I Am About To Turn 65 My Spouse Is 60 And Still Working We Are Both Covered Under Her Employers Health Plan Do I Have To Do Anything With Regard To Medicare This Year
A person with group health coverage through a current employer may be able to delay enrolling in Part A and Part B until that coverage ends, and wont face penalties for enrolling later, but only if the employer has 20 or more employees. If your wifes employer has at least 20 employees, you may want to enroll in Part A but delay enrollment in Part B until your group coverage through your spouses employer plan ends.
If you are already receiving Social Security benefits, you will be automatically enrolled in Part A and Part B when you turn 65. If you do not want to pay a premium for Part B benefits now because you have comparable coverage under your spouses employer plan, you will need to let Social Security know that you want to delay Medicare Part B enrollment. You can contact Social Security about this beginning three months before you turn 65. Otherwise, Medicare will assume you want to enroll in Part B and the monthly premium will be automatically deducted from your Social Security check.
If the employer has fewer than 20 employees, you should sign up for Part A and Part B when youre first eligible or you will face late enrollment penalties.
If you do delay Part B enrollment because you are covered under your wifes plan, remember to sign up for Part B once her coverage ends. That way, youll have continuous coverage and wont face a late enrollment penalty for Part B.
How Do I Disenroll From Medicare Part B
You cant disenroll online. If your employers coverage is primary and you decide to drop Part B, you need to submit Form CMS-1763 to the Social Security Administration. Thats because the agency processes both Medicare enrollments and cancellations for the Centers for Medicare and Medicaid Services , which administers the Medicare program.
You can submit the form in person at your local Social Security office. Or call the Social Security Administration at 800-772-1213 to request the form, and youll be told where to send it.
Two witnesses who know you and are willing to supply their names and addresses must see you sign it. You cant submit the form electronically, and it is processed manually.
Youll want Part B back eventually. To restore Part B when your new employers coverage ends, youll have to take action. Youll need to sign up again for Part B no later than eight months after your on-the-job insurance ends.
If you miss that special enrollment period, youll need to wait to reenroll until the next general enrollment period, Jan. 1 to March 31. Your coverage will start the first of the month after the month you enroll. But if you dont act quickly, you may have to pay a permanent late-enrollment penalty.
What Is The Medicare Cross
Retirees only: Medicare Cross-over is designed to eliminate some of the paperwork involved in filing medical claims. Some plans have an agreement with Medicare to crossover claims for any services that Medicare processed as primary. Medicare will automatically forward your Medicare Summary Notice to those plans for services you receive throughout the United States. Claim forwarding is automatic for each person covered under Medicare when a plan participates in Medicare Cross-over. You do not need to complete a form or contact a plan to take advantage of crossover. Please contact your health plan for further information.
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You Want To Use Your Current Veterans Affairs Benefits
If youre a military veteran and have benefits through the Department of Veterans Affairs, youre covered only for services provided at VA facilities. VA benefits typically wont cover services you get at outside facilities, unless specifically authorized by the VA.
In this instance, it makes sense to enroll in Medicare Part A, so you can access services you may need at non-VA hospitals.
You might be better off getting Part B during initial enrollment as well, even though you have to pay a monthly Part B premium. If you defer enrollment, long-term penalties will raise your rates.
If you do enroll in Part B, your VA benefits will continue to pay for things that Medicare doesnt cover, such as hearing aids and over-the-counter medications. You may also qualify for help paying your premiums through a Medicare savings program.
For flexibility, you might also want to enroll in a Medicare Part D plan or a Medicare Advantage plan that covers medications.
VA benefits include prescription drug coverage thats considered to be at least as good as Medicare coverage. But it requires you to use a VA medical provider and pharmacy.
If you lose your VA benefits or decide you want a Part D plan, you may enroll without penalty, even after your initial enrollment period expires.
I Am Receiving Social Security Disability Benefits
You will be enrolled in Original Medicare automatically when you become eligible for Medicare due to disability. Youll get your Medicare card in the mail. Coverage usually starts the first day of the 25th month you receive disability benefits.
You may delay Part B and postpone paying the premium if you have other creditable coverage. Youll be able to sign up for Part B later without penalty, as long as you do it within eight months after your other coverage ends.
Youll need to inform Medicare of your decision before your Part B coverage starts. Follow the directions on the back of your Medicare card.
