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Daniela Levi By Daniela Levi • August 2, 2016

6 Surprising Medicare Facts for Agents Who Know Everything

Several of the employees here at The Brokerage, Inc. have specialized in Medicare for the last decade or so, and during that time have picked up plenty of tidbits. Although we have many agents who are Medicare experts themselves, every once in a while we will get a question that we didn't have the answer to. didyouknow.jpg This blog is for those agents who already know almost everything there is to know about Medicare and the ones just getting started, to learn a little more about those tough questions that sometimes come up. If you know every single one of these, then pat yourself on the back, you are a true Medicare Guru! If not, then you are like so many of us Medicare experts, who never stop learning something new.

  1. There are several well-known SEP's that are most commonly found. However, there are some that are rarely used and that many agents don't even know about. The 5 star SEP is one such example. As many of you know, a plan is rated between 1-5 stars, 5 being considered an excellent plan. These ratings are updated each fall for the following year. A client has a special enrollment period if there is a 5-star Medicare PDP, MA, or Medicare Cost plan available in their area that they would like to switch to.  The client can only use this SEP once between the timeframe of Dec. 8 to Nov. 30 of the following year.
  1. If your client is already getting Social Security by the time they turn 65, they will be automatically enrolled in Medicare Part A and Part B. However, if they aren't yet receiving Social Security, they’ll have to act on their own to sign up. One reason this might happen is that both the client and their spouse already receive health care coverage from their employers, and do not yet need Medicare coverage.
  1. If a Medicare number ends in a T, it means the client is not yet taking  social security.  It also means  that they will have to be billed for their Part B (since there is no social security check to withhold it from).  Billing is Quarterly, not Monthly.  Once they start taking their social security, their Medicare number will change, probably to an A.
  1. Most Medicare agents know the rules for guarantee issue rights concerning Medigap plans. The first of 2 that are most often overlooked or that we find agents have the most questions on are when your client enrolls in an MA or PACE plan when they first became eligible for Part A and B at age 65, and within the first year decided they wanted to switch to Original Medicare. The second is when the client drops a Medigap policy in favor or an MA plan for the first time, and in less than a year decides they want to switch back.
  1. Generally, your client's Medicare starts on the first of the month that they turn 65.  But if their birthday is on the first of the month, Medicare starts the first of the previous month.
  1. Your clients must apply for their Part B within 8 months of being covered on the group policy as a Current  Employee.  If they don’t, they will have to wait until the General Enrollment Period to enroll in Part B. (See Medicare and You, starting on page 26.)

    Although we know plenty more of these complicated Medicare facts, some are too long and complicated to write a short paragraph about, and may be featured in blog posts of their own so keep an eye out as we approach AEP! Know any other tricky Medicare rules, or little-known facts? Comment below, We’d love to hear them!

    by: Daniela Levi with special Medicare expert help from Pepper McCarty