Saturday, June 15, 2019

What’s with my Medicare Part A effective date being backdated six months?

Many people now work after age 65 and are surprised when they decide to sign up for Medicare learn Part A's (hospitalization) effective date was adjusted back six months from the date received for Part B (outpatient treatments0.

The first part to answer this is to understand three things about the MediCare enrollment process. The MediCare system tells us:

First - When a person turns 65 they are considered – Eligible the month of becoming 65.

Second - When an application for Part A & Part B is submitted and complete the person is considered – Entitled. [not enrolled] 
Note: Their ID card will show Entitled above the coverage date.

Third - A person who is becoming eligible has a seven-month Initial Enrollment Period (IEP). They can apply in any of the three months before eligible, the month they are eligible, and during any of the three months after becoming eligible.

Now why does Part A’s effective date go back for six months?
The source of the rule stating Part A will be retroactive is found on Page 9 of a Medicare Enrollment Pub (1) It’s in a section of the Pub called -  When can I sign up?- and reproduced here. I added bold to keywords
-  -  -   You can sign up for free Medicare Part A (Hospital Insurance) (if you’re eligible) any time after your Initial Enrollment Period starts. Your Part A coverage will start six months back from the date you apply for Medicare (or Social Security/RRB benefits), but no earlier then the first month you were eligible for Medicare.
(1)   The above information, shown between [snip], is from – Enrolling in Medicare Part A & Part B.  This Pub is - CMS Product No. 11036 - Revised January 2018.

Now I want to share some points on how Part B’s effective date is set and how the Part A dated is adjusted:

First - When a person submits an application after they are eligible, the system will set their Part B date connected to when they apply and Part A is connected to their Eligible month. Let’s say a person is in their IEP and they apply:
    + A month after Eligible - Part B is delayed two months from the month of application and Part A will be back to their Eligible month.
    + In the second and third month after being Eligible [last available in IEP] - Part B is delayed three months and Part A will be back to their Eligible month. 
   Note: Applying in the last available IEP month results in B being six months after A.

Second - The rule which sets Part B’s effective date when a person applies in the last month of their IEP, is thus applied to anyone who signs ups after being Eligible. Backdating Part A, however, will be no more than six months.

Thus,  the famous – Part A is always back for six months. 

 Couple other points:
   + Having Part A backdated has an impact on a person who has a HSA medical benefit plan. 
   + More information about signing up for MediCare can be found on this page of my MediCare site.

John C Parker, RHU, LTCP
Niantic CT