We have some exciting news for Medicare Beneficiaries enrolling after age 65 (e.g. coming off of a Group Health Insurance Plan).
In the past, these Beneficiaries had to complete paper/pdf forms and send them (or drop them off) to the Social Security office. About a month ago, Social Security started providing a fax number that would allow individuals to fax these forms in since the Social Security offices have been closed due to COVID.
Just this week, there is a new enhancement deployed by Social Security that will finally allow these individuals enrolling after age 65 to complete their forms online using an electronic signature.
Below is a snippet from an email that we received from an inside source at SSA/CMS.
Effective Tuesday, May 26, 2020, based on the collaborative efforts between the Centers for Medicare & Medicaid Services (CMS) and SSA, the new online process for handling Medicare Part B SEP enrollment will be available online. The online process provides beneficiaries the option to complete the Medicare enrollment forms under an SEP for SSA to process. The online Medicare Part B SEP enrollment link www.ssa.gov/Medicare-PartB-SEP will be available on both SSA and CMS websites effective Tuesday, May 26, 2020. Once the beneficiary completes the online enrollment forms, the forms will automatically transmitted to the SSA Field Office of jurisdiction.
As a requirement, regardless of the service channel, in order to enroll for Medicare Part B during an SEP, the following are required:
· The individual must be covered under a group health plan (GHP) based on his or her own or a spouse’s current employment status, or covered under a large group health plan (LGHP), and the coverage must be based on his or her own, or a family member’s current employment status.
· The individual can enroll:
- during any month (including a partial month) in which they are enrolled in a GHP or an LGHP based on current employment status, or
- in any of the 8 consecutive months following the last month, during any part of which, the individual was enrolled in the GHP based on current employment status,
- or beneficiaries are eligible for equitable relief if:
o The beneficiary had an SEP during the period from March 17, 2020, through June 17, 2020; and
o The beneficiary did not apply for Part B during that SEP.
o Eligible beneficiaries who wish to take advantage of the equitable relief must file their enrollment request by June 17, 2020.
· The beneficiary must complete the CMS-40B enrollment form, paper or online to request enrollment. In addition, he or she must complete the CMS-L564 form, paper or online.
· The Form CMS-L564 has two sections:
- Section A - the applicant completes Section A.
- Section B - the employer, the GHP or LGHP completes Section B of the form. The information in Section B provides evidence of GHP or LGHP coverage and dates of employment.
NOTE: If the employer cannot sign the CMS-L564, the beneficiary can provide other evidence of previous employment or coverage of GHP or LGHP, or other documents for evidence of employment. Refer to HI 00805.295 – Evidence of GHP or LGHP Coverage Based on Current Employment Status.
Online Enrollment Guidelines
· The online enrollment process will require beneficiaries to complete the CMS-40B, CMS-L564 (one combined online application), and submit any required evidence during one online session.
NOTE: The online enrollment process does not offer beneficiaries the option to save and revisit the application.
· Failure to complete and submit the correct documentation may result in a delay in processing the Medicare enrollment.
· If the beneficiary fails to complete the forms or submit the correct evidence, Field Offices should follow normal business process and develop for the missing information.
During the COVID-19 pandemic, CMS waived the wet signature requirement; however, the online option will require beneficiaries to provide an eSignature (digital signature) and a valid email address.
As of March 17, 2020 the Social Security offices have been closed due to COVID-19. This presents some challenges for Medicare Beneficiaries signing up for Medicare after age 65.
Prior to COVID, we always recommended that post-65 Medicare Beneficiaries take the completed Part B enrollment forms (CMS-40B and CMS L564) to the Social Security office to sign up for Medicare Part B. After the Social Security offices closed, we were told to have Beneficiaries mail the CMS forms to the local Security Security office to sign-up for Part B which presents other challenges with lost mail, timing delays with postal mail, and risks of going to the Post Office to mail certified mail.
