Folks, the problem is not in the intelligence of the people applying for Medicare. It's in t the LACK of intelligence of the program itself. This process, to which I have also been recently introduced, is an enigma within an enigma within an enigma. Or for those old Star Trek fans, it's like a card game of Fizzbin (https://en.wikipedia.org/wiki/List_of_games_in_Star_Trek#Fizzbin). Who made of these wacky rules? Yes, we have to have rules, but when taxpaying citizens are offered a game of Fizzbin, I think the game is at fault. I find it crazy, absurd, and completely asinine that a penalty is assessed should an applicant NOT sign up for Part B at the time they sign up for SS. In my view, they are actually SAVING the system money by not using its assets. The policy is a tax upon a tax upon a tax for those who have supported the system throughout their taxpaying lives. When they need to, let them sign up. Don't Fizzbin them. People like to point to socialist countries' crazy bureaucracies. This policy tops them all - in the name of democracy.
48
Medicare and private insurance companies treat businesses with <20 employees differently than businesses with >=20 employees.
With <20 employees, Medicare is primary and group health is secondary. Employees are required to sign up for Medicare at age 65, even if covered by a group health policy. Medicare part B premiums for well compensated employees could be $5,000 per year, in addition to the $9,000+ per year group health premium. If employees delay signing up for Medicare, they are subject to premium penalties for the rest of their lives. Group health plans do not pay for claims that would have been paid by Medicare. Not enrolling in Medicare at age 65 is not a good option.
With >20 employees, Medicare is secondary and group health is primary. Employees covered by a group health policy are eligible for a waiver from Medicare, and can choose to delay signing up for Part B until they retire, with no penalty. Employees do not pay the part B premium in addition to the group health premium. Because group health is primary, claims get paid.
For <20 employees, why not drop group health at age 65? Spousal coverage. In Georgia there are no individual policies with good POS networks - only limited HMO networks are available. The only way to get a POS network is with an employer policy. Therefore, the only way to get good insurance coverage for a slightly younger spouse is for the employee to be covered.
For public policy, why the unequal treatment? I don't know.
8
As someone who works in a successful Medicare Supplement and Medicare Advantage plan office, I find a lot of errors on this. First off, Medicare sends a Medicare and You booklet to everyone Medicare Eligible everywhere. This book is clear about the repercussions of not signing up for Part B or Part D at the right time. There are exceptions though. If you are still working after 65 and coming off a group plan, the you have a new enrollment period. Find a reliable broker in your area who can help you understand the ins and outs of Medicare. Ask your friends who they trust. That goes a long way. And be very cautious of articles.... they are not always right.
19
Wait a minute. There is a 20 employee minimum for employer provided health insurance to qualify for the exception? Is this recent or has it been in place for many years?
3
A great online resource, sponsored by the Medicare Rights Center, is medicareinteractive.org It has thorough explanations of Medicare issues including on how to appeal penalties.
I've used it; a friend used it to help a sister who failed to sign up for Part D ( she wasn't using ANY medications) - and was assessed penalties. Her income was actually low enough to qualify her for an "Extra Help" state program which picked up the cost.
It would be ideal if there was automatic cross checking for individuals for appropriate program referrals, but until then, we have to do some checks
10
I don’t know how anyone could miss this, every newspaper article on Medicare mentions it.
7
What a nightmare this man had to endure. I'm 60 and have Tricare, but I guess it will terminate when I turn 65?
At least I have some time before I make the dive into this!
1
I’m a licensed agent here in Florida, your Tricare will turn into Tricare for life when you reach 65, you will be required to sign up for Medicare part B. You will automatically be signed up for Medicare if you are collecting social security. To be sure of your options when turning 65, contact a licensed agent in your area.
4
The late enrollment penalty is grossly unfair. At the very least, it should be time limited. Ironically, late enrollment may actually save money for the Medicare system.
Suppose during the three years Mr. Zeppendfeldt-Cestero was not covered by Medicare Part B had been a time of frequent doctor visits. Not uncommon for one over the age of 65. The cost to Medicare of a single office visit with a few lab tests would far exceed any annual premium lost from the article's author.
I'd bet that a cost/benefit analysis of the thousands of late enrollees would show they actually save the system money.
8
Imagine a country in which one gets the healthcare one has earned without jumping through hoops. Better yet, imagine a country that so values life that it provides healthcare.
73
@KM - I can imagine that country because I live in it. Single payer in Canada is not perfect, but it is simple... every citizen and legal resident has access to their Province’s system from birth on.
All it takes is political will. Good luck with that.....
26
@paulaspan
I’m confused.
The Social Security Admin phone rep my my newly-65-year-old spouse spoke with — at length — told him that because he is part of his former employer’s insurance plan — for which we pay completely out of pocket — he absolutely did not need to enroll. (On top of that, he doesn’t have enough credits for Medicare anyway.)
So the rep gave him the wrong info?
6
If the gentleman in your story delayed enrollment for 3 years ( i.e. Between 36 and 47 months he'd have a 30% premium surcharge raising the basic $134 premium to $174.20, not $187.60 as cited. He also did not pay an estimated $4824 in premiums during those 3 years. Note: $187.60 suggests 4 years of delay in enrollment.
Why did your story not cover why the gentleman did not read the information Social Security has been sending out for years to workers in the US? I know I received many notices over the years about benefits and Medicare. Yes, it can be complicated but a lot of people would rather fuss than do the work to understand the rules.
The article also fails to note that Part A, Hospital Insurance is financed by the Medicare tax. The basic premium for Part B is 25% of the actual cost. The remainder is paid for by general revenues, higher premiums for well-to-do taxpayers, and yes, by increases in premiums for late enrollment.
I had a favorite economics book when I was in school called TANSTAAFL.....
There Ain't No Such Thing As A Free Lunch. The money has to come from somewhere!
Since turning 65 I've used my Medicare several times. The claims were processed reasonably quickly and accurately.
14
Our case is a little different. My spouse and I live in Australia as permanent residents, which allows us to access their health care system. We have not signed up for part B even though be both get SS payments.
When we return to the States to live, will we be considered to have had alternative health coverage during the time we didn't not pay into Part B? Will this allow us not to pay a penalty?
3
@susan No. Read Dona Vaughaun's post about the same thing when she lived in Costa Rica.
1
I am still working at 65 and have insurance from my employer (the state of Hawaii), but applied for spousal benefits to begin in January 2018, when I reach my full retirement age. Do I have do also apply for Medicare if I am getting spousal retirement benefits from Social Security?
2
It’s interesting that your lede mentions a health-care consultant getting caught by part B late enrollment penalty. A health-care consultant? Really? The economics of health care revolve around paying for care for us seniors. How could a former hospital front-office executive possibly be ignorant of this?
I figured it out by going to the public library and asking the reference librarian for help. She showed me a “for dummies” book that spelled it out. Yeah, it’s a bit complicated, so ask for help! But maybe not from a health care consultant.
21
A few months before my wife and I turned 65, the Social Security Administration sent us notices that we had to sign up for Medicare and a booklet explaining pretty much what this article explained.
On the other hand, I've never understood why the Medicare beneficiary who misses the deadline has to pay a higher premium. I've never met a person who qualifies for Medicare by age who wants to skip a few premiums because he or she feels healthy at 65 or whenever their employer insurance ends. People our age want the coverage and, if we miss a deadline, it's not because we are gaming the system. I think the monetary penalty is unfair and should be repealed.
23
@maqroll
A similar penalty applies for people who do not sign up for Medicare part D when first eligible. Its penalty is 1% per month for every month of delay.
9
Why are they making people pay penalties at all?
7
@maqroll Medicare needs everyone in the pool, both healthy and not. If everyone were not required to enter the Medicare pool, they could choose to skip coverage. Everyone may want coverage, but many would choose to forego it if they felt the premiums would pinch them financially. I could see many healthy 65 year olds gambling and waiting until age 70 to opt in.
7
I left my last job nine years ago, at the age of 68. To continue my wife’s coverage I got a very expensive COBRA policy. A few months later I required hospitalization, to the tune of $3,000 . Guess what? The COBRA policy did not cover me, because I should have had Medicare. Nobody at my employer’s HR department had warned me, and none of the moral ciphers at Anthem cared that I had been spending almost $1,000 a month and getting no coverage for myself. A pox on insurance companies, and on the legislators who refuse to pass universal health care free of these little gotchas.
95
It is a mystery to me why someone who delays signing up for Part B, who saves the government potentially thousands of dollars, should then be permanently penalized for the late sign-up. And why isn't this whole process just simplified to the point of kindergarten-level simplicity, with open enrollment at any time after 65, with no penalties for anybody?
Hopefully my calendar reminders will be enough to get me through this stupid sticky wicket.
15
@David white
It is for the same reason Obamacare charged a penalty for people who waited until they got sick to sign up for Obamacare.
Someone who is healthy pays premiums but doesn't cost the government anything, or pays more in premiums than he gets back in benefits.
Under Obamacare rhetoric, he would be classified as a free-rider for the three years he didn't pay part B and D premiums.
7
Also a penalty if you don’t enroll in part D which I didn’t do because I thought it was for people with huge drug bills. I pay $4 every month from here on out.
5
I am so confused. Thanks to Reagan and the 1983 Social Security Act amendments, I have to work to 66 yrs 2 months to get my full benefit. So if I sign up for Part B at age 65, does that mean I have to pay the premium out-of-pocket for those 14 months?
