Social Security & Medicare Questions: July 2012

Social Security & Medicare Questions: July 2012

Q: Presidential candidate Mitt Romney has said he will not enroll in Medicare on his 65th birthday. How does that work? I’ll turn 65 in September and have excellent health coverage that I would prefer to keep.

A: Before you skip enrollment in Medicare, make sure you understand enrollment deadline rules and who pays first once you turn 65 and become eligible for Medicare. A growing number of seniors who pass up Medicare enrollment because they already have good insurance are discovering, too late, that they need to be enrolled in Medicare in order for their other health insurance to work.

The “primary payer” is the insurer that pays what is owed on your bills first, and then your provider sends the rest to the “secondary payer”. Once you turn 65 and Medicare eligible, there are special rules that determine whether your current health plan will pay first or whether Medicare does. If your health plan is not the primary payer, and Medicare is, then your current health plan may not cover any of the costs if you aren’t enrolled in Medicare. Be sure to check your health insurance plan’s benefits administrator first, and here are four things you need to know:

1. Employment status determines whether you can delay enrollment in Medicare Part B. If you or your spouse is still working, and you have health insurance through that employer or union, contact your benefits administrator to find out how your coverage works with Medicare. You might be able to delay enrolling in Part A, B, and Part D without penalty, but you need to check, because not all employer health insurance qualifies, particularly if the employer has fewer than 20 employees. If you lose your job or retire, COBRA and retiree health benefits DO NOT count towards delayed enrollment coverage. Once employment ends, or if your employer drops health insurance benefits (whichever happens first) then you would need to enroll in Medicare.

2. Active duty military should enroll in Medicare before retiring. If you are active duty military and eligible for TRICARE For Life, you need to enroll in Medicare before you retire to avoid a lapse in coverage. TRICARE For Life pays for services from a military hospital or other federal providers, but may pay second otherwise.

3. Medicare needs to be notified to ensure proper payment. About three months before you turn age 65 and are eligible to enroll in Medicare, you will receive a letter with a username and password for Visit the site to fill out your “Initial Enrollment Questionnaire” (IEQ) to make sure your medical bills are paid correctly and on time. The IEQ asks if you have group health plan coverage through your work or a family member’s work.

4. Check your insurance policy about who pays first. Your current policy may include rules about who pays first. Or call the Medicare Coordination of Benefits Contractor at 1-800-999-1118. For more information see the Medicare publication “Who Pays First”, CMS Product No. 02179.