Medicare Late Enrollment Penalty Archives

2 Basic Ways to Enroll in Medicare After Losing Group Health Insurance

Bob Vineyard · April 28, 2020 · Leave a Comment

If you or your spouse continued to work past age 65 and continuously covered by EGH (Employer Group Health) as your primary insurance, you can still enroll in Medicare Part B without delay or LEP (Late Enrollment Penalty)

How to enroll in Medicare after group health insurance

How to Enroll in Medicare When SSA Offices are Closed

Social Security offices are now closed to the public for in-person service. Traditionally, this was the only way to get Part B when you already had Part A (such as for those coming off a group). There are new procedures in place due to the Covid-19 pandemic.

Now, Social Security is allowing folks with Part A to fax in the CMS-40B (application for Part B) as well as the L564 (Request for Employment Information) along with proof of employment or Group Health Plan to 833-914-2016.

The employer does NOT currently need to sign Part B of that form, just go ahead and send it. Local offices may only check their mail once a week, so faxing to this main number is best. It is currently taking about a week to process the paperwork. For updates, see the Social Security Coronavirus web page as well as the Information for Groups page.

Send BOTH forms (CMS-40B and L564) at the SAME TIME.

Get Your Medicare number When You Don’t Have Your Card

Log in to your MySSA account and look for a link labeled View Benefit Details under the Benefits and Payments section. Click the link and scroll down to Get a Benefit Determination Letter. Click that link and it will open a window with a Benefit Letter. You can save and/or print the letter. Scroll down about 3/4 of the way and will see your Medicare number.

Note When you want to enroll in Medicare and are completing the CMS L564

State on the form “I want Part B coverage to begin (MM/YY)”
If possible, your employer should complete Section B.
If your employer is unable to complete Section B, please complete that portion on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
- income tax form that shows health insurance premiums paid;
- W-2s reflecting pre-tax medical contributions;
- pay stubs that reflect health insurance premium deductions;
- health insurance cards with a policy effective date;
- explanations of benefits paid by the GHP or LGHP; or
- statements or receipts that reflect payment of health insurance premiums.

Eighteen Months to Enroll in Medicare or Two Months?

Remember, coming off of Cobra is NOT the same as coming off of a group where you are covered as an Active Employee. Beneficiaries have 8 months from the time they are covered as an Active Employee to apply for Part B. If they miss that window, even if they are covered by Cobra, they will have to enroll in Part B during the General Enrollment Period, which means applying January through March for a July effective

Avoid the COBRA Trap!

CMS rules grant you an 8 month window after leaving employer group health insurance if you need to enroll in Medicare Part B. If you are 65 or older you have 8 months to enroll in Medicare Part B without penalty or delay.

But if you take COBRA the 8 month window no longer applies. Enrolling in COBRA means you could wait a year or longer before your Medicare Part B is effective. And you will pay a LIFETIME late enrollment penalty.

As if that isn’t enough, without Medicare Part A and B in place you cannot buy a Medigap plan or enroll in an Advantage plan. All you could have is Part A and a Part D drug plan.

Employer group health insurance is considered creditable DRUG coverage but the health coverage is NOT deemed creditable by Medicare.

If you follow all this you can enroll in Medicare without falling into the trap.

Do I have to enroll in Medicare if I am still working?

You are not REQUIRED to enroll in Medicare at age 65 if you are covered under an employer group health insurance plan. SOME employer plans are secondary to Medicare. If that is the case for you, then you will WANT to sign up for Medicare.

What qualifies as a Medicare SEP (Special Enrollment Period)?

Involuntary loss of employer group health insurance can create an SEP for you. You may also be entitled to enroll in a Medicare supplement plan without answering health questions.

Can I have employer group health insurance AND Medicare?

Yes, you can have BOTH employer group health insurance AND Medicare. But doing so may be a waste of money. It is unlikely that Medicare Part B will pay any claims if they are secondary to your group health plan. Also, enrolling in Medicare may disqualify you from making HSA contributions.

Can I drop employer group health and have Medicare as my primary coverage?