New Submission Method - FAX
We are excited to announce that Medicare beneficiaries can now fax Medicare Part B form, CMS-40B and CMS L564- Request for Employment Information, along with proof of employment, Group Health Plan (GHP), or Large Group Health Plan (LGHP) to
Social Security also temporarily removed the requirement that the Employer has to sign the CMS L564 form. As long as you provide proof of employment (e.g paystub) and proof of Group Health Plan, the Employer signature is not required on the CMS L564 form.
You can read more info here: https://www.ssa.gov/thirdparty/whatsnew.html?utm_campaign=thirdparty&utm_medium=email&utm_source=govdelivery
This new Part D Savings Model (which will take effect in 2021) will allow Manufacturers and Part D Plans to offer a flat monthly copay of $35 (or less) for the entire year.
For beneficiaries that enroll in these Plans for 2021, we are projecting an annual savings of $700+ for their Out-of-Pocket Insulin Costs.
For this new Part D Savings Model, there will be certain plans that cover certain medications (e.g. Insulin) that will have additional coverage throughout the year, thus keeping a flat copay of $35/month or less.
Current Model Out of Pocket Costs Illustrative Example with One Insulin with retail cost of $435/month
- January = $435 (deductible)
- February through September = $50/month copay during Initial Coverage Level
- October = ~$80 copay (partial month of Coverage Gap)
- November = ~$109 (25% of full retail cost while in Coverage Gap)
- December = ~$109 (25% of full retail cost while in Coverage Gap)
Total ~ $1,135 annual cost
New Part D Savings Model Out of Pocket Costs Illustrative Example with One Insulin with retail cost of $435/month
- January - December = $35/month copay
Total ~ $420 annual cost
Projected Annual Savings ~$700
CMS held a public webinar on Thursday, March 12, 2020. One of my concerns from this presentation is that this new Model is Voluntary for the Part D Plans and the Drug Manufacturers. Most of the cost savings (about $250 Million in projected savings) is coming from the Drug Manufacturer, so my concern was that the Drug Manufacturers wouldn't participate since this is a voluntary model.
However, I was excited to find an article from Lilly indicating their planned participation in the model for 2021. This is really great news for Medicare beneficiaries and we look forward to seeing the Savings when we run the Part D reports in October 2020 for the 2021 Part D Plans.
Finally some good news for Diabetics taking Insulin!
Below is a link to an article that was written on the Panel that I hosted in D.C. a few weeks ago with Congressman Allyson Schwartz.
Jim also happened to be actively involved with the Medicare Plan Finder activities we were working on with CMS.
At the end of Jim's presentation, he surprised me with this award.
What an amazing honor from such a senior representative at Health and Human Services (HHS).
You can watch the video of the award in the LinkedIn post below.
On Monday Feb 24, 2020, I was given the opportunity to moderate a Medicare Panel with some esteemed Medicare experts:
We had a really interesting discussion touching on several topics:
It was a great honor to moderate this panel and I look forward to continued partnerships between NAHU (National Association of Health Underwriters), Better Medicare Alliance, National Coalition on Health Care, and Healthcare Leadership Council.
At the National Association of Health Underwriters (NAHU) Capitol Conference, I was able to participate in a panel with some of our Medicare Advisory Group Members to discuss some of the key areas that our group has been working on.
The individuals on the panel are listed below:
Key Topics discussed on the Panel:
On the initial call, CMS agreed to have twice weekly calls throughout the Annual Enrollment Period to allow us to raise any key issues/requests with the Medicare Plan Finder and work through them with CMS. So, these calls continued through the Annual Enrollment Period (ending December 7, 2019).
A lot of key issues were addressed from these calls with CMS:
These calls proved to be a very successful Partnership with CMS as we were all striving to improve the Beneficiaries experience with the new Medicare Plan Finder.
At the end of the Annual Enrollment Period, we still had a number of open items that would improve the Beneficiary experience with the Medicare Plan Finder.
