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Deferring Medicare Enrollment

Caregiver helps patient with ESRD defer Medicare Enrollment

Part A

As a patient diagnosed with ESRD, having the required amount of work credits automatically qualifies you for Medicare Part A. Primarily hospital insurance, Part A is without a premium and covers inpatient dialysis and kidney transplantation. Part A eligibility guarantees you Part B and D eligibility as well, though these programs are not free. To calculate your Part B premium, please go to our Part B premium page.

Part B

Though Part B is not free, it is recommended that you sign up for it at the same time as Part A. This is because, should you want to enroll in Part B at a later date, you will  have to wait until the General Enrollment Period (January 1st through March 31st) to enroll, begin your coverage July 1st, and you will likely pay a penalty. The penalty is 10% of the premiums for every 12 month period that you have Part A coverage without Part B. Deferring Part B enrollment could jeopardize your ability to have important treatments like dialysis or transplantation paid for by Medicare.

Medicare and Your Group Plan

When you sign up and when you get care in Medicare

Another reason why someone may want to defer their Medicare enrollment is that they may be already enrolled in a group plan that covers some of the treatment for ESRD. In this case, it is important to fully understand your coverage and how both plans work together as primary and secondary payers. Because your eligibility for Medicare usually cannot start until the fourth month of dialysis, the first three months are covered by you and your employer or union’s group plan. During this time, you may be able to get help paying your coinsurance through a Medigap plan or a state Medicaid program. Once Medicare kicks in at the fourth month, you begin what is known as the “coordination period,” a time when your group plan continues to be the primary payer, but Medicare helps to pay for some of the remaining costs. It is very important that you notify your provider that you have both plans so that the billing is done correctly and you are not stuck with any unnecessary costs.

Should I Defer My Enrollment?

If you are sure that your group health plan will cover all or most of your ESRD health care costs, it may be a good idea to delay your Medicare enrollment until after your 30-month coordination period has ended. At this point, you will not be charged a higher Part B premium because you deferred your enrollment. Likewise, if you are sure that your medication will be covered by your group plan, it may be wise not to sign up for a Medicare Part D (Prescription Drug) Plan when you enroll in Medicare Part A and B. However, if you decided to enroll in this plan later, you will only be permitted to do so between October 15th and December 7 each year, during the Annual Enrollment Period. If you do this after your initial enrollment period and there was a period of more than 63 consecutive days when you did not have a prescription drug plan with at least as much coverage as Part D, you may have to pay a penalty. For more information about enrollment periods, check out our late enrollment penalties page. 

*Source:
http://www.medicare.gov/publications/pubs/pdf/10128.pdf