Column: Will I Be Penalized For Not Getting Medicare At 65 It Depends
Ask Phil, aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of the book, Get Whats Yours for Medicare, and co-author of Get Whats Yours: The Revised Secrets to Maxing Out Your Social Security. Send your questions to Phil.
When You Miss A Part C Or Part D Premium
If you miss a Part C or Part D premium, the consequences will depend on your specific plan. Either way, your coverage cant be dropped without warning.
All Part C and D plans must have a grace period thats at least two months in length, and some plans have a longer grace period. If you fail to make a premium payment, your plan must send you a written notice of non-payment and tell you when your grace period ends. Only once you fail to make your payment by the end of your grace period do you risk disenrollment from your plan. In some cases, youll be given the option to contact your plan administrator if youre behind on payments due to an underlying financial difficulty.
If youre disenrolled from your Part D plan, youll have the option to re-enroll during the Annual Election Period, which runs from October 15 to December 7 of every year. Keep in mind that if youre disenrolled due to a failure to pay your premiums, you may be required to make good on your outstanding premiums before getting back on the plan you once had. Furthermore, if you go without drug plan coverage for 63 days or more, you may be liable for a Part D late enrollment penalty once you sign up for a new plan.
If youre disenrolled from Medicare Advantage, youll be automatically enrolled in Original Medicare. During this time, you may lose drug coverage. You can then enroll in Medicare Advantage again during the Annual Election Period of October 15 through December 7.
I Have An Employer Health Plan Through My Job
You may be able to delay Part B enrollment if all of the following statements are true.
You may qualify for a Special Enrollment Period when your employer coverage ends if you meet these qualifications. Youll have eight months to sign up for Part B without penalty. You can also and sign up for Part A if you havent already.
If you have coverage from a small company with fewer than 20 employees, youll likely need to enroll in Medicare Parts A & B when you turn 65. Small workplaces are not required to continue your health care coverage once youre eligible for Medicare.
NOTE: If you have health coverage through your spouses employer, regardless of the employers size, you may need to enroll in Medicare in order to stay on the employer plan as a dependent. Check with the employer about their rules for covering Medicare-eligible spouses.
Whats The Penalty If You Dont Sign Up For Medicare
Some people donât realize that there may be penalties for not signing up for Medicare when theyâre first eligible. Most people donât pay a late-enrollment penalty for Medicare Part A. If you delay enrollment in Medicare Part B and/or Medicare Part D, you might face penalties. Donât worry â there are usually ways to avoid these penalties. Weâll take you through some common scenarios.
Get Help Finding A Medicare And Medicaid Policy
Medicaid and Medicare are not that similar. Medicaid is available to individuals and families living below the poverty level. But, Medicare is for people 65 and older, as well as those on disability.
Once you have clarity on the facts regarding Medicare vs. Medicaid, you can make the right decisions. If you have questions about your Medicare options, contact us today.
Our agents can inform you of all your options. Call us at the number above and we can help you review your best options. Or, fill out an online rate form to see your rates now.
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I Have Va Health Care Benefits
VA benefits cover care you receive in a VA facility. Medicare covers care you receive in a non-VA facility. With both VA benefits and Medicare, youll have options for getting the care you need.
Its usually a good idea to . VA health care benefits do not qualify as creditable coverage. You may have to pay a penalty if you delay Part B enrollment, unless you have other creditable coverage such as through an employer.
What Happens If You Opt Out Of Part B
Be aware that if you opt out of Part B and then later decide to join, you will pay a Part B late penalty. Youll also need to wait until the next General Enrollment Period to enroll, which means there could be a delay before your coverage becomes active. In my opinion, most Veterans should sign up for Part B.
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The Cares Act Of 2020
On March 27, 2020, President Trump signed a $2 trillion coronavirus emergency stimulus package, called the CARES Act, into law. It expanded Medicare’s ability to cover treatment and services for those affected by COVID-19. The CARES Act also:
- Increases flexibility for Medicare to cover telehealth services.
- Increases Medicare payments for COVID-19related hospital stays and durable medical equipment.
For Medicaid, the CARES Act clarifies that non-expansion states can use the Medicaid program to cover COVID-19related services for uninsured adults who would have qualified for Medicaid if the state had chosen to expand. Other populations with limited Medicaid coverage are also eligible for coverage under this state option.
Can I Get Medicare If I Turned 65
You say you chose not to get Medicare, so I assume you already have turned 65. But if you just turned 65, its standard for Social Security to send you notice about Medicare enrollment. Social Security administers many aspects of Medicare including the enrollment process and handling the deduction of Part B premiums from monthly Social Security …
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Do I Have To Sign Up For Medicare When I Turn 65
The short answer? It depends. Most people whove worked and paid taxes are eligible for premium-free Medicare Part A when they turn 65, even if they still have health insurance from an employer. So signing up right away makes sense.
Part B, on the other hand, requires that you pay a monthly premium , so if you feel you dont want it or need it, you may assume you can just delay your enrollment.
But depending on your circumstances, it may be in your best interest to to avoid any late enrollment penalties.
Stay Put And Pay The Difference
If your doctor is what’s called a non-participating provider, it means they haven’t signed an agreement to accept assignment for all Medicare-covered services, but can still choose to accept assignment for individual patients. In other words, your doctor may take Medicare patients but disagrees with the program’s reimbursement rates. These non-participating providers can charge up to 15% over the official Medicare reimbursement amount.
If you choose to stick with your non-participating doctor, you’ll have to pay the difference between the fees and the Medicare reimbursement. Plus, you may have to cough up the entire amount of the bill during your office visit. If you want to be paid back afterward, either your doctor will submit a claim to Medicare, or you may have to submit it yourself using Form CMS-1490S.
Let’s say, for example, your doctor’s bill comes to $300, and Medicare pays $250. This means you’ll have to pay the $50 difference, plus any copay, out of pocket, assuming your doctor agrees to the program’s reimbursement rates. This can add up quickly over time. However, you may be able to cover these extra expenses through a Medigap insurance policy, aka Medicare Supplement Insurance. Provided by private insurers, it is designed to cover expenses not covered by Medicare.
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Visit An Urgent Care Center
Urgent care centers have become a popular place for people to go for their healthcare needs. There are now more than 9,000 urgent care centers in the U.S. These centers may also operate as walk-in clinics. Many provide both emergency and non-emergency services, including the treatment of non-life-threatening injuries and illnesses, as well as lab services.
Most urgent care centers and walk-in clinics accept Medicare. Many of these clinics serve as primary care practices for some patients. If you need a flu shot or you’ve come down with a relatively minor illness, you may consider going to one of these clinics and save the doctor visits for the big stuff.
What Happens If We Dont Take Medicare Part B
Q. My husband turns 65 this month. We have chosen not to participate in Medicare Part B. We have full coverage insurance through his retirement program from the federal government. We are curious as to whether or not this was the right decision. I am not yet 65 so we have to keep this coverage until I receive Medicare. What are the consequences if we dont take Part B?
A. Were glad you asked.
Its very important to understand the consequences of not taking Part B, which you do not have to take.
The first thing that you need to find out is if Medicare is primary on your husbands retirement plan, said Jeanne Kane, a certified financial planner with JFL Total Wealth Management in Boonton.
If it is, he must sign up for Medicare Part B to avoid coverage gaps, she said.
In almost all circumstances, if you are Medicare eligible and participating in a retirement program, then Medicare becomes primary to the retirement plan, she said. This means Medicare is responsible for its portion before the retirement plan contributes towards any medical bills.
For example, she said, Medicare covers the first 80% of Medicare-approved medical expenses, such as doctors, other providers, tests, durable medical equipment, and more, so you have significant exposure, she said.
So if you dont have Medicare Part B and have a $10,000 medical event, you would be responsible for $8,000 before his retirement program kicked in, she said.
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Why Would I Opt Out Of Medicare
Part B comes with a premium in most cases. Some people delay enrollment in Medicare Part B to avoid paying the premium â especially if they have other coverage. The same can be true of Part A, for people that must pay a premium for it.
If you delay enrollment in Part B or Part A, make sure you plan it well to avoid problems. For example:
- Group health plans may have different coverage rules if youâre eligible for Medicare coverage. Check with your plan and ask how it would work with and without Medicare.
- You might face a late enrollment penalty if you delay Part B and/or Part A coverage. To avoid a penalty, make sure you enroll in Medicare promptly when your employment ends, or when the group health coverage ends. After the month coverage or employment ends , you might have an 8-month Special Enrollment Period to enroll in Medicare without a penalty. Ask your benefits administrator, or contact Medicare.
What If I Need To Be In A Nursing Home
Medicare covers most of the costs associated with skilled nursing after an inpatient stays in the hospital. If you have both Medicare and Medicaid, a stay at a skilled nursing facility will cost very little.
After inpatient treatment, many patients need more outpatient care in the home setting. To learn how to get financial assistance for home health care, read How to Qualify for Home Health Care & Get Financial Assistance.
If you require assisted living because you are no longer able to live independently, read Does Medicare Cover Assisted Living Costs? What About Independent Living?
If you need long-term care and have limited resources, Medicaid can help, however, strict asset limits do apply. We have a complete guide to long-term care if you need it.
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Information About Your Rights And Privacy
With a Kaiser Permanente Medicare health plan, you have a range of guaranteed rights and protections, including:
- Timely access to covered services and drugs
- Fair and respectful treatment at all times
- The right to file a complaint
- Security and privacy for your health information
- Clearly explained treatment options and participation in making decisions about your treatment options
- The right to get plan information and treatment explanations in a language or format that works for you
Find more details in your plans documents, such as the Evidence of Coverage, or in the Medicare & You handbook available at medicare.gov. You also can call Medicare at 1-800-MEDICARE , 24 hours a day, 7 days a week.
Q: How do I ask for coverage for a medical service or payment of a bill? A: To request a coverage decision about medical services youd like but havent received, or about payment of a bill, contact Member Services.
A response for a standard request for care or services can take up to 14 calendar days. A response for a request for payment can take up to 30 days. If your health requires a quick response, you should ask us to make a “fast coverage decision.” You, your doctor, or your representative can make the request for medical care. We’ll respond to a fast coverage decision within 72 hours. If we say no to your request for coverage for medical care or payment, you can ask for an appeal.
For additional details, see Chapter 9 in your Evidence of Coverage.
What Do Medicare Parts A And B Cover
Part A, which in most cases is free, covers:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care
- Home health care
In 2022, the deductible for Part A is $1,566.
Part B, which has a standard premium of $170.10 in 2022, covers medically necessary services and preventive services such as:
- Durable medical equipment
- Inpatient and outpatient mental health services
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Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
Can Doctors Refuse Medicare
The short answer is “yes.” Thanks to the federal program’s low reimbursement rates, stringent rules, and grueling paperwork process, many doctors are refusing to accept Medicare’s payment for services.
Medicare typically pays doctors only 80% of what private health insurance pays. While a gap always existed, many physicians feel that Medicare reimbursements haven’t kept pace with inflation in the past several years, especially the rising costs of running a medical practice. At the same time, the rules and regulations keep getting more onerous, as do penalties for not complying with them.
Most American physicians participate in Medicare and “accept assignment” for their services without additional charges. However, if your doctor is non-participating or has opted out of Medicare, here are five options.
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What Is The Medicare Savings Program
There are four types of Medicare Savings Programs:
- Qualified Medicare Beneficiary Program
- Specified Low-Income Medicare Beneficiary Program
- Qualifying Individual Program
- Qualified Disabled and Working Individuals Program
If you answer yes to these 3 questions, to see if you qualify for assistance in your state:
If you qualify for the QMB program, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare drug coverage.
Its Worth Asking Human Resources These Questions
If youre covered by a GHP and will be qualifying for Medicare soon, its worth your time to talk to Human Resources about transitioning to Medicare coverage. Heres what you should ask:
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He managed a Medicare technical assistance contract at the Medicare Rights Center in New York City and represented clients in Medicare claims and appeals. Josh also helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including an associate at Sachs Policy Group, where he worked with insurers, hospital, and technology clients.
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