Health Insurance Nightmare: Laid-Off Worker and Spouse Face Medicare Enrollment Crisis

Great question, Jen,

There are 2 different rules regarding enrolling in Medicare Parts A and B in your household and I will make those rules SIMPLE for you both!

Art needs to apply for a Special Enrollment Period (“SEP”) by downloading the form CMS-L564 (Request for Employment Information) and CMS-40B (Application for Enrollment in Medicare Part B) from www.SSA.gov. You can also email us at info@tonisays.com and we will send you the proper forms.

What to Do Next

Have your HR department complete and sign the CMS-L564 form and attach it to CMS- 40B. Write “Special Enrollment Period” across the top of each page, then file both forms with your local Social Security office. Art should advise the Social Security representative that he is losing his spouse’s company benefits and needs his Part B to begin ASAP. On his Part B application, write the effective day as the first of the month in #12, the “Remarks” section.

Jen, your way to enroll in Medicare is simple and quite different from Art’s because you are turning 65 in a year. Go to www.SSA.gov/benefits/medicare at least 90 days prior to turning 65 and apply online for an effective date of the first day of the month that you turn 65.

Need Help with Enrolling?

Readers, if you need help filling out the form for Medicare Part B, you may call your local Social Security office directly. Most Social Security direct phone numbers can be located by searching online for that specific office’s 800-number or calling Social Security’s national 800-number (800-772-1213). Chapter 1 of Toni’s Medicare Survival Guide Advanced Edition explains various ways of enrolling in Medicare in detail. You can also call the Toni Says Medicare hotline at 832-519-8664 or email info@tonisays.com for more Medicare help.

Here is a checklist for those enrolling in Medicare:

1. Original Medicare Part A: Covers in-patient hospital stay, skilled nursing/rehab stay, blood transfusions, home health, and hospice. 

2. Original Medicare Part B: Covers nearly everything else that is not in-patient services or prescriptions. (i.e., doctors’ visits, outpatient procedures, physical therapy, durable medical equipment, blood tests, x-rays, CAT scans, MRIs, chemotherapy, etc.)

3. Original Medicare/Medicare Advantage: Discuss with your healthcare facilities and medical professionals which Medicare plans they accept such as Original/Traditional Medicare with a Medicare Supplement or a Medicare Part C (Medicare Advantage plan such as HMO, PPO, or PFFS). Research the Medicare Advantage plan’s hospital/provider online directory. Call to verify they are currently in-network.

4. Medicare Prescription Drug Plans: Research drug plans every year to see if your standalone Prescription Drug or Medicare Advantage Plan with prescriptions formulary covers all your brand name or generic prescription drugs.

5. Always make copies of every document given to the Social Security office or received from the Social Security office.