May 10, 2016
by:
Margie Johnson Ware, Aging and Health Specialist
The call came from Alice, an old college
friend who knew I worked as a Medicare adviser. “Can you help my husband?” she
began. “I left it up to him to get his Medicare organized. Now I’m not so sure
that was a good idea…”
Alice and James are typical of many couples
our age. Both have demanding professional and social lives, and very little
time for exhaustive Medicare research. Alice is under 65 and still working.
James is 65-plus and retired, and is now covered by retiree insurance. But he
hadn’t enrolled in Medicare Part B during the
seven months of his Initial Enrollment Period,
thinking he wouldn’t need it. While Medicare Part A is free for
most people, Part Btypically carries a premium, and James had wanted
to avoid paying it if he didn’t need to.
Now he has some pretty serious health issues,
but no real way to pay for them. Does this scenario sound familiar? Like James,
many individuals on retiree health insurance mistakenly believe that their
retiree plan is all they need, or they miss their Initial Enrollment
Period because they think that they can enroll in Part B any time they
want. Others are worried about their finances, and don’t think they can afford
Part B. If this applies to you, you can learn more about getting cost
assistance with Part B using the “Getting Help with Costs” guide.
The most important thing to remember? There
are five main types of Medicare plans, some of which are optional and some of
which are mandatory. Although there are some exceptions, many
beneficiaries need to enroll in both Part A (covers
hospital services, typically free) and Part B (covers doctors’ visits,
typically costs money). The other three plan types are optional (Medicare Advantage/Part C, Part D, and Medigap). If you neglect
to enroll in Part A and B on time, you may have to pay late penalties.
So, who needs Part B, and who doesn’t? Let’s
take a look.
Types of beneficiaries
who can wait to get Part B with no penalty:
- Individuals who are still
covered by their employer insurance based on employment (not retired), or
their spouse’s employer insurance (the employer needs to have 20 or more
employees to qualify for this exemption). These individuals will still
need to enroll in Part B eventually, during a Special Enrollment
Period, when they retire and lose their employer coverage. You can learn
more about delaying enrollment in Part B through the “65 and Still Working” guide.
- Disabled individuals covered by their spouse’s employer
coverage when the employer has 100 or more employees. These individuals
need to enroll in Part B if they lose employer coverage and can do so
during a Special Enrollment Period.
Types of beneficiaries
who don’t have to get Part B, but will pay a penalty if they join late:
- Veterans who have decided to
only use the Veteran’s Affairs (VA) health
system.
- Federal employees who opt to use their Federal Retiree Health
Insuranceinstead of Medicare.
Types of beneficiaries
who DO need to enroll in Part B (but mistakenly avoided it):
- Everyone else including:
- Those with retiree coverage
- People with small employer
group coverage (company is 20 employees or smaller)
- People with Tricare who
are turning 65
As you can see, unless you meet certain
requirements, you will need to enroll in both Part A and Part B during your
seven month Initial Enrollment Period.
So do you still need to enroll in Part B, but neglected to do so? Don’t
despair! There are still options.
First, you will need to enroll as soon as
possible. You will also need to pay late penalties if your Initial Enrollment
Period has passed. A five year delay subjects you to a penalty of
more than $50 per month, so try to keep your delay in enrolling as short as
possible. The Medicare General Enrollment Period for adding Part B is January 1
to March 31 each year with coverage starting July 1. You can learn more about
the General Enrollment Period through this Guide to GEPs.
Additionally, you may be eligible to have your
Part B premium paid for by your state, which can help with the costs from not
enrolling on time. If your individual monthly income is $1357 or less ($1823
for a married couple), you may qualify for having your Part B premium paid by
a Medicare Savings Program.
Although the state will look at your bank balances and any investments, the
value of your house and car are not included–so don’t automatically assume you
don’t qualify. You can contact your local State
Health Insurance Counselor (SHIP) for additional advice about
your particular situation.
No comments:
Post a Comment