Late Enrollment Penalties Waived For Some Medicare Beneficiaries

Written by Jessica Adkins

June 7, 2017

It’s no secret, each year thousands of eligible beneficiaries miss their deadline to enroll in Medicare, and federal official and consumer advocates worry that many of them mistakenly think they don’t need to sign up because they have purchased insurance on the ACA marketplace. That decision can leave them facing a lifetime of enrollment penalties.

Now Medicare has temporarily changed its rules to offer a reprieve from penalties for people who kept ACA policies after becoming eligible for Medicare.

“Many of these individuals did not receive the information necessary [when they became eligible for Medicare or when they initially enrolled] in coverage through the marketplace to make an informed decision regarding Medicare enrollment,” said a Medicare spokesperson, explaining the policy change.

Those who qualify include individuals 65 and older who have a marketplace plan or had one they lost or canceled, as well as people who have qualified for Medicare due to a disability but chose to use marketplace plans.

They have until September 30th to request a waiver of the usual penalty Medicare assesses when people delay signing up for Original Medicare Part B. Medicare beneficiaries who already pay the penalty because they had a marketplace plan can also request that it be eliminated or reduced. Medicare also imposes a waiting period for coverage on people who do not sign up when first eligible. If they meet the waiver requirements, they can now request that be lifted.

Many agents stumble upon beneficiaries who assumed they didn’t need Part B if they had a marketplace plan, retiree coverage from a former employer, or coverage through a current employer with fewer than 20 workers or with the Department of Veteran Affairs. Those who enroll in Part B 12 months or later after becoming eligible can face a permanent penalty of 10% added to their Part B premium for each full 12-month period that a beneficiary could have had Part B, but didn’t enroll. This year, the Part B standard average premium is $109.

Medicare began emailing letters in March about the temporary waiver to some people 65 and older who are enrolled in plans sold on the marketplaces. However, Healthcare.gov and state exchanges do not appear to be reaching out to others who may be eligible.

Helping Your Clients

There has been a gray area since the beginning of ACA in the transition of Marketplace to Medicare. It’s important to begin communicating with your current customers who may have experienced the delayed enrollment now about the waiver. Start with letters, emails, or a call campaign to notify them of the waiver opportunity and how (if they have not already) to make the transition from ACA to Medicare.

Create a letter or process guide for your clients who may be experiencing the transition this year, to ensure they do not become confused about Marketplace plans vs. Medicare Health Plans, letting them know:

  1. Once their Medicare Part A coverage starts, they will not be eligible for premium tax credits or additional cost-saving through the Marketplace.
  2. If they choose to enroll in Medicare after their IEP ends, they may have to pay a Part B late enrollment penalty for as long as they have Medicare. Also, they can enroll in Medicare Part B (and Part A if they have to pay a premium for it) only during the Medicare General Enrollment Period (January 1 – March 31 of each year). Reminding them that coverage will not start until July of that year, creating a gap in their coverage.
  3. You will work with them to assist in ending their Marketplace plan when they become Medicare eligible.


For more guidance on sending a communication to your clients on the transition from Marketplace to Medicare, please contact a Regional Sales Director. We can help provide additional products that may fit your client’s medical and financial needs. Learn more by giving us a call today at 800-962-4693.

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