Understanding the Enrollment and Payment System (EPS) in Health Care
Definition & Meaning
The enrollment and payment system (EPS) in health care encompasses the processes and activities that partner companies use to manage enrollment, payments, and appeals, particularly under programs like the retiree drug subsidy program (RDS). This system is essential for providing access to health care benefits, such as those offered by the Department of Veterans Affairs (VA) to ex-servicemen.
Enrollment in health care typically involves applying for Medicare coverage, which consists of two main parts: Part A and Part B. Part A enrollment is automatic for individuals who receive social security retirement benefits or railroad retirement. Conversely, Part B enrollment is also automatic unless the individual chooses to opt out. For those over the age of 65 who are not covered by social security, enrollment in both parts is voluntary and can be completed at their discretion. If individuals miss the enrollment deadline, they may incur a late-enrollment penalty (LEP). However, those who are still working and covered by an employer health plan can postpone their enrollment without penalty, receiving a special enrollment period of seven months following retirement.