My spouse is younger and has full coverage through his employer, and I'm covered too though we have to pay part of the premium plus our HSA contributions. I sure don't want to have to pay the Medicare premium too, if I don't have to.
7
@WastingTime, if your spouse is actively working and you are covered under your spouse's employee plan, you don't have to enroll in Part B until that coverage ends. At which point you will both have an eight-month special enrollment period to sign up for Part B.
Paula Span
New Old Age columnist
11
But be sure to sign.up for Part A which.is free when you turn 65.
10
I ran into a different problem with part B. I signed up for Medicare parts A, B and D when I turned 65 but I did not sign up for a Med-gap policy the first year. I thought that I could do so during the open enrollment period in the second year if I decided that just Medicare was not enough. I can sign up for it now but I have to share my medical history and can be denied a Med-gap policy. The way it works, I discovered, is that I actually had only 6 months after I signed up......to get a Med-gap policy without having to share my medical history. That was my Initial Open Enrollment Period! I had no idea that there were different kinds of Open Enrollment Periods. Waiting to see if pre-existing conditions keep from getting the Midi-Gap policy.
10
@Laura Linton This also varies by state. Medigap policies are subject to state insurance laws and regulated by state insurance depts., unlke Medicare,Medicare Advantage plans and Part D plans. I don't believe such pre-existing condition exclusions could be applied under New York law, although there might be a financial penalty for going without coverage for a while.
2
Yeah, I followed the rules and got a fiasco. No where on the Medicare website do they offer you the option of just receiving Part A, as I am working full time and have health insurance thru my company. So, they gave me both A and B and tried to bill me. After numerous phone calls, a written certified letter, and finally (torture!) going to the local Social Security office, (had to leave work), I was able to just get Part A. So much for trying to save the country money!
this is why bureaucracy has a bad name.
27
Just wait until they do Medicare for all to let them run the entire system.
7
The only action necessary was to refuse the Medicare card with both A and B with a cover letter declining part B. It should have been very simple.
9
@Doug Urbanus
What would be simple is to have the choice on the website at the original sign up.
10
You know how the government pays for police, the fire department, schools, libraries, road construction and maintenance and the like? That's what we should have in regard to medical expenses.
You see whatever medical provider you like, pay a deductible to cut down on frivolous visits, then the government covers it according to a fee schedule tapered to your region. Doctors who disagree with the fee schedule may do so by posting a notice to that effect in their offices. You pay the difference or go elsewhere.
The money comes from the substantial taxes that we pay. Raise taxes if you have to That's it.
We are the wealthiest nation on earth. It's 2018. We can do this. No more complicated nonsense.
24
@MIKEinNYC
And of course, providers in NYC will be paid higher reimbursements than in the rest of the country, despite the fact that NYers don't pay higher payroll taxes, because they are special.
2
@ebmem: you don’t know that. The Medicare surtax is what is relevant here. Look it up.
3
Since turning 64, I have been ceaselessly bombarded with unsolicited mail and phone calls from health insurance companies. These companies have but one goal: profit gained by signing me up for one of their plans. The time it would take someone to investigate and verify the legitimacy, let alone the value, of all this information is so mind boggling as to render the task nearly impossible.
The administrative costs of "finding customers" and then processing all their respective claims (i.e., denying payment for those claims) is a huge part of the American health insurance--not health care--dollar. We would be wise to adopt a simpler, non-profit model, one that truly benefits the average consumer--rather than funneling massive amounts of money to an industry with one goal: minimize payments while maximizing profit.
It's a sick system. No pun intended.
60
@Tim
Most of those insurers are not profits, as are most of the providers. It's not the profit motive that has caused inflation, it is government involvement. Medicare pays far more for the retired than any of the famed single payor or socialized medicine countries you admire.
1
@ebmem And they are most likely Medicare Advantage plans, under which there is far more profit than under a Medigap policy.
4
I was still working after becoming eligible for Part A. I called the Medicare number and asked if I needed Part B because I was covered by my company's insurance, but would need it when I stopped working. I was told that I would have to wait about six months to get Part B coverage (and be without coverage for that time) so I needed to sign up now. I paid for the double coverage for three months and then contested when I was to pay much more retroactively because of my income. I ended up having to pay for three months of coverage at the basic rate. When I stopped working, I kept getting a surcharge as if I were still making the income I made when I worked. After many visits in which my income was confirmed as not being what I made when I worked, someone consulted with the top person who wrote that I had zero income on the form. That stopped the extra assessment based on my previous work income. All too confusing for even the employees who work for social security.
I did receive notice that I owed additional taxes from the IRS. When I checked my records, I discovered that that the year I was said to owe money based on a form the IRS received and I hadn't "declared" wasn't even for the same year. I called, they checked, and the matter was quickly resolved. I didn't owe anything.
5
The whole part B penalty thing is a scam, and should be eliminated. I owned my own business, didn’t need the coverage, and from what I remember, was never informed about the coverage, only learning about it later on TV. And yes, we need single payer coverage like the rest of the progressive nations of the world. I’ve received minor medical assistance while in both Spain and France and was never even asked if I was covered.
32
If your Senator is voted out after one term and is over 62 at that time, as a federal employee he/she and spouse can get Federal Blue Cross for life for about $400/ month when under Obama care with their income that high they would pay about $1050/ month in part B premiums. Congress takes care of itself.
23
@James Krause
The same is true of all federal employees who are early retired as well as for municipal and state employees. That's why taxes are high.
1
@James Krause They also get a much better plan than they would get under Obamacare, plus dental, vision, etc.
2
I was a permanent resident in Costa Rica when I became eligible for Medicare. I was covered for a very modest fee by Costa Rica's almost universal health care and there were no facilities in that country that accepted Medicare so I chose not to enroll. I had no idea that there would be a penalty.
Three years later I returned to the United States to live and discovered the penalty rule. This has been a nightmare for me. There was once year that my Social Security actually was decreased very slightly due to the penalty increase. I hope that Social Security does a better job of informing seniors of this regulation.
5
For a writer who sets out "to clear a path through the thicket" of Part B enrollment, Ms. Span makes a major error. At least twice she claims that you "have to sign up for Part B" or "are supposed to sign up for Part B." That's absolutely false. Nowhere in the article does she mention that enrollment in Part B is in fact OPTIONAL. Granted, most seniors would be wise to enroll. But Part B coverage is NOT mandatory.
Ms. Span makes another error, I believe, when she contends that "there’s no substitute for consulting with an expert." She's apparently forgotten that her article leads off with the sad tale of an expert who got it all wrong! In fact there exists an excellent substitute for consulting with an expert: the book "Medicare for Dummies," by Patricia Barry, formerly an AARP editor. It's an indispensable how-to guide through the "thicket" of Medicare.
16
@gtodon
Well, that's true, Part B is optional. You only "have to" or "are supposed to" sign up for Part B *if you want Medicare coverage* for doctors, tests, physical and occupational therapy, ambulances, injected drugs, etc. I assume most of us do, and we don't want permanent penalty payments or months-long coverage gaps.
Note that the gentleman in the story is a health care consultant but not an expert on Medicare regulations. The Social Security Administration, the Center for Medicare Advocacy and the Medicare Rights Center are more reliable sources of information. The column
links to their websites.
Paula Span
New Old Age columnist
7
I was covered by my company's plan, but when I applied for Medicare when I retired at 66 I was penalized for not signing up at 65. Why? - my company saved the government a year of all medical costs. Perhaps the government penalizes anyone who fails to enroll @ 65 whether it makes sense or is just a way to garner more money.
5
@Malcolm The reason for the sign-up penalty is actuarial: The expectation is that people would wait to be covered until they needed more care. Since people are likely to be healthier at a younger age, the premiums collected earliest are for the least coverage, on average, even though the dollar amounts are the same for all participants from 65 to 105 and beyond.
7
@Malcolm I signed up for Part A while I was working. I knew that I needed to provide Medicare with a specific form signed by my employer when I went onto Part B when I decided to get it while still working but older than 65. No penalty because I knew that form was required. Were you penalized because you didn't submit that form?
2
Yup, my parents lived overseas for 20 years and returned to the US in their 70's this fall. They didn't sign up for Part B because they were not using any healthcare in the U.S.
There was no notice from Medicare/Social Security that they would have to pay a penalty - so now they have to pay 10 years worth of penalties to get Part B, and they actually have to wait until open season January 2019 and wait for coverage to start next JULY. So, my elderly parents will have to pay out of pocket for doctor's visits and medication for about 9 months. Very punitive system they have set up. I have been told there is nothing anyone can do for us. Private insurers refuse to cover them.
35
@Jin L. Are your parents eligible for Free Medicare Part A and US citizens? If so, there might be a special enrollment period and no penalty. See the bottom example of this medicare website (https://www.medicare.gov/information-for-my-situation/signing-up-for-par...
2
@Jin L. Sorry I made a typo: There might be a special enrollment period and no penalty if your parents are *NOT* eligible for free Part A, are US citizens and were outside of US when they turned 65.
5
@Jin L.
For 20 years, they paid no Medicare payroll taxes. But since they did pay in for at least tens years, they are entitled to free Medicare part A insurance that covers hospital care. Because they did not sign up for the optional parts B and D, they have to pay higher premiums for the rest of their lives. Sounds fair.