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You Found Private Medical Insurance That You Prefer
For most seniors, Medicare will be the best insurance plan out there. However, some individuals have specific needs that arent covered as thoroughly by Medicare as by private insurance companies. An example of this includes long-term care for dementia and Alzheimers patients, which isnt usually covered by Medicare.
To remedy this, most people can find a suitable Medicare Advantage plan that fits their needs. However, if you cant find such a plan, it may end up being worthwhile to disenroll in Medicare and enroll in a private health plan that better suits your needs.
In this situation, make sure that you analyze how much your new plan will cost in detail. Although some plans can seem cheaper, this isnt always the case. In this way, finding a private plan will usually be more complex than keeping Medicare. However, it will be the best path forward for some.
Can I Stop Medicare If My New Job Offers Health Insurance
Before deciding whether or not to disenroll from Medicare Part B, first find out whether Medicare is primary or secondary to your employer coverage. That will determine whether dropping Part B could leave you with coverage gaps.
At a large employer. If you work for a company with 20 or more employees, the employers coverage is primary and Medicare is secondary. You can disenroll from Medicare Part B and use your employers coverage instead.
You generally cant drop Part A unless you have to pay a premium for it. For people who have paid Medicare taxes for 40 quarters 10 years of work that dont have to be consecutive Part A is free anyway.
But to avoid a permanent Part B late-enrollment penalty, when you leave, lose or retire from your new job, you must then reenroll in Medicare Part B while youre still on the job or during a special enrollment period that lasts for eight months after your job-based private health insurance stops.
At a small business. The coverage rules are different for smaller companies. For most places with fewer than 20 employees, Medicare becomes your primary coverage at age 65 and the employer plan provides secondary coverage.
This means Medicare settles your medical bills first, and your private group plan pays only for services it covers that Medicare doesnt. If you drop Part B in this situation, you will be left with big coverage gaps.
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If Medicare Coverage Is In Effect How Do I File Medical Part B And Pharmacy Claims
If Medicare is the primary insurance, your provider must submit claims to Medicare first. Once Medicare processes the claim, Medicare will send you a quarterly Medicare Summary Notice . Exception: If you are enrolled in the IYC Medicare Advantage plan, your provider will submit claims to that plan and they will send you an Explanation of Benefits .
IYC Health Plan Medicare:Many of the health plans have an automated procedure after Medicare processes the claim, through which the provider then submits it to the health plan for processing. However, some health plans require members to submit a copy of the MSN and, in certain circumstances, a copy of the provider’s bill. You should discuss with your provider if they will bill Medicare and your health plan on your behalf. Contact your health plan for additional information.
IYC Medicare Advantage:
IYC Medicare Advantage, offered by UnitedHealthcare, allows members to seek care anywhere in the United States and its territories. The benefits are the same in- or out-of-network. You can see any provider that accepts Medicare and is willing to treat you and bill UnitedHealthcare. When you visit your provider, you must show your health plan’s card. Your provider will submit your claims directly to the health plan. To request reimbursement for a covered service charge that you paid, send your receipt and a copy of your card to the address on the back of that card. Contact UnitedHealthcare for more information.
Id Cards & Other Plan Materials
Once your enrollment has been processed, it can take up to two weeks for you to receive your ID card in the mail. In the meantime, we can provide you with your plan policy number that you can use until you receive the card in the mail. You can also create an online account with the insurance company and print a temporary ID card.
The fastest way to secure a new ID card is to call the insurance company or use your online member account to request a new one. When calling, many insurance companies have automated phone prompts through which you can request a duplicate ID card. It usually takes around five minutes to request a new one. You should receive the new ID card in 7-14 business days. Call our team if you need any assistance with this.
Ultimately, you must request a provider directory from your insurance company however, we encourage clients to search online using the insurance company website which contains more current provider information than printed directories. Providers may leave or join a plans network at any time during the year. If you need assistance searching for a provider, call our team for assistance at .
You must contact your insurance company to request plan materials such as the Evidence of Coverage, Summary of Benefits, or Formulary. You can also download the plan materials from your insurance companys website. Contact us if you need assistance with reaching out to your insurance company.
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What Are The Enrollment Periods
A person is first eligible for original Medicare in their initial enrollment period , which begins 3 months before the month they turn 65, includes their birthday month and ends 3 months after the month they turn 65.
People who wait to enroll in Medicare after the IEP and do not qualify to defer may pay a lifetime late enrollment penalty. The penalty increases the longer a person waits to enroll.