I have clients who have continued to work past age 65, dropped their group health insurance, and used Medicare as their primary plan. Often their out of pocket savings for medical claims is thousands of dollars LESS than it would be under a group health insurance plan.

Medicare COBRA Trap

Bob Vineyard · March 13, 2020 · Leave a Comment

The Medicare COBRA trap is catching many seniors off guard and costing them delays in Part B coverage and penalties. Due to the recession, more Americans are working longer including past age 65. Some of those opted for COBRA (for different reasons) once employment stopped. I suspect many did so because of a non-working spouse under age 65 even though they were 65 or older.

COBRA Trap Means Late Enrollment Penalty

Even though COBRA has been around for over a quarter of a century, most people do not understand their COBRA rights. They believe COBRA is only available to family members if the former employee ALSO elects COBRA.

In reality, every covered family member have COBRA rights separate from the other. A non-working spouse or child can exercise their own COBRA rights even if the former employee does not.

Bill Bregar Was Bitten

This confusion plus the recession has led to problems when the age 65+ COBRA participant enrolls in Medicare once COBRA ends.

Under current law, working Americans with employer health coverage can postpone signing up for Medicare until after 65. When they retire, accept a buyout or are laid off, they then get an eight-month special enrollment period to sign up for Medicare Part B (which covers doctors visits and other outpatient services) immediately and without penalty.
But many people in these circumstances are able to extend their employer coverage for a year or two under a 1986 law known as COBRA, which is what Bregar did.
What they may not realize is that waiting until their COBRA coverage expires to enroll in Part B disqualifies them from the eight-month grace period. Instead, they must wait to sign up during open enrollment, from Jan. 1 to March 31 each year. And coverage won’t begin until the following July. They also get hit with a late penalty, an extra charge added permanently to their Part B premiums.

This COBRA trap will catch you off guard if you do not know about it, triggering an LEP (late enrollment penalty) from Medicare.

Avoid the Part B Penalty

You can avoid the penalty and delay by enrolling in Medicare Part A and B when you turn 65.

the crucial Medicare regulation barring a special enrollment period for people whose COBRA coverage is ending is rarely publicized. It is not mentioned in the Department of Labor’s guidance for people considering COBRA. The penalty mentioned briefly on page 18 of the official handbook, “Medicare & You 2020” . However, there is not any warning of a delay in Part B coverage. It isn’t included in Social Security’s general website information on enrolling in Medicare or in its frequently-asked-questions section. But you can enter “COBRA” into the site’s search engine leads to an explanation.

This is a real problem that was never anticipated when COBRA laws were written.

Avoid the Medicare COBRA Trap

When you are ready for Medicare, let the experts at Georgia Medicare Plans help you find affordable Medicare supplement rates to fit your budget. Compare plans and rates from Anthem, Mutual of Omaha, Humana and others instantly online. GA Medigap rates.

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Turning 65 Medicare Options

Bob Vineyard · July 6, 2017 ·

Are you turning 65? Do you know ALL your Medicare options? When and how should I enroll in Medicare? Do I need Medicare if I am still covered by an employers group health insurance plan? Is there a penalty if I don’t sign up for Medicare? Can I get Medicare if I don’t enroll in Social Security? Can I change my plan at any time? When can I sign up for Part D? What are the most common complaints about Medicare? What are the best Medicare supplement plans in Georgia? Which carriers usually have the highest rate increases?

How much easier would it be if you could see ALL Georgia Medicare rates in one report? Know your Medicare options before buying a plan.

Turning 65 – What are my Medicare options?

About 8,000 of us turn age 65 every day. Every one will face decisions about Medicare options. Am I automatically enrolled in Medicare? Do I need to sign up? How do I enroll in Medicare A and B? Do I need both parts? Is there a penalty for delaying my Medicare enrollment?

Most of your answers can be found in the Medicare and You booklet. Other answers will come from Choosing a Medigap Policy. You can also go online to Medicare.gov or call 1-800-MEDICARE 24 hours a day, 7 days a week (except federal holidays).

But who wants to spend hours reading government documents, searching a massive website or waiting on hold for the next representative?

