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Will my private insurer drop me if I don’t get Medicare?

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of the new book, “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil; and he will answer as many as he can.

Sandra – Texas: My 29-year-old daughter has been on Social Security Disability Insurance (SSDI) for 24 months and just became eligible for Medicare. She has a mental health disability and we just now have found out that treatment facilities that treat her specific disorder do not take Medicare. She had a Blue Cross Blue Shield (BCBS) policy when she became eligible and we have kept that plan in place. Now that we realize we’d have to pay for her treatment with Medicare, it makes more sense to get her off SSDI and Medicare altogether. Can she get off SSDI and Medicare? Will BCBS drop her if she does?

Phil Moeller: Your daughter can keep receiving her SSDI payments even if she declines to enroll in Medicare.

No one is forced to take Medicare. The two issues here are: 1) whether failing to take Medicare will expose your daughter to costly late-enrollment penalties when she later does enroll in Medicare, and, 2) will her BCBS plan drop her if she rejects Medicare.

The answer to the first issue is that it appears your daughter will not face any penalties or other adverse Medicare conditions if she fails to enroll now and later does enroll, whether at 65 or some younger age. Social Security, which oversees Medicare enrollments, provided this excerpt from Medicare’s formal enrollment rules. It’s written in “Medicarese” and not plain English, but I hope you will get the gist of it.

“An SEP [Medicare special enrollment period] also became available, effective January 1987, for disabled beneficiaries under age 65 who did not enroll in SMI [Part B of Medicare] when first eligible (or who terminated SMI enrollment because of coverage under a GHP or a large group health plan (LGHP) based on their own or a family member’s current employment status. These individuals may also enroll in SMI anytime while covered under the GHP/LGHP or during the 8-month period immediately following the last month of GHP/LGHP coverage based on current employment status.”

You or your daughter will have to speak with her private insurer about the second issue. While most insurers would not drop her if she did not get Medicare, there are enough exceptions that I do not feel comfortable giving people blanket advice about how they would work in a situation like this.

One key matter here is whether her coverage is part of an active employer group health plan or some kind of retiree plan into which she was placed following her disability. The rules for these two types of plans regarding Medicare often are different, with active plans generally not requiring Medicare, and retiree plans requiring it.

If, on the other hand, she has a policy through the Affordable Care Act, you should check to see if her eligibility for Medicare would cause her to be ineligible to continue to receive income-related government subsidies that are available to help pay for this policy. This would clearly be the case if she had become eligible for Medicare because she just turned 65.

Peggy – Wash.: My husband will turn 65 later this year; I am 62. He is not working, but has not filed for Social Security benefits. I am still working. My Social Security benefit payout would be twice as much as his. If I am not retired, can he file for Social Security and collect a spousal benefit on my record, deferring his own benefit until full retirement age at 66 for him? He was born before the Jan. 2, 1954, cutoff date in the new Social Security rules that Congress enacted in late 2015.

Phil Moeller: In order for either of you to file for a spousal benefit, the first spouse must already have filed for their own retirement benefit. You could file for your own benefit at 62 and make him eligible for a spousal benefit. But your retirement award would be sharply reduced, and this is not a good strategy for you.

As the higher earner in the family, I suggest your strategy be based on maximizing your own retirement benefit. The only way to do so under the new rules is for you to wait until you turn 70 to file. Your husband is free to file for his own benefit whenever he wishes, although his benefit also would increase the longer he waits to file.

Once you have filed, your husband is free to file for a spousal benefit. If it’s greater than his own retirement benefit, he would receive an additional payment equal to the difference.

Steve – Fla.: I am a 100-percent disabled veteran receiving all of my medical care from the Veterans Administration. However, Medicare premiums are still being deducted from my Social Security payment. Do I have any recourse?

Phil Moeller: You should be able to get this money back from Social Security. I’d call the agency and explain. If this doesn’t help, the State Health Insurance Assistance Program (SHIP) provides free counseling; I suggest you contact a local office and see if someone there can help you. Please let me know how things turn out.

Steve: I just wanted to thank you for the response. I contacted the Social Security Administration today and explained my situation. They are mailing me out paperwork to sign. Once I’ve returned it, they said they will stop the deduction.

Anon. – Texas: I am 70 and currently on my spouse’s group medical plan since retirement. When I apply for Part B and Medicare benefits, what information will I need?

Phil Moeller: Because you are older than 65 — the initial age of Medicare eligibility — you will need a form from your spouse’s employer certifying that you have been covered by that plan since turning 65. This allow you to sign up for Part B during a special enrollment period. and you will not be charged with late-enrollment penalties.

Gary: Is a change from one Medicare Part D drug plan to another subject to underwriting and rejection for preexisting conditions?

Phil Moeller: No. You cannot be denied coverage or charged a higher premium by a Part D plan due to your age or health.

Frank: You may already know this, but did you know that “Get What’s Yours: The Secrets to Maxing Out Your Social Security” is cited in “A Generation of Sociopaths: How The Baby Boomers Betrayed America” (p. 231) as an example of the Boomers’ relentless drive to maximize their unfunded gains at the expense of following generations? Even though I am a Boomer, I must say there seems much truth to the author’s contention.

Phil Moeller: I respect anyone who feels this way. I also support anyone who desires to get the most favorable treatment they can obtain legally under the rules. In a parallel situation, it’s easy to get upset by rich people reducing their taxes, but I certainly understand their right to do so. If people don’t like the rules, they should change them. That’s what happened in late 2015 when Congress eliminated some of the favorable Social Security claiming strategies highlighted in our book.