Jeanie’s mother is 67 and was recently diagnosed with colon cancer. When she turned 65, she enrolled in Medicare Part A, but not B or D. Jeanie’s mother didn’t think it was necessary to pay for Parts B and D because she hardly ever went to the doctor, and she would have rather used the ‘savings’ on her car payment. Unfortunately, she needs that coverage now, but a call to Social Security informed Jeanie that she missed her “window of opportunity” to enroll in Medicare Part B this year. Her mother will have to wait until January 1 of next year to enroll. Now, what!?
Here’s my response to Jeanie, her mom, and the thousands of other Boomers out there who need to know Medicare’s rules.
Currently, there are over 700,000 Medicare beneficiaries who are receiving a Medicare Part B and/or D penalty – costing on average $5,000 in Medicare lifetime penalties because they did not enroll under Medicare enrollment periods. Your mother has an extremely serious Medicare issue because the General Enrollment Period for those that never enrolled in Medicare ended on March 3; as the Social Security rep stated, your mother will have to wait until next January 1 to begin her process of enrolling in Medicare Part B. And, it looks like your mother will be joining that group because she will receive a Part B penalty.
She can enroll in Medicare Part D during Medicare Open Enrollment, which begins October 15 of this year – and her prescription drug plan will begin January 1 of the following year.
She will not be able to enroll in a Medicare Advantage plan because her Medicare Part B will not go into effect until July 1 of the next year if she enrolls during the upcoming General Enrollment Period. When your mother, who will be 68 at the time, enrolls in Medicare Part B during Medicare’s General Enrollment Period, she will receive a Part B penalty which is 10% for each 12-month period that she did not have Part B (in this case, her penalty will be 30%; 10% times 3 years). This penalty will never go away.
The Medicare Part D penalty is 1% of the national Part D average premium and this also changes each year for each month you could have enrolled in Part D from age 65 but did not (in this case, her penalty will be that specific Part D 1% penalty times 36 months).
Most people think that when they turn 65, a magical switch is turned on, and, poof! You’re on Medicare! This is not true!
Medicare changed the rules during the Clinton administration when it extended the time for receiving 100% of your Social Security benefits. To receive your Medicare card on time depends on whether you are receiving your Social Security check. Receiving your Social Security check is your ticket to Medicare. It starts the process for you to reive Medicare benefits and your Medicare card. Social Security does all of the paperwork for Medicare – and for those turning 65, Social Security wants you to enroll in Medicare online at ssa.gov/benefits/medicare.
Remember, Social Security processes all the paperwork for Medicare!
Always check with human resources if you are delaying Part B. Many health insurance carriers are changing their rules regarding Part B and may require you to enroll in Medicare.
Begins 3 months before turning 65 and lasts through the 3 months after you turn 65.
Here is what’s confusing about Medicare’s Initial Enrollment Period. There is a term called the enrollment effective date schedule, which is not mentioned in the Medicare and You Handbook. The handbook, under Initial Enrollment Period, states, “if you enroll in Part A and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Medicare coverage will be delayed.” The effective date schedule is the 7-month period which occurs 3 months before turning 65 and 3 months after turning 65.
Enrolling after 65 when delaying Medicare Part B due to working full-time with company benefits. This is an 8-month window of signing up for Part B without receiving a Part B penalty.
If you are turning 65 and still working, talk to your employer’s human resources. Ask if you need to enroll in Part B. If you do not need Part B because you are still working or your spouse is still working, then call Social Security to delay Part B. Let them know that you have creditable coverage with your group plan. You will receive your Medicare card with Part A (hospital insurance) only. See the Medicare and You Handbook about delaying part B.
Still working are magic words when it comes to enrolling past 65 and losing your or your spouse’s company benefits.
The Medicare and You Handbook discusses under the title, “Should I Enroll in Part B?” about delaying Medicare Part B when you are leaving your or your spouse’s group benefits and that you can sign up for Part B “any time during the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first.”
Part B needs to be enrolled prior to either enrolling in COBRA or retirement group benefits because of the continuation of coverage rules that wants to coordinate with Medicare. No Medicare Parts A or B and you have 8 months to enroll without receiving the famous Medicare Part B penalty.
There are 2 forms available on Social Security’s website. On the top of each form, write SPECIAL ENROLLMENT PERIOD. This tells the Social Security agent that is processing them that you are signing up at the right time and keeps them from giving you a penalty.
Proof of group health care coverage based on current employment. If you have had 2 or more jobs since turning 65, then all companies you or your spouse have worked for from age 65 to the time of retirement, then sign this form. If you are married, you will need the same number of forms filled out for your non-working spouse and signed by the companies’ HR departments for which you or your spouse have worked, proving the non-working spouse was covered under group health insurance. On the top of each form, write SPECIAL ENROLLMENT PERIOD.
This is your and your spouse’s application for medical insurance from Medicare Part B. Social Security fills out this form. Also, on the top of each form, write SPECIAL ENROLLMENT PERIOD.
Take forms in person to your local Social Security office, fax them to the office, or send them by priority mail.
Toni Says: Remember to always make copies of everything you are taking in person or sending to Social Security!
Originally published October 24, 2023