Tips, deadlines and reminders for Medicare and Medicaid

Issue November/December 2017 December 2017 By Jo Babiarz
Health Law Section Review

Here is some general information about upcoming health insurance application deadlines and insurance gaps. As with anything, the devil is in the details, so make sure you read all the fine print. A portion of this information comes directly from the 2017 Elder Law Education Program, “Taking Control of Your Future: A Legal Checkup,” eighth edition; Alex Moschella, Esq. Chair of the MBA Elder Law Advisory Committee (published by the MBA and the Massachusetts Chapter of the National Academy of Elder Law Attorneys). Other resources are listed at the end.

The Medicare Part D enrollment deadline is December 7, 2017.

People must separately enroll in Part D (Prescription Drug Coverage). The open enrollment period for 2018 begins October 18, 2017 and ends December 7, 2017. People can make selections online, but do so carefully — do not assume that plans can be switched mid-year.

For 2018, CMS calculates the standard initial deductible at $405; initial coverage limit (yes, there still is the donut hole) is $3,750. Per CMS calculations, if a person purchases medications of less than $312 per month, the person will not enter the donut hole. If the person does enter the donut hole, the total estimated costs are $5,000. CMS estimates the average basic premium is $33.50/month. These averages probably don’t apply if a person takes five or more medications a month, or one “specialty drug,” which costs more than $600 per month.

It pays to use the Medicare Part D Plan Finder to shop for insurance coverage. Tip: The pharmacist can print out a list of medications. Input that list in the U.S. government website, at (do not use a commercial insurance calculator), and run the program. Compare plans and pharmacies to arrive at the best price. Be patient — there can be significant differences.

Mind the gap

There is a 12-month gap between being eligible for Medicare (65) and full retirement age for Social Security Benefits (66 or later). If a person chooses to work until full retirement age, there is that issue of health care — to take Medicare or not to take Medicare. A person cannot stay on an employer’s plan, if the employer has fewer than 20 employees, but must go on Medicare. Otherwise, the person can choose between the employer plan and Medicare. If the person stays with the employer, be sure there is continuous health insurance coverage and collect all paperwork to avoid the late enrollment penalties.

Note: Part B premiums are means-tested, using the adjusted gross income earned two years prior to the Part B application. For example, 2017 Part B premiums are based on 2015 AGI. Part B premiums can be lower if paid by deductions from social security retirement benefits, but there are significant financial consequences for filing for social security benefits before full retirement age.

Massachusetts insurance open enrollment and waivers

There is a different time period for this —o pen enrollment starts November 1, 2017 and ends January 31, 2018. These dates do not apply if a person becomes eligible for MassHealth at any time, or when a person qualifies for subsidized health insurance under the MAHealth Connector.

Useful websites include: