To ‘B,’ Or Not To ‘B,’ That Is The Question
Question: I have Medicare A and I have health insurance from my employer. I recently got a letter from Medicare saying I might have to sign up for Part B. Is that true? I was told previously that I didn’t need Part B. Can’t I sign up for Medicare Part B anytime?
Answer: “It Depends!” This question can have so many answers. You explained your situation well; you are working, you carry insurance from your employer and you have Part A only. Medicare has started working harder to be sure that those eligible for Medicare get signed up in an appropriate manner. The letter you received is part of that effort.
For those individuals who have only Medicare Part A, Centers for Medicare and Medicaid Services (CMS) has started mailing a letter to state that you may need to sign up for Medicare Part B. You received that letter because you have Medicare Part A only AND we are currently in the General Enrollment Period. The General Enrollment Period (GEP) for signing up for Medicare Part B is now, it runs from Jan. 1 to March 31 each year. If you failed to sign up for Medicare Part B when you should have, you can sign up now during the Annual GEP and your Medicare Part B will begin July 1st. This GEP is appropriate for those individuals who failed to sign up for Medicare Part B when they should have started.
This does NOT sound like your situation, but Medicare sent you that letter because you only have Part A and they are reaching out to everyone in that situation. It is a general letter informing you about the GEP and the rules around that.
Your individual situation is different. You have insurance from an employee plan. I am hoping your employee group is larger than 20 employees if you are over 65 (larger than 100 employees if you have Medicare due to a disability). As long as your employee group meets those size requirements, and you carry insurance through your employee group, it means that Medicare is secondary in your situation and therefore you do not need Medicare Part B at this time. You have done the right thing for you.
Once you stop working, or decide to drop the employee coverage, you have a Special Enrollment Period (SEP) to sign up for Medicare Part B at that time. Once you complete the paperwork to get your Medicare Part B started, your coverage will begin and you will begin to pay the Medicare Part B premium ($134 per month for most enrollees).
Each person’s situation is different than any other person. Remember that Medicare Part A, B and D all have different rules. So in this article I am speaking to the rules regarding Medicare Part B only.
If you turned 65 and were working, or covered by your employee insurance, you may have signed up for Medicare A and refused Part B because you had insurance from another source. You made a correct decision in this scenario. Your decision to refuse Part B, means that at some point you have to change that decision and enroll in Part B. That point should be when you stop working or when your insurance coverage ends or is more expensive than you think it is worth. If you drop your employee coverage and request Part B to start immediately you are fine, no gap in coverage and therefore no problems. Sometimes individuals do not make that transition as smoothly, since they don’t sign up for Medicare Part B in a timely manner.
For Medicare Part B, the window to sign up after your coverage ends, is 8 months. You have 8 months from the date your coverage ends, to the start date of Medicare Part B, without a penalty from Medicare. Now I would not recommend going for 8 months without Part B insurance coverage, but sometimes people want to do that for reasons that make sense for them.
If you go more than 8 months without Part B coverage AND no insurance from another employment source, you will have limited opportunities to sign up for Part B. That limited opportunity is now. The General Enrollment Period (GEP) for Medicare Part B is from Jan. 1 to March 31 each year. When you sign up for Medicare Part B during this GEP your Part B starts July 1. This is another significant delay in insurance.
This delay in signing up for Part B also has a premium penalty. That premium penalty is 10 percent for each 12 months lacking coverage. That penalty of 10 percent is based on the current Part B premium (10 percent of $134) and lasts for the rest of your life.
You can see I don’t recommend delaying enrollment in Medicare Part B. It doesn’t take long for the ‘savings’ of not paying for the premium is eaten up by the penalties and delays.
Some of the reasons that people miss this enrollment in Medicare Part A & Part B is that they have insurance through work, or they have a COBRA plan or they have a Market Place Plan. These last two reasons are NOT good reasons to delay Part B. If you are carrying COBRA insurance and are eligible for Medicare, you MUST enroll in Medicare Part A & Part B. If you have a Market Place Plan you MUST consider enrolling in Medicare. There may be a reason to delay Medicare with a Market Place Plan, but not for most people.
Some individuals are offered insurance at a lower cost or no cost to them when they first leave work, so they keep this insurance and then don’t sign up for Medicare Part B. I would NOT recommend that, you will have a penalty and restrictions in signing up for Medicare Part B when you try to sign up. If you are not going to work for the company that provides the health insurance to you, you almost always need to have Medicare A & B.
So the letter that you received from CMS was a prompter for you to think about your situation and be sure that it is okay to not have Part B. I try to talk about this GEP a lot because there are not many SEP’s available to get you into Medicare Part B if you missed the Initial Enrollment Period (IEP) or the GEP.
Thinking about Medicare and making decisions about Medicare is often “If this than that, but if that than this” type thinking. It makes it hard to understand and follow the right path for you. Thanks for asking for clarification.
To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at email@example.com.