Medicare

Q&A: Avoiding Medicare sign-up penalties

September 16, 2019 By Liz Weston

Dear Liz: Someone recently asked you if signing up for Medicare is mandatory. Your answer implied no, one does not have to sign up at 65. However, it is my understanding that if a person does not enroll when first eligible, they will be hit with large penalties on their Medicare premiums if they sign up later. Am I missing something?

Answer: Not at all. That answer was too short and should have mentioned the potentially large, permanent penalties most people face if they fail to sign up for Medicare Part B and Part D on time.

To review: Medicare is the government-run healthcare system for people 65 and older. Part A, which covers hospital care, is free. Medicare Part B, which covers doctor’s visits, and Part D, which covers prescriptions, typically require people to pay premiums. Many people also buy Medigap policies to cover what Medicare doesn’t, or opt for Medicare Part C. Part C, also known as Medicare Advantage, is an all-in-one option that includes everything covered by Part A and Part B and may include other benefits.

There’s a seven-month initial enrollment period that includes the month you turn 65 as well as the three months before and three months after.

People who don’t sign up when they’re first eligible for Part B usually face a penalty that increases their monthly cost by 10% of the standard premium for each full 12-month period they delay. For Part D, the penalty is 1% of the “national base beneficiary premium” ($33.19 in 2019) times the number of full months the person was uncovered.

People who fail to enroll on time also could be stuck without insurance for several months because they may have to wait until the general enrollment period (Jan. 1 to March 31) to enroll.

People typically can avoid these penalties if they have qualifying healthcare coverage through a union or an employer (their own or a spouse’s). When that coverage ends, though, they must sign up within eight months or face the penalties. Also, they might not avoid the penalties if their employer-provided coverage becomes secondary to Medicare at 65, which can happen if the company employs fewer than 20 workers. Anyone counting on union or employer coverage to avoid penalties should check with the company’s human resources department and with Medicare to make sure they’re covered.

The original letter writer had no income to pay Medicare premiums, so the answer also should have included the information that Medicaid — the government healthcare program for the poor — might help pay the premiums. People in this situation should contact the Medicaid office in their state. (Medicaid is known as Medi-Cal in California.)

Q&A: Timing those spouse benefits

May 6, 2019 By Liz Weston

Dear Liz: My husband and I are retired. He is 67 and I’m 65. We have been delaying Social Security as we are financially able to wait until he turns 70 to begin benefits. We both turned 62 before January 2, 2016, and are wondering how the “restricted application” rule applies to us. My husband was the primary worker and will have a payout at 70 that is more than twice what I will be paid, so I would be the one taking the spousal benefit. Would you recommend we continue to wait until he is 70 to start benefits, or does the rule make it smarter for us to begin sooner?

Answer: Typically when someone applies for Social Security, she is “deemed” to be applying both for her own benefit and for any spousal benefit that might be available. Restricted applications allowed someone to apply only for a spousal benefit, allowing her own benefit to grow, since delaying the start of benefits increases the amount by about 7% to 8% each year. She could switch to her own benefit when it maxed out at age 70.

Congress changed the rules to eliminate restricted applications for people who turn 62 on or after Jan. 2, 2016. Although a restricted application is still available to you, your husband must be receiving benefits before your spousal benefits can begin. (There used to be something called “file and suspend,” that would allow your husband to trigger spousal benefits without receiving his own, but that has been eliminated. He would have had to reach his full retirement age and requested the suspension before April 30, 2016.)

One other detail that’s important: While your husband’s benefit will continue to grow if he doesn’t start until age 70, the spousal benefit will not. The maximum spousal benefit is 50% of your husband’s benefit at his full retirement age, which was 66. The spousal benefit is further reduced if you should start it before your own full retirement age (which is also 66).

In most cases, it’s best for the higher wage-earner to wait as long as possible to begin, which would mean you would start spousal benefits in three years when your husband turns 70. Remember that it’s the larger check one of you will have to live on after the other one dies; you don’t continue to receive two checks, so it’s usually worth trying to max out the larger one. If you file a restricted application for spousal benefits only, you’d have the option of switching to your own benefit at 70 if it’s larger. You may want to use the Social Security claiming calculator at AARP’s site to evaluate your options.

