Hello Toni:
My husband, Steven, has been laid off from a company he worked with for over 20 years. His employer is downsizing due to changes in the economy and May 31 will be his last day.
Steve is 68, enrolled in Medicare Part A but never enrolled in Medicare B because he had employer benefits. He is stressed, wondering how to apply for Medicare Part B properly to avoid receiving a penalty. I am turning 65 in September and also will need to enroll in Medicare.
Please explain what our Medicare enrollment options are since we are different ages and have different enrollment situations. Thanks, Toni.
— Patti from Midland, Texas
Great question, Patti:
There are two different rules regarding enrolling in Medicare Parts A and B in your household and I will keep how to enroll in Medicare for both you and Steve SIMPLE!
Below are Medicare Enrollment Rules:
1. Past 65, leaving employer benefits and the simple way to enroll in Medicare Part B:
Steve needs to apply for a Special Enrollment Period (SEP) by downloading the forms CMS-L564 (Request for Employment Information) and CMS-40B (Application for Enrollment in Medicare — Part B) from SSA.gov/forms, or email info@tonisays.com and the Toni Says Medicare team will email you the forms. Have Steve’s human resources department sign off on the CMS-L564 form and attach it to CMS-40B. Under item 9 (Remarks) on the CMS-40B, write what month Part B should begin. (Steve’s start is June 1, 2024.) File both forms with the local Social Security office. Advise the SS representative that Steve is losing his company benefits and needs his Medicare Part B to begin June 1 since his last day of employment is May 31. (Make copies of every document given and received from the SS office.)
2. Turning 65, not receiving your Social Security check, and enrolling in Medicare:
Patti, your way of enrolling in Medicare is simple and quite different from Steve’s because you are turning 65 in September. Go online to www.ssa.gov/medicare/sign-up at least 90 days prior to turning 65 and apply online for a September 1 effective date.
3. Turning 65 and receiving your Social Security check:
Your “Welcome to Medicare” Kit with your Medicare card will arrive via mail 90 days prior to turning 65.
(Chapter 1 of Toni’s Medicare Survival Guide Advanced edition explains in detail how to enroll in Medicare the right way.)
Here is some helpful information regarding Medicare parts and options:
1. Original Medicare Part A (hospital insurance): Covers in-patient hospital stays, skilled nursing/rehab stay, home health and hospice.
2. Original Medicare Part B (medical insurance): Covers primary care or specialist physicians, whether in the office or performing surgery, outpatient surgery, durable medical equipment, x-rays, CAT scans, MRIs, chemotherapy, etc.
3. Original Medicare or Medicare Advantage: Discuss with your healthcare facilities and medical professionals which Medicare plans they accept, such as Original/Traditional Medicare with a Medicare Supplement or a Medicare Part C (Medicare Advantage plan such as HMO, PPO or PFFS). If you are considering a Medicare Advantage plan, research the plan’s hospital/provider online directory to be sure your physicians and hospitals are in that specific plan’s network. Verify with them that they are currently in the network.
4. Medicare Prescription Drug plan: Research the plans every year to see if your stand-alone Prescription Drug or Medicare Advantage Plan with prescription’s formulary covers all your brand name or generic prescription drugs.
5. Long-term care: Research options such as LTC policies, hybrid annuities or life insurance with LTC riders, new Short Term Care plans or specific states’ Medicaid rules for long-term care needs.
Don’t forget with Medicare, it’s what you don’t know that will HURT you!
Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. The “Medicare Survival Guide Advanced” edition and her new “Confused about Medicare” video series are available at www.tonisays.com.