3
The fact that entire books such as Medicare for Dummies are written to help seniors negotiate Medicare is an indication of how overly complex our dysfunctional health care “system “ is.
19
...and universal plans would have no limitations and restrictions? I think not. The simplest system covers all, is on demand, covers everything and costs the patient nothing. But that would be too costly. Restrictions that are equitable make for complicating rules.
1
Excellent summary of a much misunderstood Medicare issue.
Now, please write one about Part D, including whether remaining on group health insurance as a dependent stops the permanent increase, by month, in delaying signing up for Part D. I can't get a straight answer about which is "primary" and "secondary" from my health plan, partner's employer or Medicare.
Never mind the whole thicket of Part C plans, which usually restrict where you can seek medical care.
5
@RIck:And unlike it says here, companies don’t make mistakes in what they tell you, they out & out lie. My husband’s company (which in the previous 10years had gone from a very large company, to a very small one [family owned they decided they didn’t want to work as hard, so sold off all their construction parts of the company & kept the ‘management’ parts]). As my husband was approaching 65 (with no hope of retirement) they told him he couldn’t leave the company health plan, but, had to stay with them. Well, I didn’t believe it & he signed up, with me following 5 months later. They grumbled but stopped charging him the premiums for the company plan. We had picked an Advantage plan, with the same company his company had, for no premium. Basically the same plan. Now the ‘sign up 3 months before to 3 months after’ is bull. We wanted to do the paperwork for both of us at the same time. So, we thought he does it 3 months after & me 3 months before. Nope he had to do it in our birthday months. We were both told that 3 month before to 3 months after was bull, by the Medicare people. Now, I use a wheelchair outside the house. Have for 20 years. Needed a new one. Badly. At each step we told the 1. Insurance Co, 2. Medicare 3. The company supplying the chair we wanted to BUY a chair. Only after I got it, painted it to suit, did everyone say, ‘oh no we only rent chairs’. How nice. Have since found out that’s all they do. It’s a scam. Chairs are cheaper & better through Amazon.
"A legislative attempt to fix the mess, the BENES Act (for Beneficiary Enrollment Notification and Eligibility Simplification), would send notices to those approaching age 65, clearly explaining Part B enrollment. The bill has made little headway, despite bipartisan support, but advocates hope it will gain traction after the midterm elections."
Keep in mind that one way Trump has fought health care is by cutting funds to "navigators" who provide advice about government health programs. I suspect that his minions in Congress are behind this "little headway" and that the "hope it will gain traction" is code for "if the Democrats when the House".
Medicare law is not the only place with obscure language. Times editorials are another.
8
You’d never know that this is the Information Age. Apart from causing mindless confusion trying to unwind the problem, one can go into a financial tailspin because of an illness or hospitalization which is uncovered. Another problem is that Social Security must be notified when you leave work or there is a hefty penalty under Windfall Elimination Provision. Did HR give you a form with your retirement package? No. Is there a notification form on SSA website? Try to find it.
If this were any other endeavor, a chargeable mixup would be reportable to the state consumer agency. The outrage is that this man was told he was "out of luck" by his senator. The proper answer would be: we'll see about this. Some changes are necessary to include monetary penalties for malfeasance. Instead, we let it pass and hope it doesn’t happen again. That’s not good enough. With a wave of the pen this malfeasance will stop. There’s a problem. They know there is a problem. They get paid to solve problems. Instead, they create them.
7
I'm confused. The Windfall Elimination Provision represents a formula reduction in the calculation of a retiree's Social Security benefit when that person receives a government pension based on wages NOT taxed for Social Security purposes. The issue about WEP always involves its fairness in the amount of the reduction.
2
Just so I'm clear -- I'm 68 and drawing Social Security. I did not sign up for Part B because I'm covered under my wife's employer health plan. If she should lose her job and her coverage (which I'm part of), I have a window of opportunity to sign up for Part B without paying a penalty?
10
@Ben Calwell That's what I have concluded. My husband who is 66 is on my healthcare plan at work. Because he is insured through my work, my conclusion is that we have a window of opportunity to sign up for Part B without penalty if he loses his coverage at my work. That said, I still cannot figure out the status of penalties if he is not signed up for Part D coverage. I can't seem to get consistent information from the sources I've contacted about this. Honestly, the best source that I have found for information is "Medicare for Dummies." No matter what anyone tells you, you have to verify and then verify again. Get things in writing.
3
@Ben Calwell
I hope that's the case--as you stated it--because I'm in the very same boat. I think you're correct.
1
The separate enrollment period begins when the employer's group coverage ends and runs for 8 months. Obviously no one wants a gap. So to be seamless you should enroll immediately. Additionally this would represent the first and only opportunity for signing up for a medigap policy. During this time no medigap policy can be denied. You should google the words Medicare separate enrollment period to more fully understand what to do and when.
4
My husband was faced with this horror recently. We contacted Congressman Sarbanes who represents us in Maryland. His office went to work on it right away and after about a month we obtained Medicare Part B. Contact your representatives!
M. Eidensohn
8
This is ridiculous. We pay for Medicare all of our working lives. Enrollment should be automatic. Failing that, there should certainly be no penalty involved for signing up late and certainly no gap in terms of receiving coverage. What an outrage.
17
The penalty and coverage gap are to encourage people to sign up when they’re first eligible, and presumably healthier. No insurance wants beneficiaries to wait until they’re sick to sign up.
6
Your suggestion is actually a step backwards. At one time everyone had only the initial enrollment period around age 65 and the annual general enrollment period. The only people automatically enrolled then and now are those who are receiving a benefit when they turn 65. But this meant people had to have Medicare part B even when they had an employer based insurance. Medicare was secondary and mostly useless. So those people now have an opportunity to refuse the automatic enrollment or defer enrollment til the employer based medical insurance ends. Efforts to expand equity tends to complicate and confuse.
4
@Sneeral
Your payroll taxes are used to fund Medicare part A for hospital coverage. There is no money in the trust funds to cover parts B and D, which are voluntary programs. Part B premiums cover 50% of the cost of part B coverage, and the taxpayer pays the balance out of general funds. Part D premiums cover 75% of the cost of the program and the taxpayer covers the other 25%. You never pay a dime for parts B and D unless and until you sign up and start paying premiums.
Because these are voluntary, but heavily subsidized health insurance plans, free riders are discouraged from waiting until they need high cost services or drugs to sign up by penalties if they delay from the time they are first eligible. For those who have employer provided health insurance, they do not start paying premiums until the employer coverage ends, and they are not assessed delay penalties.
Coverage supplied by small employers frequently does not meet the requirements to qualify an employee or his dependents from not being responsible for the delay penalty, so someone working for a small employer should attempt to get the employer to cover the Medicare premium plus a medigap policy and to drop them from the employer coverage.
3
Sorry, but this is just more evidence of the all but unlimited capacity the USA has for messing up on health care insurance, prices, and access. What an utterly mad "system"! Just foolishness, obsessed that someone might get something they "do not deserve". Why not ask the French, the Germans, the British, the Canadians, the Japanese, the Spanish, or others still, to take charge of America's non-healthy, non-caring, non-system?
34
@Michael Treleaven We have bought into the propaganda that healthcare in, say, Canada doesn't work. Talk to people in Canada and see what they have to say, same thing in Europe. If our government didn't force healthcare companies to cover pre-existing conditions and preventative medical visits, they wouldn't because they are only interested in profit. It's absurd that we Americans have to worry so much about healthcare costs. What is government for if not to provide important public goods for the population? How much easier life would be if we didn't have to worry about whether we can access healthcare because of the cost.
33
I'm quickly approaching 65. I'm an attorney. Yes, I can read complicated language. I read the rules regarding Medicare and my eyes glaze and head spins. It is ridiculous that this is so complicated. Unconscionable.
75
@Linda Maryanov My recommendation to everyone out there is to buy the book "Medicare for Dummies". It will explain things much easier, in easy to read language and organized well. It still might not answer every single question you have, but you will have a much better idea of how Medicare works.
3
Great observation Linda. Imagine the difficulty for those not as informed as yourself. Even more frustrating is trying to discuss a problem on the phone with them or at a Social Security office.
3
I'm your age, have a master's in engineering and an MBA, spent much of my career writing processes and procedures, and I agree. If we can't understand it, that's a sign of a real problem.
16
This is interesting... I have the option of continuing my employer health insurance in retirement for life. I could do that by itself, added to Medicare B, or Medicare B alone. But the means testing makes keeping both impractical mostly due to 401K distributions add to income and the Part B rates skyrocket. This is something they don't tell you about when they pitch 401K and IRA programs. Some people who would take Medicare B in retirement might have been better off forgoing the tax deferral programs... if they could manage to save that $ for retirement in regular accounts. I'd like to see a detailed analysis of this.
4
@Ray
Roth IRAs don't qualify as "income", so if you use ROTH distros instead of 401k or regular IRA distros you may be able to avoid this.
I am finding that in order to pay for ACA coverage the premiums are so high that combined with living expenses I am running into the same issue....
1
The base part B premium doesn't rise above $134 unless an individual's income is at least $85k. And there's no guarantee that your employer's insurance won't erode over time.
1
@MS When many of us were working and making 401k contributions there ws no such thing as a Roth IRA. So, unless we chose to convert existing 401ks after leaving employement, we are getting all these taxable distributions. It is a real nightmare -- a bank won't give you a mortgage because they consider the 401k money an asset, not income, yet many other programs go simply by taxable income reported on your tax return and disqualify you or make you pay more.