Q&A: Small firms have special Medicare Part B rules

October 22, 2018 By Liz Weston

Dear Liz: You recently answered a question about whether someone 65 or older with employer-provided health insurance needs to sign up for Medicare Part B, which covers doctors’ visits and requires paying premiums. Your answer was correct for an employee of a large employer. If the employer has 20 or more employees on a typical business day, then the group insurance coverage is primary when the employee has both Medicare and group insurance. So the employee does not need to purchase Medicare Part B. However, if the employer has fewer than 20 employees on a typical business day, then Medicare is primary for the employee. In that situation, the employee should buy Medicare Part B. The group health plan will not pay what Medicare should have paid had the employee elected Part B. Your answer needs the appropriate clarification.

Answer: The question was from a spouse who wanted to make sure that the rules covering her husband — the employee — also applied to her, which they do. The employee was told by his employer that he would not need to purchase Medicare Part B until he retired (and even then, there is an eight-month grace period before penalties start to accrue). That applies to spouses covered by the health insurance as well.

But you’re correct that smaller companies have different rules. It’s always a smart idea to seek clarification directly from a company’s human resources department and the health insurer as well as from the Medicare helpline at (800) MEDICARE ([800] 633-4227).

Q&A: Medicare Part B allows an eight-month grace period

October 15, 2018 By Liz Weston

Dear Liz: I have a question after reading your column about avoiding costly Medicare mistakes. My husband and I have both reached 65 this past year. We both signed up for Medicare Part A hospital coverage, which is free. I retired two years ago, but am covered by my husband’s employer’s health insurance. I’m now confused about whether I should have signed up for Medicare Part B, which covers doctors visits but requires monthly premiums. His employer explained to him that he would avoid penalties if he signed up for Part B within eight months of his retirement, but no one has mentioned his wife.

Answer: You’re covered under the same rules. As long as your spouse is still working and you’re covered by that employer’s health insurance, you don’t have to sign up for Medicare Part B. But, as your husband’s employer noted, when that employment ends you both should enroll in Part B within eight months to avoid future penalties.

Q&A: How to avoid the costly Medicare mistake that too many people make

September 4, 2018 By Liz Weston

Dear Liz: My husband retired last year at 74. He had originally signed up for Medicare Part A and Part B. But during his employment, he cancelled Part B because of the company’s private health insurance. When he retired, we used COBRA to continue that insurance coverage for our family. (I’m not Medicare eligible, and we have a son.) Our COBRA coverage ends in a few weeks.

My husband was told he has to wait until January 2019 to enroll in Part B and will not have coverage until July 2019. He is ineligible for VA benefits and has costly medical expenses. I was able to get an Obamacare plan because coming off COBRA triggers a special enrollment period for me, but he cannot get coverage because he is Medicare eligible.

What a dilemma. No one told us when he retired that he should get back on Part B right away and not take the COBRA offered. Now, when he does get Part B, he will also pay a 20% premium penalty each month for life. We are shocked that the system works like this. Any ideas how to get out of this mess?

Answer: Your husband isn’t alone in misunderstanding the importance of signing up for Part B after retirement. Unfortunately, there’s probably no remedy.

For those who don’t know, Medicare Part A is the hospital coverage that’s provided to people 65 and older. They don’t pay premiums for this coverage. People do, however, pay premiums for Medicare Part B, which covers doctors’ visits and other medical costs. Those who are still working and covered by an employer’s plan often forgo Medicare Part B. Once their employment ends, though, they’re expected to sign up for Part B within 8 months or they pay a 10% premium for every 12 months they failed to sign up. They also have to wait for the regular Medicare enrollment window to roll around, which can leave them exposed to some hefty medical bills in the meantime.

“This is the biggest mistake people make and seriously this rule needs to be changed,” says Carolyn McClanahan, a physician and certified financial planner in Jacksonville, Fla.

There is a process known as “equitable relief” that allows people to request immediate enrollment and the waiving of the penalty, but you have to prove that the failure to enroll was the result of “error, misrepresentation or inaction” by a federal employee or anyone authorized by the federal government to act on its behalf, according to the Social Security Administration. So it’s not enough to inadvertently make a mistake. You have to prove you were misled. You can read more here: https://www.medicarerights.org/PartB-Enrollment-Toolkit/Equitable-Relief.pdf