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Clearing up confusion: Here are the steps to enrolling in Medicare

Dear Toni: I am turning 65 soon and working full time with employer benefits. I am receiving conflicting information from friends and co-workers regarding enrolling in Medicare. Some say to enroll in only Part A, while others say to enroll in both Parts A and B. Can you please explain what I should do? — John, Rosenberg, Texas

Dear John: Enrolling in Medicare can be very confusing. Many people think that when they turn 65, a magical switch is turned on and — poof! — they are on Medicare. Here’s a summary of the steps to enrolling:

If you are turning 65 and receiving your Social Security check:

■ You should receive your “Welcome to Medicare” kit with your Medicare card 90 days before your 65th birthday.

■ If you are not working full time with employer benefits or are covered by your spouse’s employer benefits when turning 65, and therefore do not want to pay for Medicare Part B, do not return your Medicare card. Doing so can cause you to receive the infamous Part B penalty.

If you are turning 65 and not receiving your Social Security check:

■ Because you are not receiving your Social Security check, there’s no automatic “Welcome to Medicare” kit with your Medicare card when turning 65.

■ You must enroll in Medicare Parts A, B and D to keep from receiving a late-enrollment penalty.

■ You must enroll in Medicare at ssa.gov/medicare at least 90 days before your 65th birthday for your Parts A and B to begin the first day of the month you turn 65.

If you are turning 65 and still working full time:

1. If you have individual health insurance and are working full time or as contract labor with individual health insurance, then you should enroll in Medicare Parts A, B and D when turning 65 to avoid a Part B and D penalty. Medicare does not recognize individual health plans as “creditable coverage.”

2. If you have “qualified” employer benefits, Medicare allows you to delay your Medicare Parts A and B if you or your spouse are working full time with employer benefits — not retirement benefits. (“Still working” are Medicare’s magic words for delaying your Part B.)

■ If you are 65 or older and there are 20 or more employees where you receive benefits, the group health insurance pays first.

■ If you are 65 or older and there are fewer than 20 employees where you (or the working spouse) receive benefits, generally Medicare pays first. Your human resources department (or you) should verify with the insurance carrier as to how the current health insurance plan coordinates with Medicare to determine whether you should enroll in Medicare Parts A and/or B or can delay enrollment in Medicare.

If you have qualified employer benefits and can enroll in Medicare after 65:

■ When you are ready to enroll after delaying your Medicare Part B, have your human resources department fill out and sign the Social Security form CMS-L564 (“Request for Employment Information”), and fill out and sign CMS-40B (“Application for Enrollment in Medicare Part B”) yourself. Under question 12 of CMS-40B, state the month in which you want your Medicare Part B to start.

■ Take your forms to your Social Security office in person (the preferred option) or fax them to enroll in Medicare Part B. Write special enrollment period across the top of each form to avoid the Part B penalty.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.

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