June 8, 2023 - 8:03 am
Dear Toni: I have been laid off. My husband, Art, who is 70, has been covered under my company’s insurance for the past 15 years. I have opted not to take my company’s COBRA offer because I can get an equivalent monetary payout that should cover my insurance premiums for more than a year. (I am 64 and have gotten quotes from the insurance marketplace in my state.)
We have been told that Art will get a Part B penalty because he is over 65 and never enrolled in Part B. Is this true? Please explain what our Medicare enrollment options are since we are different ages and have different enrollment situations. Thanks. — Jen, New York
Dear Jen: There are two rules regarding enrolling in Medicare Parts A and B in your household. I will keep it simple.
Art needs to apply for a special enrollment period. Download forms CMS-L564 and CMS-40B at SSA.gov.
Have your human resources 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 your company benefits and needs his Part B to begin ASAP. Write the effective day as the first of the month in the “remarks” section of his Part B application.
Jen, your way to enroll in Medicare is different from Art’s because you are turning 65 in a year. Go to SSA.gov/benefits/medicare at least 90 days before turning 65 and apply for an effective date of the first day of the month that you turn 65.
Readers, if you need help filing for Medicare Part B, you may call your local Social Security office for help filing the forms. Most Social Security direct phone numbers can be located by searching online for that specific office’s 800 number; or call Social Security at 800-772-1213.
Here is a checklist for those enrolling in Medicare:
1. Original Medicare Part A: Covers inpatient hospital stay, skilled nursing/rehab stay, blood transfusions, home health and hospice.
2. Original Medicare Part B: Covers virtually everything else that is not inpatient services or prescriptions. (i.e., doctor visits, outpatient procedures, physical therapy, durable medical equipment, blood tests, X-rays, CT scans, MRIs, chemotherapy, etc.)
3. Original Medicare/Medicare Advantage: Discuss with your health care facilities and medical professionals which Medicare plans they accept such as original/traditional Medicare with a 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 in network.
4. Medicare prescription drug plans: Research drug plans every year to see if your stand-alone prescription drug or Medicare Advantage Plan with prescription’s formulary covers all your brand-name or generic prescription drugs.
5. Always make copies of every document given to or received from the Social Security office.
Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email firstname.lastname@example.org or call 832-519-8664.