Dear Toni:
My husband recently retired from his job, and because I am over 65, I need to sign up for Medicare. I went to the local Social Security office with the Medicare documents that Toni discusses in her Medicare articles: the Request for Employment Information form (CMS-L564) that’s signed by my husband’s HR department and the Application for Enrollment in Medicare Part B (CMS 40B) to enroll in Medicare properly. I asked the Social Security agent if I needed to do anything else and he said that I was all set. A few weeks later, I received my new Medicare card in the mail with both Medicare Part A and B dates.
It was not until I went to the doctor and had my claim denied that I discovered the old employer insurance was still listed as primary, not Medicare. Now my Medicare nightmare begins!
The insurance company said that I had to call Medicare to change its information, and Medicare said it would take 10 business days to update. What do I do? I have no coverage because the company insurance is still listed as primary and neither Medicare nor my Medicare Supplement Plan G will pay. Please advise me what I should do.
—Debbie from Sugarland, Texas
Debbie:
In the past few weeks, the Toni Says Medicare hotline has been receiving questions such as yours from people who are having their Medicare claims denied after leaving employer insurance. When Medicare still has an employer group health plan as the primary health insurance, it supersedes Medicare and the Medicare Supplement or Advantage plan applied for.
There is a process for those leaving employer group health plans, whether you are the employee or the covered spouse and enrolling in Medicare. You need to inform Medicare that Medicare should be primary, and that you (or your spouse) are no longer covered in an employer group health plan.
The verification process to discover what your primary Medicare insurance is below:
1. Visit www.medicare.gov and register for a Medicare.gov account when you and/or your spouse have a Medicare number on your red, white and blue Medicare card.
2. View what is in your and/or your spouse’s Medicare.gov account and verify that the Medicare information is correct. With this information, you will be able to see what Medicare is viewing while you are discussing Medicare issues such as what Medicare plan has been chosen (either Original Medicare with or without a Medicare Supplement or a Medicare Advantage plan), the Medicare Part D prescription drug plan enrolled in or Medicare claims.
3. If you see that the employer group health plan is still primary after you have enrolled in your and/or your spouse’s Medicare Parts A and B, then call the Medicare Benefits Coordination & Recovery Center at 855-798-2627 and follow the prompts. Advise the agent who answers that you and/or your spouse are no longer enrolled in the employer group health plan. The change from group health insurance as primary insurance to Medicare is estimated to take 48 hours. (A Toni Says Medicare client recently called this 800 number, and it took about 20 minutes on the call to finalize the change for her Medicare.gov account.)
We are advising those on Medicare to open a www.mymedicare.gov account when you are turning 65 with or without employer group health benefits. Medicare mails out the Medicare Summary Notice (MSN) every 90 days, or you can view it faster via www.medicare.gov.
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. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.