Medicare Part B Enrollment

Declining to Enroll in Medicare Part B

QUESTION: I am covered for health insurance on a group health plan. Do I have to enroll in Medicare Part B ?

ANSWER: No, but there could be some consequences to not enrolling, so do your homework!

Be sure you understand the benefits offered on your group plan. Make sure there are no gaps in your coverage.

The most critical concern comes should you ever leave or loose that group coverage. In most cases, once group coverage ends you will enter a special enrollment period that runs for eight months from the time your group coverage ends. Failing to enroll in Medicare Part B during the initial enrollment period or your special enrollment period may result in a penalty being added to your Medicare Part B monthly premium once you enroll.

SOURCE: http://www.socialsecurity.gov/ ; search for publication 10043.

Medicare and Other Health Insurance

Choosing Medicare or Group Health Coverage

QUESTION: I am retiring in a few months. I am covered on my wife’s group health plan through her job. Should I stay on my wife’s insurance or go on Medicare?

ANSWER: There are a couple important things to consider in making your decision.

First, determine if Medicare is primary or secondary to your insurance.

The number of people employed usually determines if Medicare is the primary insurance or the secondary insurance. Medicare is usually (but not always) secondary to insurance provided by businesses that employ a large number of people. Medicare is primary to insurance provided by small employers (less than 20 employees). If Medicare is secondary to your insurance, there is a good possibility you will be better off staying on your current plan. If Medicare is primary its probably not going to be the best value cost wise. Your employer’s HR department can tell you if Medicare is primary or secondary to your insurance.

Your premium cost is another consideration. Compare the cost of both options and the benefits provided. Medicare will cost, on average for a 65 year old, around $250 per month for Medicare Part B premiums, a Medicare supplement and a Part D Prescription Plan.

SOURCE: Medicare and Other Health Benefits: Your Guide to Who Pays First, A booklet available from The Centers for Medicare & Medicaid Services. I will be happy to e-mail you a copy of the booklet. Click the “Ask A Question” button and request “Who Pays First” Booklet.

Medicare Part D Enrollment Periods

Enrolling in a Medicare Part D Prescription Plan

QUESTION:  My drug costs are going up. I would like to get a Medicare Part D Prescription Plan.

ANSWER:  Unless you meet one of the following conditions for an exception, you will have to wait for annual enrollment to enroll in a Medicare Part D Prescription Plan.

Those exceptions are:
- You are new to Medicare
- You recently moved outside your current plan’s service area
- You recently moved in or out of a nursing home
- Certain situations where you receive financial assistance in paying for your premiums
- You have lost or are losing employer coverage

Annual enrollment has been set by the healthcare reform bill to begin October 15, 2010 and run through December 7, 2010. THIS IS A CHANGE FROM PREVIOUS YEARS. Once enrolled, your plan will begin January 01, 2011.

Should you choose to enroll in a Medicare Part D Prescription Plan during annual enrollment and you don’t meet one of the above exceptions, you may be subject to a penalty added to your plan premium. This penalty is 1% of the monthly cost of the average premium in you geographic area, multiplied by the number of months you have gone without enrolling in a plan. For example, if the average premium is $36 per month, 1% of $36.00 is 36 cents. If you have gone without enrolling in a plan for 12 months, $4.32 ( .36 x 12 months ) may be added to your new plan premium each month.

SOURCE:  http://www.medicare.gov/, Medicare and You 2010 Handbook; pages 63-67.