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When does my client notify Medicare of a change of address?

Here are two common scenarios:

1. My client has 2 houses and goes back and forth to each of them throughout the year, which one can be considered his residence? Typically this is where they spend 6 months or more of their time and file their taxes.
2. My client is moving. When does the SEP start? Step 1 is to notify your plan of your move with your new address. This lets them know if you are still within the plan’s service area or not signaling to them to send CMS and you a letter for special enrollment period.

When is the SEP?

• If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move.
• If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.

*Medicare Supplement Plan do not give a SEP when you move. The supplement will follow you to your new residence, but often times will be re-rated.

Learn more: https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods

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How does Medicare work when you are a US Citizen but living or traveling abroad?

Travel outside the U.S.

Medicare usually does not cover medical care you receive when traveling outside the U.S. and its territories. However, Original Medicare and Medicare Advantage Plans must cover care you receive outside the U.S. in certain circumstances:

• Medicare will pay for emergency services in Canada if you are traveling a direct route, without unreasonable delay, between Alaska and another state, and the closest hospital that can treat you is in Canada.
• Medicare will pay for medical care you get on a cruise ship if you get the care while the ship is in U.S. territorial waters. This means the ship is in a U.S. port or within six hours of arrival at or departure from a U.S. port.
• In limited situations, Medicare may pay for non-emergency inpatient services in a foreign hospital (and any connected provider and ambulance costs). Your care is covered if the hospital is closer to your residence than the nearest available U.S. hospital. This may happen if, for example, you live near the border of Mexico or Canada.

A Medigap, or Medicare Supplement, policy can help cover foreign travel emergency care. Plans C, D, E, F, G, H, I, J, M or N will cover your care if it begins during the first 60 days of your trip if Medicare doesn’t otherwise cover the care. These Medigap policies will pay 80% of the billed charges for certain medically necessary emergency care services outside the U.S. after you meet a $250 deductible for the year. Medigap’s foreign travel emergency coverage has a lifetime limit of $50,000.

If you have moved outside the US, you have decisions to make about keeping your Original Medicare A & B even though it may not cover any care you receive. You will want to purchase other insurance before you qualify for certain foreign countries health benefits.

Learn more: https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/medicare-and-living-abroad/medicare-coverage-for-those-who-live-permanently-outside-the-united-states

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What came first the chicken or the egg?

In other words, what do you mark on the application if your client is within 2 enrollment periods? This can become tricky because there is a hierarchy that comes into play. Additionally, sometimes you can use one enrollment period for their Part B enrollment and a totally different one for their Medicare Health Plan.

Example of SEP occurring during IEP

Ms. Smith (claimant, born February 12, 1958) was first eligible for Medicare effective October 2016 based on disability. The claimant refused SMI because the claimant had coverage under the spouse’s group health plan, based on his current employment status.

Ms. Smith’s IEP based on age 65 attainment is November 2022 through May 2023. The claimant files an SEP enrollment request in November 2022, requesting a SMI start date of December 2022, the month the claimant spouse is retiring.

Since Ms Smith filed the enrollment request prior to February 2023 (the month attains age 65), we can process the SEP enrollment.

Learn more: https://secure.ssa.gov/poms.nsf/lnx/0600805275