Simplifying Medicare Eligibility & Enrollment

It should be understood that the health care reforms don’t seek to change the basics of Medicare. It remains a healthcare coverage for citizens of the nation and those who are legal residents and are at least 65 years of age. Those who are younger than 65 years but have a typical kind of qualifying disability can also be considered for Medicare.

Apart from these two, main criteria, those who have been diagnosed with End Stage Renal Disease and have been diagnosed with ongoing dialysis or renal transplant are also covered under Medicare. Healthcare reforms don’t change these basic eligibility conditions for Medicare. However, it does expand the benefits offered under Medicare. For instance, medication billing that was suffering from the Donut Hole of 2010 will now be neutralized with a rebate check for prescription medications. Other prescribed drugs will now be further discounted.

Getting Medicare Application Right
One of the most important part of Medicare application is getting the timing right. A qualified individual can enroll for Medicare only during the Enrollment Periods. This includes subscription to those who are enrolling for the first time and those who want to change their coverage status, i.e. cost sharing that involves Medicare or opting out of it. To better understand how insurers apply Medicare eligibility and enrollment, it is imperative that you understand the different types of enrollment periods. These have been listed below:

IEP—Initial Enrollment Period
This refers to the period when you become eligible for Medicare, for the first time. This obviously applies when you have just celebrated your 65th birthday. For those who are younger than 65 years, the IEP refers to the Disability Date.

GEP—General Enrollment Period
This is applicable once the initial period for application has passed. It is applicable from January 1 to March 31 in each year.

SEP—Special Enrollment Period
This is particularly applicable to new beneficiaries. It is meant to offer a window of application to people who did not or could not apply during the IEP.

Supplement Open Enrollment Period
This is the period during which you can buy a Medicare supplementary health insurance plan. This becomes automatically applicable when you have completed 65 years of age and you are enrolled with Medicare Part B. People who qualify can buy a supplementary form of insurance without worrying about their health insurance.

Conclusion
Medicare remains an important part of the primary types of health insurance coverages in the nation. This is why payers and providers who are ramping-up their healthcare software solutions with an eye on ACA mandates are ensuring that their software can handle Medicare eligibility enrollment with precision. Insurance software solutions being demanded by insurers, who want to create their private Exchanges, are witnessing an increasing demand for Medicare application tools or applications like a Medicare quote engine.