2
When the time comes, vote fro Bernie Sanders, and this issue will go away. Everything will be free. Isn't yet been clarified who will pay for single payer. A, B, and D etc. will simply go away.
@Dan Green
It won't be "free". Everyone including people who now pay into employer programs would pay that or similar... probably means tested... into Medicare-for-All which being a non profit would be able to deliver more health care for the $. But this will NOT be free, just taking the insurance companies out of the loop and recouping their profits to spend on health care.
12
The rules are certainly very confusing. But I have not found it to be the case that "there is no notice" that says its time to enroll -- thanks to the dozens of calls I have been receiving every day as I approach my 65th birthday from insurance companies trying to sell me supplementary plans!
9
@E Milroy
I may not know my age, but there are 100s of companies out there that know darn well I will be 65 soon. I have the mail to prove it.
5
The rules are not cofusing, only complex, so as to refect the complexity inherent in a program for tens of millions of people. If one does not grasp things, one should get help. Free from the government or non-profits, or paid-for by advisors.
4
And then there's the penalty for delayed enrollment in Part D....
5
By all means, Enroll in Part D right away, even if you’re not on any medication. We delayed when we were medication free, and now pay a monthly penalty that increases every year.
9
@Tina
It is unfortunate for the people who didn't sign up for part D as soon as they became eligible because there were really cheap plans with zero to $0 monthly premiums. They had high co-pays for anything other than generics, but they were great with people who either had low drug costs or sky high drug costs. The people with high drug costs hit the donut hole early in the year and hit their out of pocket maximum shortly thereafter.
The penalty for delay is 1% of the median part D plan for every month of delay, and the current median plan is around $35/month and will increase every year. Someone who delayed five years has to pay $21 plus the cost of whatever plan they select. For the rest of their lives.
A bit off-topic, but the Republicans want to penalize people with pre-existing conditions! Fortunately, I don't have any, but plenty of people do. Could be a death penalty for some. Yes, there is help, but it entails more loopholes and confusion and red tape.
Even worse: Our Social Security is under attack. People mocked Al Gore when he said the funds should be put in a lock box. He was right, but little did we foresee that Repuglicans would raid our hard-earned benefits. So, do I wait till I'm 70 to claim Social Security - risky if the Repubs want to steal it - or get it sooner, but at a much smaller amount?
19
@Raye
Is smoking a "pre-existing condition?" Heavy drinking? Illegal drugs?
Anyone who thinks everyday Americans are going to pay for every alleged "pre-existing condition," s/he needs psych therapy. And s/he can pay for it, herself/himself.
2
@Bang Ding Ow Well I think it's extreme to say that "smoking" is a pre-existing condition. We're talking about things like cancer, or any number of other physical issues. There's many physical issues that people have no control over and they shouldn't be denied medical treatment because of that...just as you would not want to be denied because of some illness you or a family member had.
In recently applying for a Medicare supplement policy (to pay the 20 percent of Part B costs Medicare doesn’t cover) I learned that smoking is penalized by these private insurers. Moreover, smoking aside, if you want to change plans later you may be subject to preexisting condition exclusions, also known as underwriting.
1
When writing an article about this subject you are remiss in not including information regarding the penalty details of what one incurs if they delay signing up for Part D (prescription coverage) at age 65 when first eligible.
19
@Estelle79
We share a first name, and had the same thought. For every month of delay in signing up for part D, the penalty when the person ultimately signs up is 1% of the median premium for every month of delay. For someone signing up this year after a delay of 5 years, that is around $20 on top of the cost of any plan they select. And the penalty increases every year, as the median premiums increase.
I recently retired with an employee sponsored health plan, but don't plan to take social security until I reach my full retirement age (~66). Once I enroll in Medicare Parts A & B at 65, who bills me for my Part B premium for that one year interval before my social security kicks in (when the premium is deducted)?
1
Social security benefits age requirements and Medicare age requirements are Not the same. I suggest you check into this further.
2
@Ron Coleman
I am 65 and recently applied for part B. I received a bill in the mail from Medicare directly for a quarter. I guess I will receive a bill every quarter until I qualified for SS at which time it will be deducted directly from it.
6
You will be billed quarterly. When you do sign up for Social Security the part B premium will be deducted from your Social Security benefit.
9
I would not be surprised if the seniors who delayed Part B enrollment (intentionally or not) were more likely to be those most in need....e.g., financially disadvantaged, less educated, more life chaos. If so, the penalties for late enrollment could further widen previous social inequalities in health care access. Thus this policy which aims to encourage compliance and full coverage may unintentionally hurt the most vulnerable (See the “inverse care law”.)
8
I doubt your premise. Anyone poor enough to be on Medicaid will find their state not only encouraging them to file for Part B of Medicare but requiring it, since this saves the States money. This is also true of those entitled to Supplemental Security Income/State Supplemental Payments. Possibly people on the ACA, but almost impossibly since eligibility to both Medicare and Medicaid is screened for those eligible to "extra help." That leaves those with no medical insurance of any kind, who are either incurious or simply unaware. No doubt some fall into either of these categories and fail to timely file for Medicare. Still almost everyone knows someone on Medicare and should have some inkling. A reminding notice would be useful for the few who do not realize like any insurance program timing is everything.
6
@Doug Urbanus
"A reminding notice would be useful for the few who do not realize like any insurance program timing is everything."
Of course, by "any" insurance program you mean any American insurance program. For example, the logical, humane, excellent insurance program of our Canadian neighbors does not penalize anyone for bad timing or being confused about the complexity of signing up. That's because there are no penalties for confusion--and there is no complexity associated with enrollment.
For the average American, the cost and complexity of health insurance is often, quite literally, sickening.
2
I am a volunteer in our county’s State Health Insurance Assistance Programs (SHIPs), which funded by the federal and state governments. There are ~50 of us and we help people through Medicare enrollment, selection of plans, appeals etc by providing well educated and independent information. This is my first year of volunteering and I’m impressed by two things: the complexity of the system (even though I have worked in life sciences for 20 years) and the caliber of our volunteers and staff (many of them are (retired) attorneys, pharmacists, HR professionals for example). I wish more people know about the services we provide.
E.g. 1: We would point to an Equitable Relief for Part B penalty if Mr. Zeppenfeldt-Cestero has had a Marketplace plan instead of a private plan
E.g. 2: A popular Medicare Advantage plan in our county will be terminated in 2019 and its almost 5000 members have to select how their Medicare will be covered. We provide a clear step-by-step timeline to help people make their choices
I hope NYT could investigate the business motives that drive the differences in Medicare Advantage landscapes across different counties. Our county has a big population and is only 40 miles from SF. We have only 5 viable plans and the cheapest one has a monthly premium of ~$65. LA has ~20 plans and some of them have zero premium. How do the dominance of hospital systems, demographics and other factors play a role and what can be done so that people have more choices.
61
Northern California is more expensive - translate, less competitive - than Southern California. Whether Medicare Advantage, Federal Employees Health Benefit plans or employer based plans, Northern California is always pricier than Southern California. That's why they want your zip code and not simply State when sorting through the tier levels of even plans that are state-wide.
This is not the case with Medicare supplement policies. I live in San Diego, and my sister lives outside San Francisco. While recently pricing Medicare supplement plans, I learned that the plan I chose (Plan G) would cost me about $30 less per month if I lived in my sister’s zip code in Northern California.
@A volunteer Medicare Counselor 200 miles further North in Humboldt County where we live, Anthem is the only provider, there is no competition and very little choice. When Obamacare first started, the only hospitals it paid for in our (mandatory) program were a free clinic and a hippie quasi-cooperative. Oddly, that was so scandalous it was somewhat improved. This almost gives me hope.
The United States of America is the only country in the world where people want to be OLD , 65 y/o to be precise , to have some sort of universal healthcare that has been granted for decades in the other industrialized countries .
Quite shameful , quite backwards for such a rich country, that starts helping its citizens only when old age arrives.
We have to be grateful to President Lyndon Johnson who helped create this safety net for the elderly .
Watch out Americans the GOP is planning to take away this immense government gift ( paid at any rate by the contributions of the sweat of millions of workers...) .
Stay on guard , protect Medicare and kick the GOP out of office these coming elections.
80
@Inter nos Why do people continue to vote for the GOP when they want to take away healthcare and Social Security so that more money can be spent on the military? I do not get it.
17
@Inter nos
You comment would be entertaining if it weren't so tragic. It was the Democrats who defunded Medicare to the tune of $0.8 trillion dollars, which has been reflected in increased Medicare premiums for retirees and additional cost shifting to everyone else. Not a single Republican voted to defund Medicare.
Gruber was right.
1
"You have seven months — the month in which you turn 65 and the three months both before and after it — to apply for Part B without penalty. You can apply online at https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b or at a Social Security office."
Minor correction: If you don't sign up for Part B when you sign up for Part A, you cannot sign up for Part B online.
From https://www.ssa.gov/planners/retire/justmedicare.html at the very bottom of the page :
"If you already have Medicare Part A and wish to sign up for Medicare Part B, you cannot sign up online. Please call us at 1-800-772-1213 (If you are deaf or hard of hearing, please call our TTY number at 1-800-325-0778.) or call your local Social Security office to sign up for Medicare Part B only."
I'm headed to their office this week.
