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Delayed Enrollment In Medicare Part B

When it comes to delayed enrollment in Medicare Part B, there are multiple factors to consider.  There are valid reasons why someone should and could delay enrollment in Medicare part B without a penalty.  However, the rules for who can delay are very specific. Failure to follow them can lead to delayed enrollment penalties in the future.  Read further to make sure you are following the rules.

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Who should considered delayed enrollment in Medicare Part B?

The majority of people turning 65 should enroll in both Medicare Part A and Medicare Part B.  Part B has a monthly premium that is either deducted out of the Social Security check or billed quarterly for those not receiving Social Security payments.  Those receiving SS payments when they turn 65 will be automatically enrolled in Medicare.  Those not receiving SS payments will need to manually enroll either at a local SS office or online CLICK FOR ONLINE ENROLLMENT

For some people it may make sense to delay enrolling in Medicare part B.  This often is the case for those that are working past the age of 65 or those getting coverage through a spouse working past age 65,  There are three specific conditions that need to be met in order to waive Medicare Part B and not be subject to a penalty down the road.

Delayed enrollment in Medicare Part B:  Conditions to waive B

• Actively working or getting coverage through an actively working spouse.  If your are working and getting coverage through work, you may be able to waive Medicare Part B.  Same goes for someone that is getting coverage through a working spouses employer coverage.
• Having coverage through the current employer.  The coverage needs to be through the working spouses employer.  If the spouse is working but getting coverage through Cobra, a past employer or an indvidual plan of some type, you cannot waive Medicare part B
• The employer group most have 20 or more employees.  If the employer has less than 20 employees you should enroll in Medicare Part B even if still working and getting coverage through work

Comparing the employer coverage to Medicare

Just because someone is meeting the criteria to waive part B does not mean the necessarily should.  The current employer plan monthly cost and benefits need to be compared to the cost of Orignal Medicare with a supplement and Part D drug plan or with a Medicare Advantage plan. It is simply a matter of seeing which way will provide more benefits for less premium.

Other things to look out for

• Delayed enrolllment in Medicare Part B can tricky.   For example: VA coverage is a valid waiver for Medicare Part D (drug coverage)  It is NOT, a valid waiver for Medicare Part B
• Cobra can be a valid waiver for Medicare Part D but it is not a valid waiver for Medicare Part B
• Working but having coverage through a plan from a former employer or COBRA is not a valid waiver for Part B
• PEO:  If you work for a small group less than 20 that is part of a PEO you may have an exception to the group of 20 or more rule.  Some PEO’s have a waiver for all their groups which allows the ones with less than 20 employees to be considered a group of 20 or more.

Delayed enrollment in Medicare Part B: Change in the Medicare GEP

Those who miss their initial enrollment in Medicare Part B have two possible election options.   The first is a Part B special election period and the second is the Medicare Part B general election period.

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Part B enrollment special election rules

Before you sign up for your Part B Medicare coverage there are some Part B enrollment special election rules that you need to understand.

You are not required to take Medicare Part B during your Initial Enrollment Period (IEP)  (the first of the month you turn age 65) if you are have insurance through work and either you and/or your spouse is still working.  You should only delay Part B if the employer insurance (called group health insurance) is the primary payer on your health care expenses.  This means that Medicare would pay secondary (after your group/employer plan pays). It is a good idea to talk with the employer or the HR department to see which is the primary payer. Usually the employer must have more than 20 employees in their plan in order for the plan to be considered the primary insurance . If you are eligible for Medicare because you get Social Security Disability Insurance, the employer must have more than 100 employees to be the primary payer.

When there are fewer than 20 employees at the company where you get your insurance, Medicare is likely your primary coverage. If this is the case, you should not delay your part B enrollment. If you do so, that can leave you without any insurance coverage at all.

In either case:

If you have insurance from a current employer, you remain eligible for a Special Enrollment Period (SEP). During this time, you can enroll in Part B without penalty at any time. This is true while you or your spouse is still working.  This is also true for up to eight months after you lose employer coverage, switch to retiree coverage, or stop working. However, if you have a lapse in coverage more than eight months at any time after you become 65 and Medicare-eligible, you will lose your SEP. A lapse means any period of time where you were not covered by either Part B or insurance from a current employer.

Part B enrollment special election rules- Cobra and retiree insurance

Important: Medicare DOES NOT consider COBRA or any retiree insurance the same as current employer insurance. If you are on either of these, you will not have a Special Enrollment Period to enroll in Medicare beyond the eight months you have after you retired/stopped working. If you have COBRA or retiree insurance and delay enrollment in Part B, you will likely have a Medicare Part B late enrollment penalty when you do sign up for part B

It important to note:

If you had already taken Social Security before you turned 65, or if you become eligible for Medicare due to disability, you will be automatically enrolled in both Medicare Part A and Part B. It is not mandatory that you take Part B.  If you decide not to take Part B, you will need to send back the Medicare card you received in the mail with the form you received stating that you do not want Part B. After you do this, you will receive a new Medicare card in the mail. The new card will have part A only on it and not part B.  You will not need to pay your Medicare Part B premium as a result.

If you are thinking about turning down Part B—or enrolling in only Part A it is advised you call the Social Security Administration at 800-772-1213 and ask if you delay enrollment will you be subject to the Medicare Part B late enrollment penalty.   Be sure to explain the type and source of your other insurance and other circumstances in as much detail as possible. When you call Social Security, make sure to write down whom you spoke to, when you spoke to them, and what they said. Remember you generally must be covered under a group health insurance plan which you have access to due to you or your spouse working in order to avoid the part B late enrollment penalty.