Good news! We know you have better things to do than learn about your Medicare options. Don’t waste time doing the research. We have done that for you.

At Georgia Medicare Plans you can find answers, get GA Medigap quotes, view rates and benefits, compare plans side by side and much more.

You can also talk to us by phone or email. Straight forward answers from someone who not only has more than 40 years in the health insurance business, but like you, is also enrolled in Medicare.

How Can I Sign Up For Medicare?

Enrolling in Medicare is simple and easy. There are several ways to start your Medicare journey.

Sign up online
Enroll in Medicare at a Social Security office
Call Social Security @ 1-800-772-1213, Monday through Friday, 7 AM to 7 PM
If you worked for a railroad, call the RRB at 1-877-772-5772

Many will find the online application to be simple and painless. If you are reading this then you probably have a computer. It took me about 15 minutes to enroll in Medicare when I turned 65.

You can apply by mail but I would advise against that approach. Too many potential problems. If you already have Part A and are applying for Medicare Part B, the only way it can be done is with paper applications. If at all possible, visit a local SS office and apply in person.

Pick the one that works for you.

When Do I Enroll in Medicare?

You should sign up for Medicare three months before reaching age 65. Enroll in Medicare even if you are not ready to start receiving Social Security retirement benefits. You can opt out of receiving Social Security once you are in the online application. Then you can apply online for retirement benefits later.

Medicare Part A is offered to most people at no charge. You or your spouse paid into Medicare by way of payroll taxes so now they tell you there is no premium.

Isn’t that special?

You may qualify for premium-free Part A if you meet one of the following.

You paid Medicare taxes for at least 40 quarters
Received SSDI for 24 months
You have ESRD
Qualify as an eligible spouse if they meet the criteria

Even though you paid Medicare taxes for several years Part B is not premium-free. In 2017 your standard Part B premium is $134 per month. Higher income people may pay more under IRMAA tax rules.

You should enroll in Medicare Part A even if you are not ready to enroll in Part B. Coverage can start as early as the first day of the month you turn 65.

What is Medicare Part B and Why Do I Need It?

The short answer is, you may not need to enroll in Part B when you sign up for Part A. But be careful. Delaying Part B without following the Medicare rules could result in a late enrollment penalty. If you may also be forced to enroll in B during the General Enrollment Period.

Those covered by an employer group health insurance plan you may not need to sign up for Medicare Part B. You may be able to keep your group plan until you or your spouse retire. Special forms and rules apply if you delay Part B past your 65th birthday. Opting for COBRA after 65 can create a delay in the start of Part B. You could also be subject to a late enrollment penalty. Watch out for the COBRA trap.

Your Medicare Part B deductible for calendar year 2017 is $183. When the deductible is satisfied, Medicare covers 80% of approved charges. You are responsible for the remaining 20% balance.

Unlike other health insurance you have had in the past, there is no out of pocket cap for your Part B expenses. You pay until you are well, you die or when you run out of money.

Medicare supplement plans (Medigap) pay some or all of your Medicare Part B charges.

You may be concerned about large hospital inpatient bills but over half of all medical bills are charged as an outpatient. Items like doctor visits, labs, X-ray’s, MRI, CT scan, ambulance, ER and more fall under Part B.

Chemotherapy often runs $2500 or more per treatment. Renal dialysis is $3,000 per session. Insulin for an infusion pump is $500 per bottle. Unless you have a Medigap policy you could pay hundreds of dollars each time you incur these charges.

You may never need expensive cancer treatment, kidney dialysis or insulin. But if you do, how will you pay for it?

Learn your Medicare options BEFORE making a final decision.

Medicare Options Part D

The most confusing choices for most people is how to pick a Part D drug plan. In some parts of Georgia there may be more than 30 plans available.

Which one is right for you?

Prescription drug plans (PDP) have formulary’s, preferred pharmacy’s, copay’s, doughnut holes, catastrophic coverage and more. More often than not seniors will pick a plan with the lowest premium. Don’t ever buy on premium alone unless you are not taking any medication.

