Medicare timelines can be incredibly confusing. There is no single Medicare timeline, as Medicare features multiple parts, as well as different aspects such as enrollments and appeals, each with its own unique timeline.
Changing your coverage involves yet another set of timelines, which can vary depending on exactly what type of coverage you have and what you want to add or change. But it’s very important to understand each timeline in order to make the decisions that are right for you. So let’s break it down. Below, we will dig deeper into the various types of Medicare timelines and what you can expect from each one.
The story of Medicare: a timeline
It may help to think of Medicare as a bunch of components that all work together to create a cohesive whole. You, as the Medicare user, make your way through the various components and their timelines on your way to receiving the service you need. So it only makes sense to start by reviewing the different parts of Medicare and how they all fit together.
Medicare Part A is hospitalization insurance. It pays for hospital stays, as well as covered services such as hospice. If you worked and paid Medicare taxes, you can get Part A for free when you turn 65 or qualify due to a disability.
Medicare Part B covers general medical insurance. It covers services such as doctor visits and routine screenings. You are eligible to enroll in Part B at the same time as Part A, but it isn’t automatic or free. You will need to choose to enroll and pay a low premium each month, along with a small deductible.
Taken together, Medicare Parts A and B are what’s known as original Medicare. This system works well, but it has notable limitations. Specifically, it doesn’t necessarily cover all medical services you may need. Prescription drugs are not included. And you must pay coinsurance (generally 20% of the total bill) for all services, with no limits on your annual out-of-pocket expenses.
Medicare Part C, or Medicare Advantage, plugs some of the known gaps in original Medicare. Offered by private insurance companies such as Blue Cross and Blue Shield of Kansas, Medicare Advantage offers everything provided by original Medicare, as well as some extras. Many policies include prescription drug coverage, or Part D. There are also additional covered services and, in most cases, caps on your annual out-of-pocket costs.
Another option is a Medicare Supplement plan, also known as a Medigap plan. These plans, identified by an alphabet soup of different letters, work in tandem with the original Medicare. Medicare pays first and then your Medigap plan pays its share of the remaining bill.
So your Medicare journey will primarily focus on deciding which coverages you want and signing up for them on time. In addition, you will need to know when you can make changes to your coverages, what to do if you need to appeal a Medicare decision and how Medicare handles reimbursement claims.
Medicare sign-up timeline
Although special rules apply for those who qualify due to disability, most people can think of the Medicare enrollment timeline as a “countdown to age 65.” This is the basic timeline for Medicare enrollment, known as the initial enrollment period.
Your initial enrollment period depends on your birthday. The window opens three months before the month in which you turn 65. It runs through your birthday month and another three months afterward. This is the most important Medicare application timeline for many people because it is when you will first sign up for Medicare coverage. The Medicare new cards timeline is typically around three weeks, so if you don’t want to wait to use your new coverage, consider enrolling about a month before your birthday.
If you don’t enroll in Medicare during your initial enrollment period, you will get another chance during the general enrollment period, which lasts from January 1 through March 31 each year. Coverage then begins on July 1 of that year. You may need to pay a penalty on your Part B premium.
Medicare supplement timeline
If you want to add a Medicare supplement plan to your original Medicare, you can do so during your Medicare supplement open enrollment period. It starts the first time you enroll in Medicare Part B and will last 6 months. During this time, there is no medical underwriting, so everyone is eligible regardless of health status. You can also enroll or change plans at any time. But depending on the specifics of your chosen plan, you may then have to go undergo medical underwriting, which means you could be denied based on your current health status.
Medicare Part D timeline
You can sign up for Medicare Part D, prescription drug coverage, during your Medicare supplement window. Or you can enroll during the annual enrollment period, which lasts from October 15 through December 7 each year. Remember that some Medicare Advantage plans include prescription drug coverage, so be sure to carefully consider your needs.
Medicare Advantage application timeline
You can choose a Medicare Advantage plan during your initial enrollment period. Or if you’ve signed up for original Medicare, you can switch to Medicare Advantage during the October 15 to December 7 annual enrollment period. This is also the time when you can change Medicare Advantage plans or drop your plan and return to original Medicare.
There is also another timeline known as the Medicare Advantage open enrollment period. Lasting from January 1 through March 31, this period lets people who already have Medicare Advantage change plans or switch back to original Medicare (and add a prescription drug plan if desired). Note that during this time, you can only make a single switch. You can’t go back and forth. And if you’re on original Medicare, you are not able to sign up for Medicare Advantage at this time.
Special enrollment period
If you or your spouse are still working and you are covered by employer-sponsored group healthcare, you can delay enrolling in Medicare after you turn 65. You can sign up at any time while still covered, or for eight months after you retire or lose your group health insurance. Other situations that trigger a special enrollment period include moving back to the United States after living abroad, moving into or out of a long-term care facility, or moving away from your current plan’s service area.
Medicare appeals process Timeline
If Medicare denies a claim or assesses a penalty on your monthly premiums, you have the right to appeal. You have 120 days to start the appeals process. For best results, you will want to submit as much documentation as possible with your appeal. You should receive a response within 60 days of Medicare receiving your appeal. There are a total of five levels of appeals. Level 2, or reconsideration, also has a 60-day window for Medicare to respond, while the higher levels could take even longer.
Medicare claims and reimbursements timelines
It takes about 30 days for Medicare to process a claim from a provider. In most cases, your provider will file with Medicare and bill you only for your portion of the charges. Medicare pays the provider directly and you don’t need to get involved.
However, there are some cases in which you will need to pay the provider yourself and then file for Medicare reimbursement. This can happen in two situations: if the provider does not accept Medicare’s rates, or if the provider does not accept Medicare assignment.
Medicare assignment means that the provider agrees to Medicare’s established rates for each procedure and bills Medicare directly. Some providers agree to the rates but choose not to bill Medicare. In this case, you’ll need to pay the bill up front and then file for reimbursement by Medicare.
If you use a provider that accepts Medicare patients but does not accept Medicare’s established rates, you may be billed up to 15% more for each procedure. You will need to pay upfront and then submit a reimbursement form to Medicare. But be aware that you will be responsible for the excess charges, or the difference between what Medicare has agreed to pay and what the provider charges for those services.
When filing for Medicare reimbursement, it generally takes at least 60 days to receive your reimbursement payment. Sometimes it takes even longer. If you are not prepared to cover the full cost of the bill until you receive reimbursement, either work out a payment arrangement in advance or choose a different provider that accepts Medicare assignments.
Medicare is a complex system with many different moving parts, each on its own timeline. It can be quite confusing to keep up with all the details, especially if you are just getting started with Medicare. Therefore, it is always best to work with a trusted advisor who can help you navigate the process. To learn more about Medicare and the timelines you need to follow, call Blue Cross and Blue Shield of Kansas today at 866-627-6705.