6
@Jp
Yeah but it is very easy. I applied for Part A first but not be and received it. 2 months later I changed my mind and wanted part B also. I went online to download form CMS 40B, filled it out and received my card 1 month later.
4
@linhtu: Sure it's easy but the article states it can be done on line. It can't. That's important for people to know as they may be expecting to complete the process on line.
1
As soon as we turned 64 we started counting the days until we could sign up for Medicare part B. It is one of the best birthday presents you could ever have. One caveat is that because we sold a home for a profit when we were 64 our premiums were 428.00 a month which was still less than our private insurance. However, the next year when our income dropped to 75K the premiums readjusted to 134.00 a month. Medicare premiums can readjust every year depending on your income for the previous year.
6
@poets corner Actually, I was briefly on Medicaid and it was far better than Medicare. Almost everything was at no cost;
1
There is a look back period of 2 years that determines a current year premium. The $134 is the base premium. I've forgotten the formula but the wealthier do pay more. Once you got through the bubble of inflated income you dropped back to the base premium.
3
I find it interesting that a hospital administrator and health care consultant didn't know when to enroll in Medicare.
20
Medicare is complicated to confuse newcomers to pay more by "falling through the cracks."
Medicare is now pushing "new and improved" Medicare, Medicare Advantage, one run by insurance companies. Medicare Advantage offers a universe of benefits for one low price: drugs, dental, vision, hearing, gym memberships.
Dental coverage consists of one free checkup and teeth cleaning a year. Everything else is full price, out-of-pocket. There is only one dentist for SF, CA.
I knew I would be stuck with a network of doctors, but I didn't expect restrictions on medical procedures. I have a trick knee. Kaiser Senior Advantage informed me that they do not "do" arthroscopic knee surgeries, only total knee replacements (TKR). I had the same problem with my other knee 15 years ago which was fixed with arthroscopic surgery, and it's still okay. I am not looking forward to 10-15 years of increasing incapacity before I am a candidate for a TKR.
Now I know why people go ballistic.
22
@Bill You have it backwards
1. Most of Medicare (A, B and D) is run by insurance companies (most for profit not that I have anything against profits)
2. Most of public Part C Medicare Advantage is run by non-profit integrated health delivery systems such as Kaiser, the Part C provider/sponsor you use, not insurance companies
It is unfortunate that some number of people on Medicare (a small number proportionately) do not understand how health insurance works. @Bill, did you never have to choose an insurance plan before you reached Medicare age?
4
@Dennis Byron
Maybe I have it backward. Maybe I'm stupid.
But there are no good reasons why choosing a Medicare plan should be this complicated, only evil ones.
There are no good reasons why one should not be able to go back to Original Medicare since Advantage Plans are allowed to change their terms anytime they want. If they were honest, Medicare Advantage would be called Medicare-Minus.
Once-a-year teeth cleaning does not represent an honest dental plan. Trickery in contracts is the devil's work, as in the "Devil is in the details." And you wonder why Trump is doing well by demonizing those in power.
2
I think you want to do some homework regarding that knee surgery…
If you Google “Kaiser Permanente knee arthroscopic surgery,” you get post-op instructions off there site.
1
There seems to be an error in your article re special enrollment period SEPYou indicate that the employer must have more than 20 employees for the group health insurance plan to qualify one for the SEP when employment ends. I don’t find that anywhere can you please confirm. The only thing I have seen is a employer must have 100 employees if you are already on disability and want to switch to Medicare part B please re-check the rules and confirm that your 20 person employer is incorrect for the group health plan to qualify for the special enrollment period SEP
@Andy Kay The 20 employee rule has something to do with which insurance is primary -- Medicare or the employer's? -- if you are ON Medicare. The SEP applies to someone wanting to sign up for Medicare. I do not know if the two facts are related but I think not.
(I guess the disability related Medicare related rules are all different or new because I never heard anything about 100 employees and I was trained by CMS... but some years ago).
@Andy Kay
Mr. Kay, while you or a spouse is working, employer-provided insurance allows you to delay Part B enrollment without penalty. You are entitled to a special enrollment period after that coverage ends.
The size of the organization comes into play in determining whether your employer plan or Medicare becomes your primary insurer after age 65. If the company has 20-plus employees, the employer plan continues to be primary. Medicare, if you choose to enroll, becomes secondary.
But in an organization with fewer than 20 employees, Medicare becomes primary. If you don’t enroll in Part B, your secondary insurer may not cover the bulk of your care and may even try to recoup costs it mistakenly paid.
Paula Span
New Old Age columnist
2
I work for a highly regarded healthcare system in Homecare and Hospice. I see people every day on traditional Medicare A & B with a D pharmacy benefit. I also see people on Advantage plans. I see some with only A. That is the worst. Some people have commercial insurance along side their Medicare, thinking everything will now be covered. Not true. If Medicare denies coverage on something, your commercial insurance or your supplement will not kick in and cover. Their thinking is if Medicare denied this benefit, we will too. People generally do not find this out until they are quite ill. The Advantage plans are easier to sign up for, but they have limited benefits and co-pays and out of pocket expenses if you go out of network. I am not a fan. When I turn 65 in 6 years, I will be looking to have Medicare A and B with a pharmacy benefit under D. That is the best. Keep in mind home IV Antibiotics are not fully covered under Medicare. If you need 6 weeks of IV antibiotics and have Medicare D, there will be out of pocket expenses. I see surprised people every week. It is something no one thinks about, but should.
I may have to wait until 66 or 67 but will be calling at age 65. There are government agency Aging Services that can review all of this with you for free. Many times the Senior Centers in town will have free symposiums on this. Don’t shun your local Senior Center. They are a wealth of knowledge for anyone over 55.
50
Thank you so much for this valuable information! It was clearly written and straightforward. Much appreciated.
5
You are partly correct. Fee for service Medicare plans are unable to tie Part D (the drug being infused) with Part B (the equipment doing the infusion). Medicare Advantage plans can tie them together and offer home infusion. See page 6 of this report on current policies in coverage of home infusion under Medicare. http://www.nhia.org/resource/legislative/documents/NHIAWhitePaper-Web.pdf
1
@Janice Badger Nelson
The fact that so much effort is required to simply understand the cost of health insurance (not health care) in America is very sad. It's a system that's been so perverted by the profit motive that it can't rightly be called health insurance. It certainly "insures" confusion and, often, regret.
4
I am a regulatory healthcare attorney and have worked in and around hospitals since 1980. I work frequently on matters involving Medicare Conditions of Participation and communicate regularly with Centers for Medicare and Medicaid Services (CMS). This advice and guidance is spot on and highlights the problems that arise when people have insurance when they turn 65, but don't understand how Medicare coverage works.
I am an NYT online subscriber. As a public service, I respectfully request that NYT make this article available beyond the paywall. This information is so important for all of us to understand.
148
I agree about the article’s importance, but found some of the writing to be murky. I would like the comments to be available as well. They clarified the details of part B coverage.
8
@Karen Nemchik
I agree with making this article available. I just turned 63 and am trying to learn what I don't know about Social Security. This article and the comments have been helpful. I even reprinted it to take for my meeting with Social Security at the end of this week. The line "Without good information, people make mistakes and their costly", may be good to show the person I meet with, if asked why I scheduled a meeting with no intent to sign up now.
3
If you are on COBRA and don’t sign up for Part B at 65 because you believe you have coverage until your COBRA benefit expires, in the eyes of Medicare you do NOT have coverage and you will be penalized. Depending on the timing, you may be uninsurable for six months.
8
No where did you mention insurance agents. We are the “experts” you refer to but never name. If people worked closer instead of feared, insurance agents specializing in Medicare, we can prevent the late Part B, as well as other penalties.
19
@Sylvia Gordon
The problem is, as I see it, that all of the people who specialize in Medicare are looking to take my money as they sell me something, and there is a lot of differing information. As I begin learning about S.S., and am still a few years away from 65 years old, I see how easy it would be to choose wrong.
5
@Joe You are right. My husband wanted to sign up for Medicare and I gave him the go ahead though I am the person in the household that makes the financial decisions. My husband contacted some person to guide him though the enrollment process and I didn't supervise and that was a mistake. The advisor didn't ask my husband the right questions. It turned out that it was way better for my husband to stay on my healthcare plan at work. Once I figured out what was going on, I got involved and had to undo the decisions my husband made at the advice of this advisor. I'm still dealing with the fallout and am not completely sure of the penalties we'll have to pay for this mistake. I don't trust anything anyone tells me about Medicare unless I get verification and try to get confirmation from more than two sources.
4
@Sylvia Gordon If they are independent agents representing multiple companies then I might be interested in talking with one. Since the only ones I'm aware of where I live represent only one company, not so much since the pitch is likely to be snow job. Sorry to be so negative, but I've seen too many examples of "insurance" that was sold under false pretenses.
3
I ran into this problem after returning to the US at age 69. Medicare is useless overseas so why buy it, I thought. On returning I needed to wait 9 months for the open enrollment window. So I tried to get a private insurance policy for the gap. No dice. Medicare sucked the air out of post-65 private insurance. What doesn't make sense to me is the rationale for companies charging more to cover pre-existing conditions is the same as the Government charging more (and blocking) older people joining Part B late. They can do it but private companies can't?
Now I am back overseas and still paying the Part B premium for useless insurance. I am in a country that has nationalized health care but everybody - yes, everybody - I know has private insurance because of the low quality of the free plan. The government needs to save money. I have 3 providers.
