Q&A: How Medicare, COBRA interact

Dear Liz: You recently wrote about how Medicare coverage interacts with employer coverage. My husband will retire next year at age 65. His company has over 20 employees, so it’s considered a large company plan that won’t require him to sign up for Medicare. Is it better for him to elect family COBRA coverage for 36 months and defer Medicare coverage, since his company healthcare plan will be superior to Medicare? Can he elect Medicare coverage once COBRA terminates? Coverage matters more than costs.

Answer: He shouldn’t put off signing up for Medicare, because COBRA won’t insulate him from penalties.

The previous column mentioned that Medicare Part A, which covers hospital visits, is usually premium-free, but people generally pay premiums for Medicare Part B, which covers doctor’s visits, and Medicare Part D, which covers prescription drugs.

Failing to sign up when you’re first eligible for Part B and Part D typically means incurring permanent penalties that can be substantial. You can avoid the penalties if you’re covered by a large employer health insurance plan — but that plan must be as a result of current employment, either yours or your spouse’s. Once your husband retires, his employment is no longer current, so he should sign up for Medicare to avoid penalties.

If you or any other dependents need coverage, he may end up paying for additional insurance through COBRA on top of what he pays for Medicare. He can have both COBRA and Medicare for himself if his Medicare benefits become effective on or before the day he elects COBRA coverage. If he starts Medicare after he signs up for COBRA, his COBRA benefits would cease but coverage for you and any dependent children could be extended for up to 36 months. Another option to consider would be to cover you and any dependents using a plan from an Affordable Care Act marketplace. You may want to discuss your options with an insurance agent before deciding.

In fact, getting expert opinions is a must, because Medicare rules and health insurance in general can be so complex. Anyone nearing 65 also would be smart to discuss their individual situations with their company’s human resources department and then confirm the information with Medicare before deciding when and how to sign up.

Q&A: Medicare vs. spouse’s health plan

Dear Liz: I am planning to retire in a few months at 65. My husband, who is five years younger, works for a corporation that provides excellent health insurance. When I sign up for Medicare, will I still be able to stay on my husband’s health insurance? Which insurance will be listed first for coverage?

Answer: The rules are different depending on whether your husband’s insurance is considered a large employer plan or a small employer plan.

If the plan covers 20 or fewer employees, his employer can boot you off the plan or make it secondary to Medicare. If the plan covers more than 20 employees, though, the employer typically can’t treat you differently from younger employees and spouses and must allow you to stay on the plan, which would remain your primary insurance with Medicare as the secondary insurer.

Medicare penalties are another issue to consider. Medicare Part A, which covers hospital visits, is usually premium-free, but people generally pay premiums for Medicare Part B, which covers doctor’s visits, and Medicare Part D, which covers prescription drugs. If you don’t sign up for Medicare Part B and Part D when you’re first eligible, you could face permanent penalties that would raise your monthly premiums for life.

These penalties don’t apply if you put off signing up for Part B and Part D because you’re covered by a large employer health insurance plan from current employment, either yours or your spouse’s. Once that employment or coverage ends, though, you’ll need to sign up for Part B and Part D promptly or the penalties kick in.

Notice the use of the words “typically,” “normally” and “generally” in the paragraphs above. Medicare’s rules and exceptions can be tricky to navigate. Talk to the benefits manager at your husband’s company so you know where you stand, and what parts of Medicare to sign up for as you turn 65.

Wednesday’s need-to-know money news

Today’s top story: Understanding the differences between Medicare and Medicaid. Also in the news: How hungry college students can get help, Robinhood takes another shot at cash management accounts, and a new scam that asks for your bank PIN on the phone.

Hunger on Campus: How College Students Can Get Help

What Is the Difference Between Medicare and Medicaid?
Understanding the government-run health care plans.

Robinhood Takes Another Shot at Cash Management Accounts
This time with FDIC backup.

Beware a New Scam That Asks for Your Bank PIN on the Phone
This is a particularly savvy scam.

Q&A: Medicare has a prerequisite

Dear Liz: In a recent column, you mentioned that Medicare Part A is free, but that requires 40 quarters (or 10 years) of U.S. employment to qualify. There are, unfortunately, many of us with offshore employment who have found this out too late. Even if one has worked in a country with a tax treaty with the U.S. that allows you to transfer pension credits to Social Security, that will not allow you to qualify for Medicare. I think it would have been very helpful if I had known this about 10 years ago!

Answer: Medicare is typically premium-free, because the vast majority of people who get Medicare Part A either worked long enough to accrue the necessary quarters or have a spouse or ex-spouse who did. (Similar to Social Security, the marriage must have lasted at least 10 years for divorced spouses to have access to Medicare based on an ex-spouse’s record.)

But of course there are exceptions, and you’re one of them. People who don’t accrue the necessary quarters typically can pay premiums to get Part A coverage if they are age 65 or older and a citizen or permanent resident of the United States. The standard monthly premium for Part A is $437 for people who paid Medicare taxes for less than 30 quarters and $240 for those with 30 to 39 quarters.

Q&A: Avoiding Medicare sign-up penalties

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.)

Thursday’s need-to-know money news

Today’s top story: What will long-term care cost you? Also in the news: Social Security myths, the best cities for first-time home buyers, and how to pay less to your credit card company.

What Will Long-Term Care Cost You?
Almost everyone will need it after 65.

Don’t Believe These Social Security Myths
Checking the facts.

These are the best cities for first-time home buyers
7 spots to look at.

Here’s how to pay less to your credit card company
Just pick up the phone.

What will long-term care cost you?

Many people are frightened of long-term care costs — for good reason.

Most people over 65 eventually will need help with daily living tasks, such as bathing, eating or dressing. Men will need assistance for an average of 2.2 years, while women will need it for 3.7 years, according to the U.S. Department of Health and Human Services’ Administration on Aging.

In my latest for the Associated Press, the high cost of long-term care and why planning ahead is essential.

Q&A: Timing those spouse benefits

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

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

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.