Often the plan with the lowest monthly premium has the highest drug costs. Pick the wrong plan and you can’t change until the next open enrollment period.

At Georgia Medicare Plans you will be able to learn all of your Medicare options, ask questions and get detailed answers. We take the confusion out of Part D.

Georgia Medicare Supplement Choices

Bob Vineyard is not just an independent broker for Medicare supplement plans, he is also enrolled in Medicare. Which plan and carrier did I pick?

This is not about me, it’s about you. For many people, the most important decision they will make is choosing the right Medigap plan that fits their needs and budget.

Best GA Medigap Plans with Lowest Rates

If you are turning 65 and enrolling in Medicare, you want the same thing everyone else does. The best Medicare supplement plan with the lowest price.

Medigap plans are designed by Medicare to be identical in every way. Except price. All F plans are exactly the same. This is true for G, N and the other 7 letters. Every carrier pays their portion of Medicare approved claims, usually in 3 to 5 business days.

Any doctor that participates in Medicare will also accept your supplement plan, regardless of the issuing carrier.

If you are looking for the lowest Medicare supplement rates, that is easy too. As long as you know where to look. Most people don’t.

Seniors who are online shoppers will typically visit half a dozen sites or more. They will fill out a request form and immediately their phone rings off the hook. Once burned they will still complete forms but enter bogus contact information.

At best they may see 15 or 20 plans and rates. That’s not enough. After seeing the same carriers on multiple sites they give up, believing they have seen it all.

Truth is there are over 170 different Medicare supplement plans available in Georgia. There is only one way to gain that information. Ask us for a detailed report like this one. We are happy to share. No sales pitch. No obligation to buy.

Don’t want plan F? No problem. Tell me which plan or plans you want and you can have those reports too. I also run these reports for my clients on each renewal.

But there is a catch.

This is only for clients. Everyone else will have to shop every year and only see the same 15 to 20 plans.

Clients of Georgia Medicare Plans can call or email any time they have questions. Any time. And they always know if their renewal is fair or not.

So far this year 28 clients have been relocated to another Medigap plan and are saving anywhere from $18 to $53 per month vs. their renewal.

You won’t get that when you buy direct from AARP, Blue Cross or through any other agent. If you have talked with other agents, not a single one has offered you a Medigap report like the one linked to above.

You can buy your plan anywhere, but you can only get your Medicare options report here.

Take care.

Bob Vineyard, CLU

https://www.facebook.com/GeorgiaMedicarePlans/

#GeorgiaMedicarePlans #GAMedigapRates #MedicareSupplementRates #Turning65 #MedicarePartD #EnrollMedicare

I Enrolled in Medicare at Age 65

Bob Vineyard · April 13, 2016 ·

Last year (2015) I enrolled in Medicare at age 65. But this is not about me, this is about you. Now that you are ready to retire you are told you can’t get the Medicare supplement plan you want.

What’s up with that?

The lady at the Social Security office told you to sign up for Medicare Part A and Part B on your 65th birthday which was 8 months ago. You will retire in two months and want Medicare supplement plan G. But you are told only way to can get plan G is to answer health questions.

You thought Obamacare required insurance companies to take anyone, regardless of their health. Well, you are wrong.

I can understand your confusion. Let’s take a look at how and when to sign up for Medicare when you are approaching age 65.

Enroll in Medicare at Age 65

You should sign up for Medicare Part A 60 – 90 days before you turn 65. For most people, there is no premium for Part A as long as you (or your spouse).

You paid into the Medicare system all your working life. Now it is ………… “free”.

You may not need Medicare Part B if you are covered by an employer group health insurance plan. In many cases your group plan is the primary payer while Medicare is secondary.

But if you work for a small employer, less than 20 employees, Medicare may be primary and your group plan a (very expensive) secondary payer. In that case you should go ahead and enroll in Part B.

Don’t just assume you need part B. Make sure before enrolling or delaying enrollment in Medicare Part B.

Shop and compare GA Medigap quotes. Instant rates. Side by side comparisons.

Your information is never sold.