And one other point. If the government is the only provider, what happens if they decide they don't want to insure you as they did me for 9 months? Suppose you aren't the correct political persuasion. Look at the IRS, FBI, and Department of Justice. How do we prevent health care from being weaponized?
2
@The Golden Years
With private insurance, once you have a disease, say cancer, and lose coverage, you can never get coverage for it again. It's not a matter of a few months, it's never again. And before the existence of Medicare, most older people couldn't get insurance period because premiums were so high that only a handful of people could afford it and most of those could pay out of pocket anyway. It's hard to make a business insuring against something that has a very high probability of happening.
4
I can understand why you would like to suspend Medicare part B while out of country. Presumably you would like to have it reinstated the day you step off the plane. Can you imagine the optics of someone apparently wealthy enough to live abroad who returns to the USA only to use Medicare but only began paying for it the day he got off the plane!
9
@roseberry What you say is not correct in all states. Private insurance is governed by state insurance law. What you describe could not happen, for example, in New York state.
You should also be aware that the way Medigap premiums are determined also varies by state. In New York State they are community rated, so a 65 year old pays the same as an 85 year old. In other states, they are age rated, so in a state like California, and maybe yours, an 85 year old pays more than a 65 year old.
I work full time and handle several older relatives affairs. The "system" is so complicated and if you think Medicare B is confusing how about Medicare D. Every year the benefit and drugs the plan will cover will change. Sure there is a web site but its fairly useless as what you drugs/services will be approved and which company will still be in business.
I finally hired an insurance consultant, a man who makes his living helping people 64 and up make it through the maze of Medicare . The cost is very reasonable and the service has saved the family thousands of dollars.
. I use him for all my relatives even my 97 year old aunt. There is no way she or many of my aged relatives could understand this stuff and make informed decisions.
Universal Health Care NOW!!! if you are against it just imagine you are lucky enough to live to be old. I hope you have someone very competent to take care of all this for you or retirement savings may all go for health care .
70
How did you find this consultant and what were his qualifications?
10
I am an American citizen and 14 years ago at age 69 I moved to the Netherlands and was required to enroll in the National Healthcare system. The coverage is outstanding but not cheap. Between premiums and taxes about 280 - 350 euros/mth.
By law I had also to pay the Medicare premium to avoid the 10% a year penalty, which I did for a while but became prohibitive. What is more Medicare does not cover medical expenses outside the U.S.
The Medicare requirements should allow people to enter the system when can be proven that full coverage was maintained through employer or foreign country health system.
I receive Social Security and have Medicare A
12
@Cornelius I agree with you re recognizing other coverage. Clearly whoever drafted these rules recognized that some people might be working after 65 in the US, but did not contemplate people simply living outside the US and either paying into the public health care systems of other countries and/or buying private insurance to cover healthcare in the other country. As long as you can provide proof of other coverage, you ought to get credit for it here.
2
@Cornelius
You are 83 years old and think 280-350 euros per month is an expensive health insurance premium?
4
I live abroad at the moment, have done so for 15 years. Turned 65 five months ago, received the application and ignored it as I will be living here for at least 5 more years and didn't think one could apply for it while living abroad. Don't know if that was a mistake or not, after reading this article.
@Liz
My question, too. Especially if we live now where there is a national health system that tones down the health care offered to the very old (socially rational, individually not so much).
@Liz
Today, the standard Medicare premium for an individual with less than $80,000 in annual income is around $150. Someone signing up for Medicare today, at age 70, a delay of five years, would have to pay $150 plus $75 or $225/month. The 50% premium would increase every year, as Medicare premiums increase, and you would have to pay the 50% premium for the rest of your life.
If your income is greater than $80,000 per year, you'd have to pay more than $150 per month to protect against the premium. You'll just have to do the math to decide.
I have to wonder about the quality of his consultation given his “blunder.”
6
His advice is spot on. If any of the individuals who are living abroad think they want to return to the US for care at any point, you may not be covered if you don't enroll now or well before you return. This also goes for your occasional visits to the US. Read this advice and think about the various ways it may effect you or relatives now and in the future.
3
Medicare part A pays for hospital admission and care, but they can treat you under observation without admission, and that is only covered by Part B coverage. You can even be treated in an ICU for 24 hours, as I experienced, as a non-admitted patient. The cost for 21 hours in ICU in my case was $65,000.
Only covered under Part B.
15
@OSS Architect -- this is a problem that definitely needs to be fixed! It's shameful.
4
@OSS Architect
Known as the two-midnight rule. Always ask if you are being admitted or under observation. And now they are asking you to sign a form that you have checked that a hospital's providers are in your network. Wait, let me plan that heart attack...
3
I qualify for Medicare when I turn 65 on January 1, 2019. You can bet that I needed no outside notice to sign up for Parts A and B the morning of October 1, 2019--the first day of the six-month window (three months before your birthday month + three months after). Having self-paid for health care since 1984, I would not have missed this deadline for the world. It's been like crawling across glass the past few years: paying four-figure-a-month premiums because our household income exceeds the ACA's limit by a relatively negligible amount. Just earn less, you say? Stay home and do nothing or gallivant around town? Can't. My husband is in his mid-70s and thus his Social Security and mandatory IRA drawdown are counted in total household income--yes, his retirement savings are being eaten up by my insurance company. For my part, I run a business and cannot take zero income on contracts we landed two or three years ago. We have to fulfill them according to contracted multi-year payouts.
Bottom line: If you're a 2-person household making more than $68K, the government thinks you're the Koch Brothers. My premiums in this year before Medicare have eaten up more than 20% of our income.
131
Another marriage penalty. I swear, we should all get divorced at 60. Otherwise, you will end up responsible for huge medical expenses that aren't yours, and they'll take everything you have if, God forbid, one of you ends up in a nursing home. And don't even get me started on remarrying later in life!
9
@Jersey jazz If you literally turn 65 on January 1st, 2019 (as opposed to sometime in January 2019), you are eligible to start Medicare on December 1, 2018
6
Correction to previous post: I signed up the morning of Oct 1, 2018. You can see how much I want 2019 to come soon!
1
A great benefit, but Medicare, like Social Security and the IRS, are organizations with terrible, largely unreachable, customer service and rules so impenetrable, its users are left to seek third-party help. The best book to identify how to tackle this, however smart you think you are, is “Get what’s yours for Medicare.”
10
@JP
My one call to Social Security connected me to an agent who told me I was ineligible for Medicare. Completely and totally ineligible. I was so shocked I almost fainted. I insisted for some time, so she put me on hold to consult a superior and then returned saying indeed I was eligible through my husband's social security history. Considering how rickety the current information structure for old-age programs is, I would not be in favor of extending this to the entire population in a "Medicare for all" system.
6
Here is the real issue which this article completely ignores. Why in the world should you pay a Medicare penalty the rest of your life because you cost the gov't less by delaying applying for Medicare Part B.
In fact you should get a discount for every year less that you use Medicare. - the same logic in reverse that allows you to get a higher Social Security payment if you wait a few years to collect Social Security because that saves the gov't money.
The Medicare Part B "penalty" is nothing but a scam that has no purpose other than to give the gov't an excuse to charge some of us more for the rest of our lives !
40
The purpose is to deter people from skipping the premium payments while they’re relatively healthy only to sign up later when they need treatment.
46
@AH2 You likely also believe the ACA Individual Mandate is a scam. Do you not understand the principles of insurance risk? Or do you think people should only be allowed to buy insurance when they need it?
16
If the purpose was to deter people from waiting until they are sick to sign up then they wouldn't penalize those who had other coverage during that time.
In addition, your supplemental plan has to link up with Medicare in order for your medical office billing to go to Medicare first, and then to your supplemental plan. If this doesn't happen, you won't be billed properly by your supplemental plan. This link is not automatic. I happened to call my supplemental plan to ask a question, incidentally raised a billing question, and it turned out that the linkage had not been made. It is worth checking on soon after enrollment.
18
I remember learning about the late-signup penalty when I signed up (on time) and realizing what a shocking secret it was. I told several friends who didn't know. Adding a permanent surcharge is an absurd ripoff. They might charge a one-time penalty or maybe for a year, and only after notifying people by letter. They don't hesitate to bombard us with information we don't need.
I hope many 64-year-olds read this article and forward it to their friends. We are such pioneers in this country that we have to figure out everything for ourselves.
18
Take it from me: also when you turn 65 enroll in a Medicare Advantage Plan (Part C). I was healthy back then so waited years before finally enrolling in one. My reasoning was that I would wait until I was old and really sick, then get one. Now I must pay a monthly penalty *every* month, for the remainder of my life.
15
Or a supplemental plan. If you enroll in a ‘gap’ plan, you can change your mind and move into an advantage plan later w/o answering any medical questions. The reverse is not true. If you have an advantage plan and want to get a supplemental one, you may not qualify. I did months of research before settling on a gap plan.
25
@Bailey Me too (researched Gap plans vs MedAdvantage and exactly what you mention). There is a lot of information out there - but people have to at least make an effort.
It's about time the American people are waking up to the fact that we don't have any coherent healthcare system in this country. It is time for a simple single-payer system from cradle to grave like other countries have.
