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    Medicare Part B Late Enrollment Penalty

    Hi, everyone. I just want to keep you well informed. Here is a link to Medicare's website regarding a penalty that can apply if you opt not to enroll in Medicare Part B when you are permitted to. https://www.medicare.gov/your-medica...llment-penalty.

    Rich
    Last edited by Seasha; 01-18-2020, 11:19 PM. Reason: corrected url
    Attorney Richard Feingold concentrates his law practice in helping disabled individuals obtain the monthly Social Security disability benefits and health insurance that they need to survive. Although based in Chicago, Illinois, Rich helps disability claimants nationwide. He has been answering posts in this forum since June 11, 2003. Twitter handle: @RichFeingold.

    #2
    i did not

    Hey Rich I did not enroll when they offered part b to me, but as i read all the ss litaturature i do not get a penality , since i am buying a private insurance policy that is creditable, when or if i enroll later as long as i am insured. I am not 65 as of yet and am on disability .. I read where there was a problem having both private and a ss part b together true ??? thanks

    Comment


      #3
      update

      Hey just an update,,, my large ex-company has now changed there mind--- and are requiring me to buy medicare part "B" and moving me off the active employee insurance to a retiree insur plan that suppliments medicare... and aligns with fed gov...

      Comment


        #4
        Here are some facts about Medicare Parts A and B sign-up that may be useful to you. Please read the links for more complete information.

        1. For most people, there is no reason to delay signing up for Medicare Part A as soon as you are eligible. For most people, Part A has no premium. There are a few exceptions.
        https://www.medicare.gov/your-medica...s/part-a-costs

        2. You will see that you are eligible to enroll in Medicare Part B only during certain times:
        * During your Initial Enrollment Period (when you first get Medicare)
        * Between January 1 and March 31 each year
        * Special Enrollment Period (SEP). See below for info about SEP.

        Medicare Part B has a monthly premium. If you didn't get Part B during your Initial Enrollment Period, your Part B may have a Late Enrollment Penalty. Refer to the link in Rich's 09-03-2015 post. Here is the link again:
        https://www.medicare.gov/your-medica...llment-penalty

        Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period if you're covered under a Group health plan (20 or more employees) based on current employment. Usually, you don't pay a late enrollment penalty if you sign up during a SEP.
        https://www.medicare.gov/sign-up-cha...ign-up-periods

        In summary, people who receive Social Security disability benefits and are covered under a group health plan, from either their own or a family member's current employment are eligible for a Medicare Special Enrollment Period. It is usually in your best interests to sign up for Part A (premium-free) as soon as you are eligible. Unless you have employer coverage (and the employer has 20 or more employees), it is likely in your best interests to sign up for Part B as soon as you are eligible. Although you will pay a monthly premium, you will avoid a lifetime Late Enrollment Penalty.

        For more information on situations that may qualify you for a Special Enrollment Period, contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week; TTY users can call 1-877-486-2048.
        ~ Faith
        MSWorld Volunteer -- Moderator since JUN2012
        (now a Mimibug)

        Symptoms began in JAN02
        - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
        - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
        .

        - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
        - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

        Comment


          #5
          Retirement Healthcare and SEP?

          Timely update mamabug! I have been going thru the Medicare site this weekend and have a few questions. I thought I would post them here in the hope that once answered, it will help someone else.

          Current Situation: on SSDI, declined Part B when initially eligible as I have coverage thru my husband's employer.

          Upcoming Situation: my husband is retiring in June, but we have healthcare for 5 years following his retirement.

          Questions:
          1. To avoid late enrollment penalty, it appears that I need to elect part B this year, as retiree coverage is not considered active coverage. Is that correct?
          2. If I do need to elect Part B this year, does this mean it is also the only window I have to choose supplemental coverage without medical screening?
          3. If I need to elect B this year, do I also have to elect Part D this year?


          I hope I am wrong, but it appears that I need to pay Medicare premiums for 5 years, even though I don't need the coverage.

