Medicare’s Part B penalty can be costly mistake

Dear Toni: I discovered my mother, Sarah, who is 67, never enrolled in Medicare Part B or a Part D prescription drug plan when she turned 65. She enrolled in Medicare Part A, which doesn’t have a premium, so she could pay her monthly bills. A friend told my mother if she did not go to the doctor, she could wait to enroll in Medicare Part B when she had a health issue.

Last month, my mother was diagnosed with colon cancer and received a bill from the cancer facility for outpatient care because Medicare has denied her cancer claim since she is not enrolled in Part B. I contacted the local Social Security office and was told that she must wait until Jan. 1 to enroll in Part B during Medicare’s general enrollment period. The Social Security agent said my mother had missed her “window of opportunity” by not enrolling when she turned 65 and will receive a Medicare penalty.

What I can do to help my mother? — Marianne, Baton Rouge, Louisiana

Dear Marianne: Your mother, Sarah, has an extremely serious Medicare issue. She will have to enroll during Medicare’s general enrollment period (Jan. 1 to March 31), and she will receive the infamous Part B penalty for the rest of her Medicare life.

That penalty amounts to 10 percent for each 12-month period that a person could have enrolled but did not (so 20 percent, in Sarah’s case).

There is some good news: Because we are in Medicare’s open enrollment period (Oct. 15 to Dec. 7), Sarah can enroll in a Medicare Part D prescription drug plan that begins Jan. 1 to help with her cancer treatment. She may receive a Part D penalty for not enrolling in a plan when her Medicare Part A began.

Medicare enrollment periods are as follows:

Initial enrollment period: This seven-month window includes the month that a person turns 65 as well as the three months before and the three months after.

Special enrollment period: When delaying Medicare Part B enrollment while working full time with employer health insurance benefits, there is an eight-month window to sign up after age 65 and 90 days without receiving a penalty. This window opens when employment or employer health insurance ends, whichever happens first.

General enrollment period: Jan. 1 to March 31, people past age 65 who have not yet enrolled in Medicare and can do so, with coverage to begin the first of the next month. They will receive a penalty.

Unfortunately, millions of Americans are receiving Medicare Part B or Part D penalties because they did not enroll at the right time.

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.