What You Need to Know About Medicare
By Steven A. Buttice
Older adults are working longer. By 2018, 24 percent of men and about 16 percent of women ages 65 and older were in the labor force. These levels are projected to rise further by 2026, to 26 percent for men and 18 percent for women. This is according to the U.S. Census Bureau—Current Population Survey and U.S. Bureau of Labor Statistics—Employment Projections Program. So, you are not alone.
You have things you should know, especially f you are working for a company of more than 20 employees. Generally, you can keep your group coverage and waive Medicare Part B coverage. (Part B of Medicare covers medical expenses such as doctor’s visits, outpatient services, etc.) Some employers are now offering Medicare Advantage Plans when a person becomes eligible for Medicare. In this case, you would need to enroll in Medicare Part B. Then your employer would offer the MAPD plan and remove you from the pre-Medicare coverage. You can then decide if you want to insure through the company’s insurance or buy your own coverage.
It’s very important to know that if you waive Medicare Part B coverage, you will need to enroll timely during the time of employer coverage loss through a “Special Election Period” (SEP). Ideally, you would start this process 60 days prior to losing employer coverage, but you have up to 60 days after. You actually have 8 months to enroll in Part B, but you will have a gap in coverage; so it’s best to enroll with 60 days. If you wait or miss your SEP, you will have a time period without health coverage. Don’t miss this deadline. Also note: COBRA is not considered creditable coverage by Medicare and does not give you a SEP.
Sounds confusing—doesn’t it? In addition, know you cannot afford to make a mistake. You could end up without any coverage for as long as 11 months and face lifetime penalties. What happens if you have a health event during that time?
Some Medicare basics: Medicare Part A (Hospital) has no premium to people who have worked 40 quarters or married to one who did. Part B (medical) has a standard premium of $144.60 in 2020. Single tax filers considered high earners would have an increased Part B premium if their 2018 income exceeded $87,000 ($174,000 for a couple). This is called “IRMAA.”
People should also carry a Part D plan for prescription drug coverage. This coverage, like Part B, is optional, but is necessary in most all cases. Premiums this year can be under $15.00 here in Central Illinois. If one does not secure a Part D plan timely, they would need to wait to Annual Enrollment from 10/15 – 12/7 to enroll and have a one percent per month penalty when they did not have creditable drug coverage.
In addition, you should know that you may need to apply for Medicare Part B. Unless you are in the system because you or a spouse is on Social Security retirement income, you may need to take action to apply. Look for an envelope from CMS about 3 months prior to age 65 containing your Medicare ID card. If you do not receive your ID card, you should enroll online, call, or go into the Social Security office. If you have questions about this process or are approaching 65, or over, and have employee coverage; or would like a presentation to a group of people, feel free to contact our office.
After enrollment, you can consider a Medicare Supplement or a Part C, Medicare Advantage Plan. This calls for more homework.
To have some fun: We will answer Medicare and/or insurance questions in future articles. If we use your question, we will give you a $5 Starbucks gift card. Feel free to email “Stump the Medicare Guy” at [email protected] or write our office at the contact information below.
Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors and all people with health insurance, including seminars and consultation on Medicare Plans, Long Term Care, and other types of insurance, claims issues, and sales/service of insurance products since 1984. Offices are at 809 W. Detweiller Dr., Peoria, IL 61615. Tel: 693-1060 or 1-800-383-1061. website www.MRMS-INC.com.