          Anyone with insights and aside from Medicare, who are experts I can talk with to make sure I do the right thing? I thought I had 5 years to figure it out, but I think I have 4 months!

          Thanks
          Kathy
          DX 01/06, currently on Tysabri

          Comment


            #6
            Wow, you have some good questions, Kathy.

            I see that the links address enrolling in Part B from employer coverage, from Cobra and from the Marketplace. I don't see anything about active coverage vs retiree coverage though. So I really don't have an answer for you.

            Regarding Part D, I think that's a whole different thing. I think you can enroll in either Part D or Part C during open enrollment (November or December?) every year without penalty. Or maybe even choose to be without it if you don't want Rx coverage.

            But these are important questions with significant financial ramifications. No matter what advice you receive, or from whom (except maybe Rich), it's likely a good idea for you to call the Medicare number to make sure you understand it all correctly. I suspect even Rich might refer you there, as his field of speciality is social security, not Medicare.

            It does sound, though, that you'd like an independent opinion, aside from Medicare. Maybe your local senior center could refer you to someone? Or maybe your local NMSS could?
            ~ Faith
            MSWorld Volunteer -- Moderator since JUN2012
            (now a Mimibug)

            Symptoms began in JAN02
            - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
            - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
            .

            - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
            - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

            Comment


              #7
              "COBRA and retiree health plans aren't considered coverage based on current employment. You're not eligible for a Special Enrollment Period when that coverage ends."

              Above was directly from the Medicare site. I take that to mean that the SEP I had while he is employed goes away, so I need to make my election before he retires or face the penalty.

              I am going to call tomorrow and see what they say, but would feel better getting direction elsewhere as well. I think I will check in with my husband's employer to see if they have guidance.
              Kathy
              DX 01/06, currently on Tysabri

              Comment


                #8
                Hi Kathy,

                I hope I'm wrong, but my understanding is that you will need to sign up for both part b and d.

                "If you're retired and have Medicare and group health plan (retiree) coverage from a former employer, generally Medicare pays first for your health care bills, and your group health plan coverage pays second."

                https://www.medicare.gov/supplements...iree-insurance

                https://www.medicareinteractive.org/...iree-insurance


                "Part D late enrollment penalty

                The late enrollment penalty is an amount that’s added to your Part D premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage.

                Creditable prescription drug
                coverage is coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. If you have a penalty, you may have to pay it each month for as long as you have
                Medicare drug coverage."

                https://www.google.com/url?sa=t&sour...St7dL0U7P_wXUp

                Originally posted by pennstater View Post
                "I think I will check in with my husband's employer to see if they have guidance
                The second URL I provided states to do this.

                Good luck and please let us know what you find out!

                Thanks,
                Kimba

                “When you change the way you look at things, the things you look at change.” ― Max Planck

                Comment


                  #9
                  Thanks Kimba! I thinks so too. I will be on the phone alot this week. Will update when it is resolved.
                  Kathy
                  DX 01/06, currently on Tysabri

                  Comment


                    #10
                    Yes; please let us know what you find out! Let us know, too, whether you are able to get information from someone other than Medicare, such as your husband's employer.

                    In November and December, there were agencies helping seniors with Medicare Open Enrollment. Perhaps some of those agencies could help you now too. In our community, it was our state extension office, our county department on aging, and our senior center.
                    ~ Faith
                    MSWorld Volunteer -- Moderator since JUN2012
                    (now a Mimibug)

                    Symptoms began in JAN02
                    - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
                    - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
                    .

                    - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
                    - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

                    Comment


                      #11
                      Thanks Faith. Will do. My husband works for a railroad, so waiting on the call back from their retirement board. I do plan on going to our county's center for aging for advice on plans. I was hoping to have more insight from the retirement benefits board, but I may make the appointment anyway. Once I find out my answers, I will probably delete all these intermediate threads and just put the resolution so it is easy to find in the sticky for future reference.
                      Kathy
                      DX 01/06, currently on Tysabri

                      Comment


                        #12
                        Still waiting on husband's employer to confirm.

