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 January 1st to March 31st, the General Enrollment Period (GEP) allows those individuals who did not sign up for Medicare Part B when they should have, an opportunity to sign up for their Part B benefit. There are NEW rules for the GEP this year. When you sign up for Medicare Part B during the GEP, your benefits begin the first of the following month. Signing up now in March means you will have your Medicare Part B on 4-1-23.

Original Medicare is Medicare Part A and Medicare Part B. Medicare Part A is the hospitalization coverage, and Medicare Part B is Medical coverage (outpatient services). Most enrollees pay no premium for Medicare Part A and a monthly premium of $164.90 for the Medicare Part B benefit. Some individuals pay more than that for two reasons: 1) they have 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. 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 health insurance 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 VA coverage and use that for your primary medical needs or 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 Part B, doesn’t it? Each year, we talk with 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 January 1st and March 31st. Once they use this GEP to sign up for Medicare Part B using the forms provided by Social Security Administration (SSA) (40B & L564), they will receive their Medicare Part B benefit beginning the 1st of the next month. If you don’t use this time period this year, you will have to wait for the GEP next year and that means more penalties.

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. 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, which 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% for each twelve (12) months you don’t have Medicare Part B. The current penalty is 10% of $164.90 for each of the twelve months without Medicare Part B. This year’s amount is $16.49 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.

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 reminding you of this GEP. Please reach out and ask us questions. We love talking about Medicare!

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions, concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email SLM@lutheran-jamestown.org.