The general enrollment period happens every year from January 1March 31. Coverage starts on July 1. People can sign up during this time if they did not enroll during their IEP or if they are not eligible for a special enrollment period .
After a persons IEP ends, they may qualify for a SEP. Generally, people do not pay a late enrollment penalty when they qualify and enroll with a SEP.
People covered by a group health plan through their employer will have a SEP if the person or their spouse is working, or if the person is covered by a group health plan through the employer or union.
The 8-month SEP starts either in the month a person is not employed, or the month after the group health plan ends, whichever event happens first.
A person who qualifies for premium-free Medicare Part A can enroll during their IEP, and they will not pay a premium.
Medicare Part B Deferment Penalties
Part B late enrollment penalties accumulate the longer you defer enrollment. Specifically, your Part B premium goes up 10% for each 12-month period you could have had Part B but didnt enroll.
If at some point you do choose to enroll in Medicare Part B, youll have to pay your Part B penalty every time you pay your premium.
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Medicare Part B Enrollment Avoiding The Part B Penalty
There are a few situations when you may be able to delay Medicare Part B without paying a late-enrollment penalty. For example, if you were volunteering overseas or if you were living out of the country when you turned 65 and werenât eligible for Social Security benefits, you may be eligible for a Special Enrollment Period when you return to the United States. The length of your SEP will depend on your situation. If you arenât sure if you qualify for a Special Enrollment Period, call Medicare to confirm at 1-800-633-4227 , 24 hours a day, seven days a week.
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If I Delay Taking Medicare Part B When Can I Enroll
You can sign up for Medicare Part B at any time that you have coverage through current or active employment. Or you can sign up for Medicare during the eight-month Special Enrollment Period that starts when your employer or union group coverage ends or you stop working . If you get COBRA insurance or retiree benefits after you stop working, keep in mind that this doesnât count as coverage based on current employment make sure you donât wait until your COBRA benefits end to enroll in Medicare Part B.
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How Medicare Advantage Can Save You Money On Your Part B Premiums
If you don’t qualify for the above programs, you still have options. Consider a Medicare Advantage plan that offers a rebate on your Part B premium. Here’s how that works:
A Medicare Advantage plan provides the same or better coverage than Part A and Part B . To receive this coverage, most enrollees pay a premium for their Medicare Advantage plan in addition to the cost of Part B.
But in some areas, typically large cities, Medicare Advantage providers offer $0 plans to better compete with other insurance companies. A few go even further and offer enrollees a rebate on their Part B premiums. If you enroll in one of these plans, you could pay a lower monthly Part B premiumand have more benefits, such as prescription drug, dental, vision, and hearing coverage.
These plans aren’t available in all areas, but even the average Medicare Advantage plan could help save you money. With most plans, you won’t have to pay an extra premium for prescription drug coverage or dental insurance, for example, which could free up some cash to cover the Part B premium.
To find out if a Medicare Advantage plan could save you money, give us a call.
Canceling Part B Because You Cant Afford The Premiums
If you dont have a job with creditable health care coverage but still dont want to pay Part B premiums, use caution. Without health insurance thats as good or better than Medicare, you could start racking up late-enrollment penalties the longer you go without coverage. If you decide to re-enroll in Part B later, these penalties could make your premiums even less affordable.
If you can’t afford your Part B premiums, consider other options before canceling your coverage. You can apply for Medicaid coverage if you’re in a low-income household or have few assets. Medicare also offers several savings programs, which help qualified individuals pay their Medicare expenses.
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Canceling Part B Because You Got A Job With Insurance
If you have had Part B for a while but no longer need it because youve rejoined the workforce with access to employer-sponsored health insurance, congratulations! But before you drop Part B, find out if your jobs coverage is primary or secondary to Medicare.
A primary payer health plan pays before Medicare. That means your employer-provided health plan will cover its share of your health care costs first, and if theres anything left over that Medicare covers, Medicare will pay what remains.
Conversely, a secondary payer health plan covers only costs left over after Medicare covers its share.
If your health plan at work is a primary payer, thats great. Feel free to drop your Part B coverage if you wish. The Part B premiums might not be worth any additional coverage you receive. But if you have secondary-payer insurance at work, its usually better to keep Part B, or you could get stuck paying Medicares share of your health care expenses.
Talk to your human resources department at work to find out if your employer-sponsored plan is primary or secondary to Medicare. Generally, businesses with 20 or fewer employees have secondary payer plans, while larger companies have primary payer plans.