The excuse that is given time and again is that a single-payer plan would be too expensive and would raise our taxes a bit. Are people so stupid that they think a small raise in taxes would be bigger than the high premiums, deductibles and co-pays that they have to pay the private insurance companies? Not to mention the networks that everyone has to stick to.
No matter how much Americans may want a more coherent system that doesn't drive them into bankruptcy we have a giant hurdle in front of us. That hurdle is the people we send to Washington who are only interested in themselves and treat us like we are the public servants.
Are we going to continue to tolerate a government that does what the corporations want, and the people be damned? Are we going to continue letting the powers-that-be drive us completely around the bend and stress us to an early grave?
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@Carole A. Dunn
According to CBO the government could tax the top 1% 100% and it would not pay for single payer system
@Carole A. Dunn
i think the answer is pretty obvious...
3
@Tango
Would or would not?
Would or would not?
1
Another part of the complexity involves retired people who have continuing private health insurance benefits from their former employer. Lots of people are in this situation, many of whom were public employees. After Medicare kicks in, the employer-sponsored insurance serves the same function as a Medicare supplement (or MediGap) policy, and the employer insurance may also provide the same drug coverage as Part D.
Here's a new thing I see happening. Very large employers are engaging in 3-way deals with a private insurer and Medicare to roll their employee insurance benefit into a customized Medicare Advantage Plan. Retirees are told they have no choice, unless they want to decline the employer health benefit altogether, about switching from straight Medicare into this customized Medicare Advantage Plan. Employers are upfront about saying this saves them money. So far, the coverage seems generous, but will cuts occur later? There are good reasons why people choose straight Medicare over Medicare Advantage plans. I'd like to understand the budget implications of what is going on with these big deals.
If these plans are both profitable for the private insurer and a cost saving for the employer, is it because the government is funneling lots of subsidies to the insurer? Insurance companies don't get involved unless they see $$$ profits. Obama tried to slow the tax-funded corporate gravy train, is it speeding ahead again?
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@Madeline Conant Do you mean the budget effects for the retiree, the former employer or the Medicare Trust Funds
1. The former employer saves money as you indicate (or to be more precise, can specifically budget the retirement benefit as opposed to the current open ended expense)
2. The retiree almost always saves money because on average over 10 years people on a public Part C Medicare Advantage health plan on top of Parts A and B of Medicare spend $25,000 less than people on a private Medigap fee for service indemnity policy and Part D on top of Parts A and B of Medicare. (This comparison includes -- on average -- the premiums (if any) of the public health plan plus co-pays and out of pocket costs for services not covered by the plan versus the premiums (there always are some) of the private Medigap indemnity policy plus co-pays, out of pocket costs for services not covered by the policy, and the effects of per-incident and lifetime limits with Medigap polices when factored against the annual out of pocket spend limit with Part C plans, which Parts A and B and therefore Medigap policies do not have. How this compares with the former retirement plan differs for everyone.
3. The Trust Funds lose money vs. if the person stayed on just A and B or if the person joined a public Part C health plan individually because the trend you notice relates to a special deal put in for employer/union Part C plans. That special deal is being eliminated over the next year or two
2
Advantage plans have a downside in that they don’t include all Medicare providers in their networks, may only have a limited annual number of treatments at the institutions they contract with and coverage maps are separated by individual counties.
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@From Where I Sit Yes, public Part Medcare health plans (all public Part C, not just Advantage) are networked. That is why they are $2500 less expensive per year yet provide 20% better benefits (and also cost the Trust funds less per person). Do the people who blather on about this not understand basic math
2
I was caught in this trap, because my coverage by legal
separation agreement,was suddenly stopped by my husband without any prior notice. Non of this stopped coverage was an
accepted excuse to avoid paying that Medicare Part B
penalty, and my husband got away with this too, and he
was a federal employee.
3
He is a hospital administrator and did not know the rules of med part B ? Good grief!
27
"... the full Social Security retirement age has passed 66 and will gradually rise to 67."
A very nearly useless hyperlink. You have to go through two thirds of the article to find the relevant bullet point and the bullet point itself is cryptic, at best.
3
I have wondered for years why neither CMS nor private insurers seem able to give a simple explanation for what Medicare is, and which parts must be paid for.
The simplest explanation that would apply to most people is that Medicare Part A is free, Medicare Part B must be paid for, Medicare Part B Supplement must be paid for privately, and that Medicare Part D must also be paid for.
It almost seems as if vested interests emphasize that Part B, Part B Supplement, and Part D are all allegedly optional, and in so doing, continue a myth that Medicare is free. In fact, declining any of those options is taking a great risk that could destroy one's retirement.
46
Isn’t this also true with Part D drugs?
1
This whole article is bogus. As several posts mentioned, there are multiple reminders and warnings when reaching age 65 from both Social Security and Medicare. No excuse.
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@John Ryan I've known several people who did not sign up for Part B and incurred a lifetime penalty. The only recurring reasons I have been told of for this serious error, however, were 1) that one spouse was not yet 65, and was collecting employer insurance, and 2) someone was on employer-provided disability, and the recipient incorrectly assumed that Part B sign-up rules would kick in automatically when that ended.
2
Do a little fact finding. This info is not bogus.
10
Why would one sign up for Part B and pay that premium if one is over 65 and covered already by an employer and intends to work past age 70? Isn't that paying for alot of nothing?
@Heide Fasnacht
The best thing to do is read the fine print of your employer’s insurance to see if it remains your primary insurer after you turn 65 or if it becomes a secondary insurer. If it drops to secondary, you need Medicare as primary insurance.
10
But you have to sign up for Medicare, part A and then waive Part B until you no longer have employer covered insurance. Part A is free. And you need to do this within three months of your 65th birthday. I couldn’t figure this out myself, but fortunately HR told me before the three months had ended. I called Medicare, spoke to a human being, and she confirmed that this is the case if I wanted to avoid a part B penalty. Too bad the article doesn’t mention this crucial detail.
3
Excellent point! My situation as well, and it took me, a lawyer, way too long to figure it out. Meanwhile I am getting deluged by marketing materials and phone calls for Medicare Advantage plans with no helpful guidance. Would be nice to have a directory of independent Medicare consultants who can be contacted without fear of a big sales pitch.
16
Ok gang, let's go over it again. It is not rocket science. Get a universal, affordable, quality health care plan like just about all of our peer countries have and many others around the world.
Democrats should be pushing this in purple or even red states. A majority of Americans want some form of it.
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@Paul Irrelevant to this issue and those turning 65.
7
@ring0-Thank you for your reply, agreed, I was referring to those under Age 65 and medicare as a model.
That is what blows my mind my republicans friends will fight to the death not to have a universal, quality, affordable health system like all our peer countries have for everybody but if you ask them if they want to eliminate medicare that say don't you dare touch my medicare, they love it, even though it is in essence a singer payer system!
7
@Paul
Blame Republicans.
If this is such an obvious solution, please explain why the Democrats did not pass your recommended law in 2010 instead of the unworkable Obamacare. And do not pretend that it had anything to do with attempts to appease Republicans. When Pelosi ordered her minions to vote for it so they could find out what was in it, she and the rest of the universe knew that not a single Republican was going to vote for it.
Here is the obvious explanation. In 2010, 95% of Americans were satisfied with their heath insurance and with their access to health care. Fifty nine percent [currently 49%] of Americans were covered by employer health insurance. That group included all government workers, including Congress. Unionized civil servants had exceptionally rich health insurance plans, that even extended into retirement that supplemented the deficiencies of Medicare.
The reason Democrats in Congress did not vote for single payer was because they knew they would personally be worse off, that their union donors would be worse off and 59% of the population would be worse off. Not only would they have lost the House in 2010, they'd have lost the Senate in 2010 and the presidency in 2012. They pushed the implementation out to 2014, in the hopes that it would sound good and nobody would realize how hideous it was until it was after they had destroyed the individual market.
I turn 65 on Nov.28th. In the months preceeding this upcoming birthaday, I've been receiving notices from The Social Security Administration informing me, advising me, and yes, (Warning me), about what would / could happen if I didn't answer the question of if I desired Medicare Plan B, or not. I can't help but wonder if the man didn't read carefully what was being explained to him. Also, it IS possible that he was getting mis-information from his employer too. I am receiving Social Security benefits, he was not when he turned 65; would he have not received the same mailed information as I did, since he was still working? Perhaps THAT'S the main reason his deadline came and went?
5
The rules should be changed to allow late Medicare B enrollees to have the option to pay all of the premiums that they missed, rather than paying a life long penalty.
10
State Health Insurance Assistance Programs (SHIPs) provide specially trained counselors who are available to help people understand the Medicare system and to make informed health insurance decisions that optimize access to care and benefits. SHIP counselors are not affiliated with any insurance companies, receive no commissions, and their services are free. You can find out how to contact your local SHIP counselors by visiting shiptacenter.org
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I was aware of this rule and I am no 'rocket scientist' or 'hospital administrator' like this hapless fellow...
9
It is terrifyingly easy to make an oversight or a bad choice. This is not something we should be subjecting older people to, but we do.
44
What makes the Medicare situation worse is the flood of advertisements from private insurance companies that arrive in the mailbox when one turns 65. It seems as if the private companies prey on seniors. It’s very hard to understand all the rules. And more people work full time for longer than in the past.
Thanks for bringing up the issue. I’m actually going to a “seniors speaking out” session this weekend sponsored by the Westchester Library System on the complicated choices people face.