                        I had a social security appointment this morning which answered my questions.

                        As stated above, retiree health care plans are not considered coverage eligible for an SEP to Medicare enrollment. From the date of my husband's last day of work or when he loses coverage (whichever is earlier if different), I have 8 months to sign up for Part B to avoid penalty, as well as select a supplemental plan to avoid medical underwriting. With respect to Part D, it depends if the retiree health care coverage is deemed "creditable coverage". If creditable, can defer without penalty. If not, then need to enroll with 8 months to avoid penalty. A final note, each year, you need to make sure the retiree prescription coverage is still creditable.

                        There are a few exceptions to the above, but I was told rare. We didn't get into it since not applicable to me and she had another appointment.

                        She told me some people who have lifetime retiree coverage, and the coverage doesn't require them to take Medicare, do opt to not sign up for these coverages. But if the healthcare coverage is withdrawn, changes drastically, or company goes bankrupt or closes, they are subject to penalties and medical underwriting for Medicare pricing. She had a woman last week that had this happen, and she is 11 years out from original eligibility. Needless to say, she was stunned at the penalties.

                        And the fun begins.
                        Kathy
                        DX 01/06, currently on Tysabri

                        Comment


                          #13
                          It took many calls and a lot of patience, but I obtained answers. I highly recommend for individual questions check with your state department of insurance and talk to a person who is "Apprise" certified.

                          Most true retiree plans are not qualified as an SEP for Medicare. So the timeline starts for Part B penalties, and then associated Part D and medigap enrollment rules.

                          If your retiree coverage though is an actual Medicare advantage plan, with exception of Part B, then these timelines are deferred. If Medicare advantage, you can read below for some of the keys.

                          My husband remains on his employer plan until he turns 65. Due to me being on disability, they are moving me to their retiree coverage offered for those over 65 or disabled.

                          With this move, I am required to file for Medicare part B. The actual plan his employer is using is a Medicare advantage plan. To enroll in a Medicare advantage plan, you have to be enrolled in both parts A & B. My case, it is a customized plan that offers the same benefits as the employee plan, and has a few bonus perks thrown in due to coverage required my medicare. So I now need to find out if docs accept it

                          I also keep existing drug coverage, but can use the Advantage plan drug rider when it's coverage is better. So for part D, I am not required to start this for two reasons:
                          1. Existing drug coverage is "creditable". As long as I have "creditable" coverage, I can't be penalized when I enroll for Part D later.
                          2. Even if I didn't have separate drug coverage above, the Medicare Advantage plan would be my drug coverage, which is "creditable".

                          So the key is to ask your provider if drug coverage is deemed "creditable".

                          Once my husband turns 65, we lose our coverage. I will be under 65. A few key points:
                          1. Medicare does not require insurance companies to sell medigap policies to anyone under 65
                          2. An individual state may require the insurer offer medigap to anyone under 65
                          3. If a state does require insurers to offer a policy for people under 65, they may or may not allow insurers to charge a higher premium for people under 65. Obviously if on Medicare under 65, a person is disabled.


                          My state does not require insurers to offer medigap to people under 65. If I want additional protection to original Medicare Parts A,B, and D, my only choice is to stay enrolled in a Medicare advantage plan until I turn 65.

                          So when we lose coverage in 4 years, it is considered a "life changing event". We are both eligible for SEP enrollment in Medicare. My husband will select original coverage with supplement, I will have to choose an Advantage plan.

                          Once I turn 65, I can switch to original Medicare. No penalty for Part B, since I enrolled this year. I will not get a penalty for Part D enrollment, since I maintained "creditable" drug coverage. And since I was on a Medicare Advantage plan as my first Medicare choice, I can obtain my first Medigap policy without medical underwriting!

                          Of course, this is all based on the Medicare laws as of 4/20/2020. Things may change, so you need to be your own advocate.
                          Kathy
                          DX 01/06, currently on Tysabri

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