original medicare coverage Archives

Medicare and Working Past 65

By Ed Crowe | General Articles | 0 comment | 25 January, 2025 | 0

There are a some important things to think about for those on Medicare and working past 65. This can be a tricky question to answer. Do you need Medicare Part A or Part B? Will you have a penalty for taking them later? What counts as a valid reason not to take Medicare? Read below for the details.

Medicare Part A

We will keep Medicare Part A brief as it is free to most people as long as they have worked and paid Medicare taxes for a period of 40 quarters (10 years). In other words, why would you not sign up for it; it is free and can be sued in addition to employer coverage. You can sign up for premium free Part A up tp 3 months before turning 65 or any time after you turn 65.

Those who do not qualify for premium free Part A will follow similar rules as enrollment into Part B. Please read below to learn more:

Do you need part B if you are still working

Many people need to enroll in Medicare Part B when they turn 65. Although there are some exceptions. One of the most common exceptions is for individuals working past 65. Because Part B is not free to most people, there are a few things to consider when making this decision:

Those who are working or have a working spouse and getting coverage through their employer can delay Part B enrollment in most cases. The key is that the individual must be working and getting coverage. Both must be happening in order delay enrolling in part B.

Receiving coverage through an actively working spouse is also a valid reason not to enroll in Medicare Part B.

The number of employees matters

Additionally, the employer must have 20 or more employees. In either situation above, the person must be receiving coverage through an employer of 20 or more employees. If the employer has less than 20, Part B of Medicare should be elected at age 65.

The 20 or more employees has always been the rule. although in the past, it was rarely enforced. As a result, people working with coverage through an employer of less than 20 often waived part B without issue. In the last few years, this rule has been enforced. This can lead to the denial of medical claims.

Working past 65 with Medicare: Cobra and other mistakes

It is very common for people to think they do not need to enroll in Medicare Part B if they have COBRA. COBRA is not a valid waiver for delaying Part B enrollment. Keep in mind, either the individual or their spouse must be working as well as getting employer coverage. People with COBRA are not actively working.

Getting coverage through an employer without actively work for them is also an issue. Those who work and have coverage or coverage through a working spouse, must be covered through their current employer. For example, if John is working and loses his job and enrolls in COBRA and then immediately gets a job somewhere else. Although he is actively working and has coverage, it is not through the employer he is currently working for.

VA coverage

VA coverage is a waiver for Medicare Part D. It is not a waiver for Medicare B. The standard rules apply for those with VA coverage.

What happens if someone neglects to enroll in Part A and or Part B

Those who do not enroll in Medicare when they should are likely to pay a penalty. The penalty is 10% of the Medicare Part A or Part B premium for each year they didn’t sign up and did not have creditable coverage (through employment).

Watch a YouTube video on Medicare enrollment periods to learn more

Those who lose coverage due to retirement or a loss of group coverage qualify for an SEP. The special election period for Medicare runs 8 months from the date individuals either retire or lose group coverage.

Individuals who miss their IEP and SEP for either Part A and or Part B have to wait for the Medicare general election period . This enrollment period runs from January 1 through March 31 each year. Medicare benefits begin the month following the month of enrollment.

Medicare Out of Pocket

By Ed Crowe | General Articles | 0 comment | 29 June, 2023 | 0

Medicare Out of Pocket

Original Medicare provides broad healthcare coverage for senior citizens and those with certain disabilities in the United States. It consists of Part A, which is hospital insurance, and Part B, which is medical insurance. It is a fee-for-service health plan managed by the federal government. Learn what Medicare out of pocket expenses beneficiaries should expect.

For many people, it is a relief to qualify for Medicare. It is guaranteed healthcare coverage and the costs do not increase based on age like so many other insurance plans. The ability to get coverage also does not change based on any pre-existing conditions. However, there are costs associated with this service. Deductibles, premiums, co-insurance, and more can all cost a surprising amount. For people on a fixed income, it is particularly important to be aware of the following 5 out-of-pocket Medicare expenses.

Doctors who do not participate in Medicare

While it is rare, there are doctors who do not accept Medicare insurance plans for payment. This becomes a problem when beneficiaries need to see a specialist, as there are often fewer of those to choose from in their area. This issue is compounded if they need to see one sooner rather than later. These providers will nearly always cost more out-of-pocket than a participating provider in Medicare.

Providers that do not accept assignment

There are also providers and facilities that do accept Medicare for payment but they do not accept assignment. Assignment is the agreed-upon amount that Medicare will pay for a service, exam, or procedure. Doctors or other healthcare providers who do not accept assignment do not accept Medicare’s standard rates and may charge up to 15% more for their services.

Doctors who operate outside of a Medicare Advantage plan network

While Original Medicare has a nation-wide network of providers that are covered, Medicare Advantage plans are far more local. That means that if a provider does accept Medicare but is not within the beneficiary’s Medicare Advantage network, the beneficiary could still be paying more in cost-sharing for any services they receive. There are protections in place that do not allow those doctors who are out-of-network to charge more than they would under Original Medicare, however.

Inpatient versus observation stays in a hospital

Contrary to popular belief, staying overnight in a hospital does not mean that someone is admitted to a hospital, meaning they are not inpatient. Inpatient hospital stays are covered under Original Medicare through Part A (hospital insurance) and 20% Part B coinsurance for any physician services. If someone is placed under observation, however, they are responsible for 20% of any services they receive. That can add up very quickly.

Three day rule

Leaving the hospital does not mean someone is ready to go home. Often, people are transferred to a skilled nursing facility (SNF). If the beneficiary was in the hospital for three days as an inpatient, then Medicare will only cover a short-term stay in a SNF. If the person’s stay does not meet those requirements, they could be required to pay for a SNF stay on their own, out-of-pocket.

These are some of the possible unexpected major costs for Medicare beneficiaries. It makes financial sense to learn more about these and take steps to plan for the possibility that out-of-pocket costs could be higher than originally thought.

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