Things You Should Know About The Need For Medicare Part B

Question: I have been told I need to sign up for Part B. How do I know if I do?

Answer: Happy General Enrollment Period (GEP)!

One of the most important rules to remember is that Medicare Part A, B and D all have different rules. This article defines the rules regarding Medicare Part B only.

Centers for Medicare and Medicaid Services (CMS) will yearly send a letter to those with only Medicare Part A, stating that you may need to sign up for Medicare Part B. It is currently the General Enrollment Period (GEP) allowing you to sign up for Medicare Part B, January 1 to March 31 each year. If you failed to sign up for Medicare Part B when you should have, you can sign up for Part B during the annual GEP. The letter informs you about the GEP and the general rules of the GEP.

When you are working and carry insurance from your current employer, you may not need Medicare Part B. The Medicare Part B exemption requires your employee group must be larger than 20 employees if you are over 65 (larger than 100 employees if you have Medicare due to a disability). When your employee group meets those size requirements, and you can carry insurance through your current employee group, you do not need Medicare Part B. This rule also applies if your coverage is through your spouse and their current employer coverage.

Once you or your spouse stop working, or decide to drop the employee coverage, you have a Special Enrollment Period (SEP) to sign up for Medicare Part B. There is paperwork you must file to get your Medicare Part B started. Once your coverage begins you will begin to pay the Medicare Part B premium ($174.70 per month for most enrollees).

When you turned 65, you were working with insurance, or covered by your spouse’s employer insurance, you signed up for Medicare A and refused Part B because you had insurance from another source. You made the correct decision in this scenario. Your Part B decision will have to change when you or your spouse stop working. This decision could also change because your current insurance coverage is more expensive than Medicare Part B. When you drop your employee coverage and request Part B to start immediately you are fine, as there is no gap in coverage.

You have 8 months to sign up for Medicare Part B after your employer coverage ends. Now I would not recommend going for 8 months without Part B insurance coverage, but sometimes that happens.

If you go more than 8 months without Part B coverage AND no insurance from a current employment source, you will have only the GEP to sign up for Part B, January 1 to March 31 each year. When you sign up for Medicare Part B during this GEP your Part B starts the first of the month following your request (February 1, March 1 or April 1). This late enrollment may also include a premium penalty for time without insurance coverage. The Part B premium penalty is 10% for each 12 months without appropriate coverage. The penalty is based on the current Part B premium (10% of $174.70) and lasts for the rest of your life.

You can see I don’t recommend delaying enrollment in Medicare Part B.

Other scenarios where individuals miss enrollment into Medicare Part A & B are when they have insurance through a past employer which continued to cover them after retirement, a COBRA plan or a Marketplace Plan. These reasons are NOT good reasons to delay Part B. If you are not going to work, you’re carrying COBRA insurance or a Marketplace Plan and are eligible for Medicare, you MUST enroll in Medicare Part A & B.

In some instances, individuals are offered insurance at a lower cost or no cost when they first leave work, so they keep this insurance and don’t sign up for Medicare Part B. If you are not going to work for the company that provides the health insurance to you, you need to have Medicare Part A & B.

This article hopefully prompts you to think about your situation and be sure that it is okay to not have Part B. I try to impress the importance of this GEP because there are not many SEP’s available to get you into Medicare Part B.

Thinking and making decisions about Medicare is often “If this than that, but if that then this” type thinking. It makes it hard to understand and follow the right path for you.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.


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