61
I volunteered in my state to advise seniors about Medicare. I took an eight week course, an exam and could only first see people with a more experienced volunteer. I was shocked by the complexity, the penalties and the burden it places on our seniors. Hopefully some young public health policy grads will figure out how to fix this.
118
@nowadays You are inspiring!
Since the largest insurer in my state spirited my job overseas I have been wondering what I could do as an encore.
Since the largest insurer in my state spirited my job overseas I have been wondering what I could do as an encore.
1
Excellent article. It appears that you must talk to someone at SOCIAL SECURITY and not Medicare as they don’t seem to know the nuances of the rules. When I called Medicare last week asking if I can skip part B because I am on my wife’s insurance they said ‘I should be fine’. When I asked if Medicare needed proof of coverage NOW and could send me certification that I am adequately covered they did not seem to know the answer and told me to contact Medicare if I need more info. How could Medicare itself not have this information is beyond me.
25
"Enrollment in Medicare Part A, which covers hospitalization and requires no premiums for most beneficiaries, occurs automatically at age 65 if you’re drawing Social Security retirement benefits. You have to take steps to enroll if you delay taking Social Security past age 65."
What if you are not entitled to full SS benefits until age 66? Do you still have to enroll for Part A and if so when do you have to do that??
5
@Celeste Phillips You don't have to enroll at 65 but you would be crazy not to. It's free to most people who have worked or have a spouse who worked. If you have private insurance through your employer, Medicare becomes primary or secondary depending on the number of employees who work there. You can delay Part B if you continue to work and have coverage through your employer. I would definitely check with your benefits manager.
9
Until you have had to sign up for Medicare, parts A & B, as well as part D, you may have little appreciation for how complex the process actually is... and how little help there is to navigate the process. In my case, I bought a self-help book a year in advance and them spent many hours reading and underlying the key sections. I also spent time on the Medicare and Social Security websites to gain a better understanding of what they contained and how they worked. It is also critical to understand that Medicare alone will not cover all of your medical expenses. If you can afford it, a good supplemental health care policy is a must, as is at least a minimal Part D drug policy. In the end, while I managed to sign up for parts A & B, it was only with the assistance of my insurance agent that I was able to figure out what to do about a supplemental policy and part D coverage. When my wife retired a year after me, the decisions she had to make were made much easier by my experience.
47
Would you mind telling us what book you read? I’d be interested in getting it if you thought it was helpful and accurate.
4
If your insurance agent guided you into a Supplement plan it was likely good advice but be aware that CMS regulations make all lettered plans identical so the insurer chosen by the agent could be due to commission over premium.
3
What was the rationale for placing these restrictions on when you can sign up for Part B? It's not like the government is worried about people not signing up until they get sick (as is the case with the ACA for the sign up restrictions). I do understand why people who sign up later are charged a higher price. It's to make up for the years of payments that they missed from the age of 65 so that the government does not lose any money. Based upon actuarial tables, Mr. Zeppenfeldt-Cestero will end up paying the same amount over his lifetime as if he signed up at age 65.
3
@Schneiderman
It IS that the government does not want people to wait until they get sick, exactly like the ACA restrictions.
2
Why is Medicare so damn complicated? I signed up a few months ago, when I turned 65. I consider myself reasonably intelligent, but I was flummoxed by the multitude of terms, options, etc. I'm still confused about the disadvantages of Medicare Advantage (Part C), which I have. Part C has network restrictions, which is fine. Plus I get my prescription drugs at a very low cost (which is determined by a wacky tier system). Costs for prescription drugs vary among insurers, thus complicating the confusion even more.
As JMC pointed out, we need single-payer universal health coverage. Many people have demanded this, but nothing is being done, thanks to our badministration.
Let's face it, we have better things to do with our time and our minds than to unravel the tangled mess of Medicare.
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@Raye Medicare is single payer. Will it magically become less complex if it covers everyone, not just seniors?
4
@Cas Sorry, my mistake. Just more evidence that health care coverage is ridiculously confusing! But I stand by everything else I wrote.
2
@Cas Single payer in my country of birth is simple. Everyone is on the same system from cradle to death. Everyone has a National Insurance number. When you register with a PCP you fill in a form that requires your name, address etc and your NI number. And that is IT, unless you change PCP. No more filling in of forms at the hospital, specialist, pharmacy etc. NOTHING.
2
Ha! I just cancelled mine yesterday after being given the runaround for weeks and weeks when I tried to stop paying for something I never used, or if I tried to use was denied by the InsCo Crowd. Make it a Social issue, not just another Biz Deal and the Nation will profit. We do NOT need to be paying outlandish sums to pencil pushers who do NOTHING medically whatsoever. Bye bye Part B. I will Party like I just got a Raise!!
2
Ok, this article added to the confusion.
Posit a couple with one working and one retired.
If the retired spouse turns 65 when covered under the working spouse's employee coverage, should they sign up and pay for B to avoid a 10% surcharge?
It isn't clear from the article if the surcharge is based on years since 65 or years since coverage.
22
@ian walsh
Retired spouse’s coverage may drop to secondary insurance. Read the fine print of the private insurance to learn what happens to coverage after 65.
1
@ian walsh
If the working spouse works for a small employer, the retired spouse should sign up for part B and start paying premiums when he turns 65. [Not mentioned is that the working spouse needs to sign up for part B when she turns 65, for the same reasons.]
There are two reasons. One is that the working spouse's insurance does not qualify to exempt the employee or her spouse from penalties [and the penalty is 10 % for every year of delay, not a single 10% penalty]. If you turned 65 in 2010, and erroneously relied upon your wife's coverage until she retired in 2020, your penalty would be 100%.
The second reason is that the small group policy stipulates that when the employee or dependent spouse becomes eligible for Medicare, Medicare becomes primary and the employer coverage becomes secondary. So if the retired spouse incurs medical costs, Medicare would be billed, and pay 80% of the Medicare schedule payments and the group policy would cover the deductible and co-pays. If the retired spouse did not have Medicare, the group insurer would balk at having to pay anything more than it would have had to pay had the retired spouse had Medicare.
If the working spouse has large employer insurance, there would be no delay penalties. It might be worth signing up for Medicare anyway, if the retired spouse had high medical costs and/or the insurance had a high deductible or high co-pays.
2
I had to sign up for it to keep access to Tricare.
This is another good argument for single payer universal health care coverage. Cut down the confusion, danger of losing coverage and administrative costs.
88
@JMC Americans wouldn't last a month under single payer universal care like we have in Canada. It means being told no or you must wait and Americans don't like to be told no. There is the principal of "common good" in single payer that never gets discussed.
8
@Detalumis let me assure you that unless it is an emergency, we wait... plenty. a simple doctor visit, necessary for a prescription renewal (or a prescription i've been taking safely for 8 years), has a wait of 3 months. to a doctor i've been visiting for years. a visit to a foot doctor ... six weeks. as a new patient, for a hand problem, i had to wait almost 8 weeks. no one likes to wait, but even with decent insurance (and that still leaves a lot of high deductibles and prescription charges) we have to wait, and go through plenty of paperwork. which is why i get furious when uninformed friends say "oh, well, single payer systems have to wait forever" or "there are panels that decide on your health care".... blind ignorance of our own system. and those without medical insurance have to wait even more. emergency treatment is often top notch. preventative and every day health care is often terrible.
4
@JMC Please explain in detail how Medicare for all will be paid for
Myself and many individuals I know with Medicare know the following: Traditional Medicare (Parts A and B) is much better, both medically and financially, than Part C. With Traditional Medicare you, go where you want to go for serious disease care and with Medigap Part F coverage, you simplify and secure your medical care because there are no additional bills to pay or paperwork to go through as long as the care is covered by Medicare.
34
@Emergence--I too liked the freedom of choice that a standard Medigap plan offered. I actually chose the cheaper HIGH-DEDUCTIBLE plan F instead of the REGULAR plan F.
Right now my health is reasonably good and I only see the doc a couple times a year and take two generic prescription medications. I figured I have the financial resources to cover the $2400 high deductible amount for my plan F if I have a catastrophic event. The high-deductible plan F means that I pay under $40/month for my Medigap coverage—instead of ~$175/month for the regular plan F.
The main savior in all of this is the MEDICARE FEE SCHEDULE—about the lowest you'll find anywhere. For instance, I had physical therapy and under Medicare rules for part B I had to pay 20% of the cost AFTER Medicare applied their fee schedule. My part of each session—billed at nearly $200—ended up being about $22 out of my pocket. Standard X-rays of my hip cost me $16 and a doctor visit about $20.
8
@Emergence With the trade off having to pay $25,000 more on average over 10 years even after counting co-pays. We poor people cannot afford your expensive alternative but I am happy that you have that choice. Just don't imply that I am stupid for not being able to afford your your expensive solution. It's typically become the refrain of the left
4
@Avid Newsreader
The Medicare fee schedule (and more drastically, the Medicaid fee schedule) is why many physicians do not want to accept new older patients.
Private insurance companies have now adopted a fee schedule that is typically 100 percent "plus" what Medicare would pay; e.g., 150 percent of the Medicare rate.
When I visit a physician and see a $100 fee for services chopped down to $20 to $30, I feel that the medical profession is being squeezed by the insurance industry, an industry that receives nearly 30 percent of every medical dollar spent in this country.
Yes, time for universal single payer coverage. Way past time for that, in fact.
3