In January, we received an invite to a meeting with CMS (on Feb 19, 2020) in Maryland to discuss the open items and next steps with the Medicare Plan Finder.
Quick Recap of Meeting from Feb 19, 2020 with CMS
The 3-hour meeting included key stakeholders from a number of difference groups:
The room was setup into about 10 different working groups/tables with representatives from different groups at each table.
CMS kicked off the meeting with some background on the key drivers for creating a brand new Medicare Plan Finder tool. Then, we were given direction for the working groups to discuss a few key themes and come up with a list of "Things that are working well" with the Medicare Plan Finder and "Opportunities that are still open" with the Medicare Plan Finder.
One of the really interesting things that came out of this meetings is the feedback across the working groups was very similar. These are stakeholders from all different organizations impacted by the Medicare Plan Finder and the key themes overlapped significantly. Some of the highlights are below.
"What's Working Well" with the Medicare Plan Finder
Some key "Opportunities" that still exist with the Medicare Plan Finder
I really look forward to continued engagement and partnership with CMS as we look to improve the experience for Medicare beneficiaries going forward.
Two NJ Hospitals Get 5-Star Rating
CMS has recently released updated Hospital Star Ratings, and two NJ hospitals received 5-star ratings: Morristown Medical Center and Saint Clare's Hospital.
You can search for other hospitals ratings using this link: https://www.medicare.gov/hospitalcompare/search.html
If you are interested in the Rating Methodology, you can find more information here: https://www.medicare.gov/hospitalcompare/About/Hospital-overall-ratings.html
Seminars at Morristown Medical Center
I am excited that I had the opportunity to present multiple Medicare Workshops at the Morristown Medical Center over the last couple of years, and look forward to additional seminars later this year.
Also, we wanted to extend an invite to a FREE seminar on a very important topic - Finding your Social Security Sweet Spot. The speaker for this Seminar is one of my close colleagues who is a Social Security expert, Ash Ahluwalia. If you haven't made your Social Security elections yet, I am certain you will find this Seminar useful and engaging. Details and registration can be found below.
Finding Your Social Security Sweet Spot
with Ash Ahluwalia
Thursday, March 5, 2020 I 12:00 to 1:30pm
Executive Conference Room, Third Floor
475 South Street
Morristown, NJ 07960
Navigating social security in our ever-changing financial climate can be daunting. Our guest speaker Ash Ahluwalia will break it all down to help you maximize your benefits. As president of National Social Security Partners and the 2016 National Social Security Advisor of the Year, Ahluwalia has helped over one thousand clients make the most of their social security benefits. Ahluwalia is a Certified Financial Planner (CFP) and a Chartered Accountant (CA) with two designations in social security planning and an MBA from Wharton Business School. Lunch will be provided for all attendees.
Are you paying more than the base Part B Premium of $144.60/month?
If so, this is most likely because your income is above the base level amounts for the Part B Premiums ($87,000 / year for single, or $174,000 /year for joint filers).
These Income Related Monthly Adjustment Amounts (IRMAAs) are intended to have higher income earners pay a higher portion of their Part B (and Part D) expenses to the government.
Here is a short video that helps explain the IRMAAs as well.
Since we haven't filed our 2019 Tax Returns yet, the government uses the 2018 Tax Return to determine the 2020 Premiums. For some individuals, they may be eligible to appeal the IRMAAs if they had a qualifying event since 2018. The types of life events that could qualify for an appeal are below:
Here is a link to the form SSA-44 that you can use to Appeal the IRMAAs if you had one of the key qualifying events in a prior year's income that was used to determine your IRMAA.
You must start the appeal process within 60 days of receiving the letter from the government about the IRMAA, so if you received the IRMAA letter in December, your appeal window may be running out.
You can give us a call if you have any questions and/or if you would like to review your Medicare Supplement Plans to make sure you have the most cost-effective options.
Call now -
908-272-1970 (Cranford Office) or
856-866-8900 (Moorestown Office)
See bio here