Medicare Open Enrollment

For those who want the assurance of original Medicare and the ability to continue to use your current doctor(s), you need to understand your Medicare open enrollment rights.

According to Medicare, the best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. You can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you’re 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy unless you can satisfy medical underwriting requirements.

Medigap insurance companies are generally allowed to use medical underwriting to decide if the want to accept your application. However, if you apply during your Medigap open enrollment period, you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health.

There is no annual open enrollment for Medicare supplement insurance. You can swap plans at any time, but you must answer health questions.

Your only chance to buy a Medigap plan may be when you enroll in Medicare Part B.

If you have group health coverage through an employer or union because either you or your spouse is currently working, you may want to delay enrolling in Part B. Employer plans often provide coverage similar to Medigap, so you don’t need a Medigap policy.

If you delayed Medicare Part B, when your employer coverage ends, you’ll have a chance to enroll in Part B without a late enrollment penalty. Your Medigap open enrollment period will start when you need it. If you enrolled in Part B while you still had the employer coverage, your Medigap open enrollment period would start (and possibly end) unless you bought a Medigap policy before you needed it.

COBRA and Medicare do not play well together. Medicare does not consider COBRA to be creditable coverage. When COBRA ends you are not entitled to an SEP (Special Enrollment Period). You will have to wait until the next GEP (General Enrollment Period) and pay a lifetime late enrollment penalty.

If you apply for Medigap coverage after your open enrollment period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements.

Don’t miss your chance to get the best Medigap rate or run the risk of being denied. Enroll in Medicare at age 65. Understand your Medicare Part B options.

Shop and compare GA Medigap rates.

#EnrollMedicareAge65 #MedigapOpenEnrollment #MedigapPlanG

Can I Delay Medicare Part B Without Paying a Penalty?

Bob Vineyard · May 21, 2014 ·

Can I delay Medicare Part B without paying extra? When should I sign up for Medicare? Is Medicare enrollment automatic when I turn 65? What happens if I postpone Medicare enrollment?

Can I delay Medicare Part B?

Most people will be automatically enrolled in Medicare Part A and Part B when they turn 65. And most will receive Part A at no charge, while Medicare Part B requires a monthly premium.

If you do not have health insurance now, and are turning age 65, you should take advantage of your opportunity to enroll in both parts of Medicare.

Your initial enrollment period begins 3 months before you turn 65 and ends 3 months after the month of your 65th birthday. If you fail to enroll in both parts of Medicare you may be subject to a late enrollment penalty.

If you miss your initial enrollment period you may enroll in Medicare under the general enrollment rules. General enrollment begins January 1 and ends on March 31 of each calendar year. Your Medicare coverage would begin on July 1 of the year when you enroll in the general enrollment period.

You may choose to delay Medicare Part B and enroll during a special enrollment period. If you or your spouse is actively employed and covered under an employer group health plan, you may delay enrollment without penalty. Your 8 month special enrollment period begins when your group coverage ends

Is Medicare enrollment automatic at age 65?

For most people, the Medicare enrollment process is automatic. About 3 months before you turn 65 you should receive a “Welcome to Medicare” packet along with your Medicare cards. If you decide to delay Medicare Part B (or Part A) you should contact the Social Security Administration. Delaying Part A means you will also delay receiving Social Security so think twice before postponing your Medicare Part A.

Postpone enrollment in Medicare Part B

If you are covered under an employer group health plan and wish to delay Medicare Part B you should notify Social Security. You also need to make a note to contact Social Security at least 60 days before you plan on leaving your employer group health plan and tell them to begin your Medicare Part B benefits.

Purchasing Medicare supplement coverage

Medicare covers less than 80% of your medical costs and most people will purchase a Medigap plan to fill the holes in Medicare. You must have Medicare Part A and Part B in place before you can purchase a supplement plan.

With over 170 different Medigap plans in Georgia, how do you find the right one?

Bob Vineyard at Georgia Medicare Plans can explain your Medicare rights and help you understand your choices in a 15 minute phone conversation. Feel free to call or email.

If you want to shop and compare plans on your own, we make that option available as well.