How To Know If Medicare Part B Is Right For You

Question: I don’t know if I need Medicare Part B. How do I find that out? I have Medicare Part A already.

Answer: This question came at the perfect time. We are currently in the General Enrollment Period for Medicare Part B. Each year from Jan. 1 to March 31, the General Enrollment Period (GEP) allows those individuals who did not signed up for Medicare Part B when they should have, to sign up for their Part B benefit. This Medicare Part B benefit will then start on July 1 of this year.

More on this a little later, let’s first review Medicare Parts A and B.

Original Medicare is considered Medicare Part A and Medicare Part B. Most individuals are eligible for Medicare when they turn 65. Some individuals are eligible for Medicare earlier in life, usually due to a disability or illness.

Medicare Part A is the hospitalization coverage, and for most enrollees has no monthly premium. Medicare Part B is considered Medical coverage, which we commonly call outpatient services. Most enrollees this year pay a monthly premium of $135.50 for the Medicare Part B benefit. Some individuals pay more than that for two reasons 1) they are higher income or 2) they enrolled in Medicare Part B late.

You have Medicare Part A already, but do not have Part B. There is really just one good reason to not have Medicare Part B if you are eligible for it. The reason is that you have health insurance from a current employer or your spouse’s current employer.

If you are currently going to work and have employer health coverage and your employer group is larger than 20 employees, you do not need to sign up for Medicare Part B.

If you are not going to work or get your insurance from a spouse who is not going to work, you must have Medicare Part B. Also, if your employer group is less than 20 employees or your insurance from your spouse is through a group of less than 20 employees, you must have Medicare Part B.

If you have retiree coverage from anywhere, you must have Medicare Part B.

If you have health insurance, but are not working at the employee group that the insurance is provided by, you must have Medicare Part B (This could be from a previous employer of yours that is still providing you with health insurance.)

If you have Veterans Administration coverage and use that for your primary medical needs, I strongly recommend you have Medicare Part B.

If you are a federal retiree or retired postal worker, I strongly recommend you have Medicare Part B.

I think that covers everyone who could be eligible for Medicare, doesn’t it? Each year, I meet individuals who did not enroll into Medicare when they should have. This GEP is their opportunity to now sign up for Medicare Part B, between Jan. 1 and March 31. Once they use this GEP to sign up for Medicare Part B using the forms provided by Social Security Administration (SSA), they will receive their Medicare Part B benefit beginning July 1 of this year. That is a significant delay in getting the coverage I say you need. But if you don’t use this period this year, you will have to wait to the GEP next year and then wait until July 1 of that year!

Centers for Medicare and Medicaid Services (CMS) should be sending you a letter to remind you to sign up for Medicare Part B if you haven’t already. Those letters are issued to everyone who doesn’t have Medicare Part B and some of you are allowed to wait to sign up. As I already mentioned, you may have legitimate reasons to delay signing up for Medicare Part B.

Those individuals who are still working, or whose spouse is still working and provides them insurance do not need Medicare Part B.

As long as your employer group is larger than 20 employees, you don’t have to sign up for Medicare part B at age 65.

If you have Medicare coverage due to a disability, that employee group must be 100 employees. The individuals who have Medicare due to a disability, are people who sometimes get missed by the system. Their spouse’s employer may not know they have a disability and are Medicare eligible, so they sometimes miss their Initial Enrollment Period to get Medicare Part B. This GEP is their opportunity to get the coverage they need.

I sometimes talk with individuals who use the VA for their health and medical needs. These individuals can get much of their medical care through the VA Health system, BUT when they need emergency care, that is not always possible through the VA Health system. I say “If you dial 911, a Medicare ambulance is coming to pick you up.” Ambulance Service is covered under Medicare Part B. If a veteran decided to not enroll in Part B, the Ambulance is his bill entirely to pay. When the ambulance brings you to an emergency room, that is also a Medicare Part B billable item. The veteran will pay for the Emergency Room entirely themselves. If that veteran is admitted to the hospital, the Medicare Part A will pay most of that hospital stay. This is why I strongly advise Veterans to enroll in Medicare Part B. I understand they mostly use the VA Health care system, but sometimes they may need the Medicare system.

I also talk with individuals who are retirees from the federal employee system, or the postal worker who is now retired. These individuals often get federal retiree benefits, and these plans do not require the individual to join Medicare Part B, but they will have a penalty if they decide to enroll later. The insurance will cover them even if they don’t enroll in Medicare. If they do choose to enroll in Medicare Parts B, they will have more comprehensive insurance coverage.

Those individuals who are not working and didn’t sign up for Medicare Part B when eligible, are accumulating an enrollment penalty that is paid once they enroll. If they never sign up for Medicare Part B, they never pay the premiums or the penalty. If they decide to enroll in Part B at some time in the future, they have a penalty for the period of time they did not have Part B. The Part B Penalty is 10 percent for each twelve (12) months you don’t have Medicare Part B. That means the current penalty is 10 percent of $135.50 for each of the twelve months without Medicare Part B. This year’s amount is $13.55 for each twelve months without insurance. That doesn’t sound like a lot, but it is paid every month for the rest of your life after you enroll. That is an extra $162.60 a year, for each year you did not have Medicare Part B.

I encourage individuals to enroll in Medicare Part B, even if they are veterans or Federal retirees because those penalties can add up fast, making Medicare more and more expensive every year.

The General Enrollment Period rolls around every year. Each year some individuals use this opportunity to get the Medicare Part B coverage they didn’t enroll in earlier. I am hoping I clarified for you whether you need Medicare Part B or not. If you still don’t understand, please reach out and ask us. We love talking about Medicare.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.