through medicare.gov or directly with the plan you chose. Afterwards you will receive a letter from the Part D plan saying you “may owe a penalty.” Complete the form and return it promptly. Unlike the Part B SEP, the Part D window is only 63 days from loss of prior drug coverage. However, don’t even think of the 63 days. You should plan to have your Part D in place as soon as the group coverage ends to avoid a gap in drug coverage.

Once again, keep records, follow-up and leave nothing to chance.