Q: I retired from my job at 64, but later went to work part-time for another company providing home care services. I did not sign up for Medicare Part B at 65, because I was still getting healthcare benefits from my former full time employer. I do have Medicare Part A hospital insurance. I recently had to go to the doctor and I was told that, by law, Medicare pays for my healthcare first, and that my retiree coverage from the former employer alone would not cover my doctor visits. Nobody ever told me! I had to pay the entire cost of that visit and tests out-of-pocket. I’m 71 and I can’t afford the cost of health insurance. What can I do?
A: Medicare’s enrollment process is confusing, and the deadlines to enroll are critically important — affecting what you will pay for your coverage. Under Medicare rules, when you turn 65, you may delay signing up for Medicare Part B, if you have health insurance provided by an employer with more than 20 employees and, you are still actively working for that employer. Medicare considers that your health care benefits ended when you left the employer providing the health insurance benefits. Even though you took a part-time job, your health insurance benefits were not provided by that employer, where you were actively working.
If you miss enrolling in Part B when you are first eligible, then you’ll have to pay a late enrollment penalty for your Part B coverage. Your monthly premium for Part B would go up 10% for each full 12-month period that you were late enrolling in Part B. Making matters worse, since you have missed your special enrollment period, you will have to wait to the next Medicare General enrollment period which is January 1 – March 31, to enroll, and coverage will not start until July 1 of that year.
Medicare will count the number of months after your Initial Enrollment Period ended. Your Initial Enrollment Period started three months prior to your 65th birthday, included the full month of your birthday, and ended three months later. Assuming you turn 71 in 2018, then you likely will have a penalty of about 60% (6 years x 10%). The Part B monthly premium in 2019 is estimated to be $135.50 in 2019. A 60% penalty would mean your estimated Part B premium would be $216.80 per month. That premium would be automatically deducted from your Social Security benefit.
If your income is low, however, you might qualify for a Medicare Savings Program. The programs can pay your Part B premiums and, if your income is low enough, you might qualify for help with deductibles, coinsurance and copayments.
To apply for a Medicare Savings Program, you first must apply for Medicare Part B online through the Social Security website, or your local Social Security office. Then, as soon as you receive your new Medicare card, apply for a Medicare Savings Program through your local Medicaid office.
Your situation is complex, and we strongly urge you to get free one-on-one counseling through the State Health Insurance Assistance Program (SHIP). SHIP is a free health benefits counseling service for Medicare beneficiaries and their families or caregivers. States call their SHIP programs by different names but you can find contact info for your state here. Many of the programs work through your area agency on aging or local senior centers.