Medicare Part B Enrollment Rules
Before you sign your clients up for Medicare Part B you need to be aware of the Medicare Part B enrollment rules
Should you get part B?
Most people should enroll in Medicare Part A (Hospital Insurance) when they’re first eligible, but certain people may choose to delay Medicare Part B (Medical Insurance). In most cases, it depends on your situation and the type of coverage you are going to have.
Make sure you to be careful when deciding to enroll in or drop Medicare part B. If you do not enroll in part B when during the election period to do so, you may not be able to sign up for it down the road when needed. When you do decide to drop part B you can use the methods below.
If your Medicare has not started yet, there are 2 ways to drop part B:
- If you were automatically enrolled in both Part A and Part B and sent a Medicare card, follow the instructions that come with the card, and send the card back. In fact, if you keep the card, you keep Part B and will pay Part B premiums.
- If you signed up for Medicare through Social Security, contact Social Security. They will be able to assist you with dropping your part B coverage
Your Medicare has already started
You should call Social Security or your local Social Security office for instructions to submit a signed request to drop Part B. Your coverage will end the first day of the month after Social Security gets your request.
Coverage through your spouses employer plan (group health plan)
The employer has fewer than 20 employees.
Medicare part B enrollment rules state you should sign up for Part A and Part B when you’re first eligible. In this case, Medicare pays before your other coverage. Most people assume since they are still actively working or their spouse is working they do not need to sign up. This is not the case when the employer has fewer than 20 employees.
The employer has 20 or more employees.
Ask the employer benefits person whether you have credible group plan coverage as defined by the IRS. People with group health coverage based on current employment may be able to delay Part A and/or Part B and won’t have to pay a lifetime late enrollment penalties if they enroll later.
How you go about delaying your coverage depends on your situation:
- If you’ll be getting benefits from Social Security or the Railroad Retirement Board at least 4 months before you turn 65, you’ll automatically get Part A and Part B. You’ll get your red, white, and blue Medicare card in the mail 1-3 months before your 65th birthday. In the case that you don’t want Part B, follow the instructions that came with the card. If you keep the card, you keep Part B and will pay Part B premiums.
- If you won’t be getting benefits from Social Security or the Railroad Retirement Board at least 4 months before you turn 65, nothing needs to be done. You will get a card with Part A only on it.
Important note: If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, you may have to pay a penalty.
Medicare Part B Enrollment Rules Continued: Employer/union coverage and private insurance
When the employment or employer/union coverage ends
Once the employment or your coverage ends, 3 things happen:
- You may be able to get COBRA coverage, which continues your health insurance through the employer’s plan and most likely at a substantially higher cost to you.
- You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA. To sign up for Part B while you’re employed or during the 8 months after employment ends, complete an Application for Enrollment in Part B and a Request for Employment information form. You will need the completed Employment information form when you sign up for PArt B at the Social Security office. If you choose COBRA, don’t wait until your COBRA ends to enroll in Part B. If you don’t enroll in Part B during the 8 months after the employment ends:
- You will likely have a penalty for as long as you have Part B.
- You won’t be able to enroll until January 1–March 31. Additionally, you’ll have to wait until July 1 of that year before your coverage begins. This may cause a gap in health care coverage.
- If you already have COBRA coverage when you enroll in Medicare, your COBRA will probably end/should end. If you become eligible for COBRA coverage after you’re already enrolled in Medicare, you must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have End-Stage Renal Disease (ESRD)).
I have retiree coverage (from my former employer or my spouse’s former employer) or COBRA coverage.
Due to Medicare part B enrollment rules you should sign up for Part A and Part B when you’re eligible. In this case, Medicare pays before your other coverage.
I have Marketplace or other private insurance. (Very Important To Understand The Rule If Receiving a Premium Subsidy)
If you’re eligible for premium-free Part A, you should enroll in Part A and Part B when you’re first eligible. If you have a Marketplace plan for individuals or families, you should drop it. You drop it so it stops when your Medicare coverage starts. If you receive a premium tax credit from the market place, it should stop automatically when you are eligible for Medicare. In some states this will not be automatic. Those that continue to receive a premium tax credit while eligible for part B will need to pay all tax credit subsidies back when they file their next tax return.