You play a pivotal role in your clients’ quality of life. They rely on you to match them with a plan to meet their healthcare needs. And the better you do, the better equipped they are to manage their health and finances.
But there’s more to selling Medicare insurance than understanding individual plans. A significant part of your job is helping seniors navigate the bureaucracy of Medicare.
One of the most stringent Medicare regulations involves when seniors can enter the program. A very specific set of circumstances is required for eligibility, and if a senior misses their enrollment window, they risk a gap in coverage few can afford. With changes affecting the Initial Enrollment Period (IEP) this year, you need to know how they’ll affect seniors and how to convey them to your clients.
The new Medicare Initial Enrollment Period
IEP is one of the most important parts of Medicare. But for seniors who need health care, navigating this period can be confusing. When seniors turn 65, the IEP window opens, allowing them to sign up for Medicare.
Eligible individuals can enroll in Medicare up to three months before their birth month, during their birth month, or three months after their birth month. So, seniors turning 65 in September can enroll as early as June or as late as December, for a total of seven months of eligibility.
This year’s change eliminates a potential coverage gap affecting seniors who enrolled during the last three months of their IEP. In the past, seniors who signed up in this window had to wait an additional three months before their coverage became active.
Now, if you enroll after your birth month, coverage kicks in on the first day of the next month. A senior with a September birthday who enrolls in June would see their coverage start on October 1st.
This is a positive change for seniors—and you should be excited too! Coverage gaps can cause a steep rise in healthcare costs and even prevent some seniors from getting the care they need. Eliminating this issue gives seniors more reliable coverage and gives you more leverage to sell Medicare plans during the full range of a client’s IEP.
Misconceptions about IEP
In light of this year’s IEP changes, refresh your memory with answers to common questions seniors have about when they can or should enroll in Medicare. Here are a few of the most common IEP misconceptions you may need to correct.
1. Seniors have to wait months before coverage begins.
The dreaded coverage gap is one of the issues the 2023 IEP updates resolved. Now, coverage kicks off much faster. Beneficiaries who enroll before their 65th birthday month can expect coverage to start on the first day of their birth month.
If a beneficiary signs up during their 65th birth month or one of the three months after that, they can expect their coverage to begin on the first day of the following month. For example, if a senior turns 65 in March but enrolled in April, their coverage would begin on May 1st.
2. Seniors are automatically enrolled in Medicare at 65.
You know this is entirely false, but you’d be surprised to learn how many seniors think they’ll be automatically enrolled in Medicare on their 65th birthday!
There are, however, a few rare exceptions. Citizens who began receiving Social Security retirement benefits or Railroad Retirement benefits at least four months before turning 65 are automatically enrolled in Parts A and B.
These conditions don’t apply to most of the Medicare-eligible population, though. So take steps to ensure the seniors you work with know when they’re eligible and understand how to enroll.
3. Seniors have to pay penalties if they don’t enroll during their IEP.
There are plenty of opportunities to sign up for Medicare. If a senior misses their IEP, they can always sign up during the Open Enrollment Period (OEP), which spans from October 15 to December 7 this year.
They may also qualify for a Special Enrollment Period (SEP), based on variables involving relocation, retirement, spousal coverage, and natural disasters.
Stay sharp and review these 2023 IEP changes and other requirements for Medicare enrollment to serve your clients well. Need some extra help? Financial grade is here for you. Contact us today!
image credit: shutterstock/Dragana Gordic