Harmony Healthcare Blog

Open Enrollment 2018: Medicare Part A & B

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Oct 26, 2017

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Edited by Kris Mastrangelo


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

1-Compliance.jpgEvery year this is opportunity to evaluate the current census in your facility and obtain Medicare Part A and Medicare Part B insurance for current residents.  This blog provides you with a system and sample roster for your usage.  

First, let’s review some global points related to the upcoming year.

2018 Medicare Coverage changes include:

  1. Starting in April 2018, Medicare beneficiaries will begin receiving new Medicare ID cards without Social Security numbers on them. 
  1. Medicare Part D recipients reaching the donut hole (gap in prescription drug coverage) will benefit from better prescription drug discounts. The gap in prescription drug coverage starts when someone reaches the initial coverage limit ($3,750 in 2018), and ends when they have spent $5,000 (these thresholds are each $50 higher than they were in 2017). For 2018, while in the donut hole, enrollees will pay 35 percent of the cost of brand name drugs (down from 40 percent in 2017) and 44 percent of the cost of generic drugs (down from 51 percent in 2017). The Medicare Part D deductible will be $405 in 2018, up slightly from $400 in 2017. 
  1. Medicare Part B premiums will fluctuate again for 2018. In 2017, most Medicare Part B enrollees paid an average of $109/month for their Part B premium, although enrollees with income above $85,000 had higher premiums. But the standard premium for Medicare Part B was $134/month in 2017. CMS has not yet set Part B premiums for 2018, but it’s likely that premiums will level out for all enrollees 
  1. New Income Brackets for Part B enrollees with high incomes. The Medicare Part B premiums for 2018 have not yet been set, but slightly less wealthy Medicare enrollees will begin paying the highest prices for Medicare Part B in 2018. 
  1. Medicare Advantage plans continue to see changes. 

Now we can discuss the “Open Enrollment” process that may prove to be quite beneficial to you and your residents.  However, be aware that there are two different types of open enrollment, one for current beneficiaries (existing members) and one for new beneficiaries (new members).

Medicare Part A & B Open Enrollment
Existing Members
(October 15th to December 7th) 

Existing Members 

Coverage Changes for existing Medicare Beneficiaries can be made during October 15 to December 7 with an effective date of January 1st.

Examples of Changes include:

  • Switch from an Original Medicare to Medicare Advantage, or vice versa.
  • Switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another.
  • Enroll in a Medicare Part D plan (a late enrollment penalty may apply).

Enrollment in a Medicare Advantage plan requires that the beneficiary is

  • Enrolled in Medicare Part A and Medicare Part B.
  • Live in the plan’s service area.
  • Excludes those with ESRD (End Stage Renal Disease) 

Current Beneficiaries can make changes to their benefits plan from October 15, 2017 to December 7, 2017.  Beneficiaries can switch from original Medicare to Medicare Advantage plans or vice versa during this period.  They can also switch from one Medicare Advantage plan to another.  If beneficiaries did not enroll in a Medicare Part D program when they were first eligible, they may enroll during the October 15th to December 7th period but a late enrollment penalty may apply. 

Please be aware that beneficiaries enrolled in a Medicare Advantage Plan can leave the plan and return to original Medicare between January 1, 2018 and February 14, 2018.  They cannot change Medicare Advantage plans at that time unless they have a special circumstance that would provide them with a Special Enrollment Period.  They can switch between Medicare Advantage Plans during the October 15, 2017 to December 7, 2017 period. 
OIG Compliance Program Guide

Medicare Part A & B Open Enrollment
New Members
(January 1st – March 31st)

New Members 

If a patient did not sign up for Medicare A and B when first eligible, they can sign up during the open enrollment period of January 1 to March 31st, with coverage effective July 1st 

There may a late enrollment penalty. For Medicare Part B, the penalty is an additional 10 percent of the premium for each 12-month period that you were eligible but not enrolled.

Medicare Open Enrollment 

Please feel free to implement the attached procedure to ensure that your facility/facilities have thoroughly reviewed all patients’ entitlement to his/her Medicare benefits.  If patients were eligible to enroll in Medicare before their 65th birthday and did not avail themselves of this opportunity, they may enroll from January 1, 2018 to March 31, 2018 with coverage effective July 1, 2018.  

Every year, Medicare offers an open enrollment window (January 1 – March 31) for potential Medicare Beneficiaries.  Please feel free to use the following process. 

Who may be eligible to enroll in Medicare? 

  • All persons 65 and over who are entitled to monthly Social Security benefits or Railroad Retirement benefits.
  • Persons over 65 who are still employed.
  • A dependent or survivor of a person entitled to Medicare Part A; or a dependent of a person under age 65 who is entitled to retirement or disability if the dependent or survivor is at least 65 years old.  (Example:  a woman aged 65 or older is entitled to spouse or widow’s Social Security benefit under Medicare Part A.)
  • A Social Security Disability beneficiary after meeting qualifications for disability benefits for 24 months or more (including disabled workers at any age, disable widows and widowers aged 50 or over, beneficiaries 18 or older who receive benefits because of disability beginning before age 22; disabled qualified railroad retirement annuitants.)
  • Under certain conditions, a person who becomes re-entitled to disability benefits within 5 years after the end of a previous period of entitlement (or 7 years in the case of disabled widow/ers and disabled children);
  • Individuals (and their dependents) with end stage renal disease

When does coverage begin for those Beneficiaries that are approved during the open enrollment period? 

  • Coverage will begin July 1, 2018.  

Many residents are funded by Medicaid.  What happens if they cannot afford to pay the monthly premiums? 

  • State Medicaid programs are required to pay Medicare costs for certain elderly and disabled persons with low incomes and limited resources if the individual meets the requirements as a “Qualified Medicare Beneficiary” (QMB).  There is also a program for individuals who are deemed Specified Low-Income Beneficiaries who may not qualify for payment by the State Medicaid Program. 

Where do I get an application for enrollment? 

  • Call your Social Security Office. 

What documents will I need? 

  • Proof of age
  • Proof of earnings such as W-2 forms (or tax returns for the past 2 years)
  • Social Security Card
  • If applying for disability benefits, documents related to the medical program will be required.  The Social Security Office will explain what is specifically required. 


The following Step-by-Step process is to be used as a guide.  Responsible party designees can be modified to accommodate the facility’s needs.
OIG Compliance Program Guide

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

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Tags: Requirements of Participation

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