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Can you go on and off Medicare?

Editor’s Note: Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in “Ask Phil, the Medicare Maven.” Send your questions to Phil.

Medicare rules and private insurance plans can affect people differently depending on where they live. To make sure the answers here are as accurate as possible, Phil is working with the State Health Insurance Assistance Program (SHIP). It is funded by the government but is otherwise independent and trains volunteers to provide consumer Medicare counseling in state and local offices around the country.

Moeller is a research fellow at the Center on Aging & Work at Boston College and co-author of “How to Live to 100.” Follow him on Twitter @PhilMoeller or e-mail him at medicarephil@gmail.com.

Elizabeth – Wash.: My husband and I married in July. I am 58 and have health insurance through my employer. He is 67 and has Medicare (A, B and D).

My question: Is it possible for us to drop his Medicare coverage and enroll him as my spouse through my plan? Once one has signed up for Medicare, is it possible for him to go off it and then resume if after I retire? Or is signing up for Medicare a “once and for all” type decision? My employer coverage is very good so it would definitely be cheaper to sign him up on my plan, but I don’t know if it’s possible to do so at this point. Any advice you can give will be greatly appreciated.

Phil Moeller: What a great question! It seems like most of us are going to need to work years if not decades beyond 65. Depressing as this may be, employer-provided health insurance usually costs much less than Medicare and is worth hanging onto.

Of course, the Affordable Care Act could end up driving lots of employees onto state insurance exchanges if their employers find that a better option than continuing to provide health insurance. And employer health coverage would be threatened if Congress ever removes or materially reduces the tax deduction for premiums tied to employer-provided health insurance. But enough depressing thoughts, especially during the holiday season. Feliz Navidad!

If someone is actively employed and their spouse can be covered under their employer group health insurance, he or she could drop Medicare Part B coverage and not have to pay the monthly Part B premium. There will be no penalty when the spouse later wants to re-enroll in Part B.

However, dropping Part A may be a problem. The receipt of Social Security benefits automatically triggers enrollment in Part A. This doesn’t cost anything (assuming at least one spouse has worked and paid Social Security payroll taxes for 40 quarters). But, as explained in an earlier Ask Phil rant, Part A invalidates participation in a health savings account (HSA). So, if your employer coverage is through a high deductible health plan with an HSA, you will want to talk to your benefits staff about how this will affect you.

Beyond dropping Part B, your husband also could drop Part D coverage if the drug coverage included in your employer plan is “creditable.” That’s an important code word in Medicare, meaning that the coverage provided is as good as or better than Medicare drug coverage. Your employer also should provide this information, but if the plan is as good as you say, this shouldn’t be an issue.

And, because there is no simple answer in Medicare, one of our State Health Insurance Assistance Program (SHIP) counselors warns that your husband’s future access to a Medigap policy – Medicare supplement insurance – may be at risk if he leaves Medicare and participates in your plan.

Medicare Beneficiaries have an Open Enrollment Period that begins when they enroll in part B and lasts for six months. During this period, they can purchase any Medigap policy available in their state. And they cannot be denied or charged more because of a pre-existing condition or health history. This guaranteed access to Medigap is, however, a one-time deal. So when your husband re-enrolls in Medicare, it’s possible his health at that time could affect the availability and price of a Medigap policy.

When you no longer have employer-provided coverage, both you and your husband will have an eight-month window, or special enrollment period, to get Medicare. However, his window for Part D coverage will be only 63 days. Because Part D coverage should be part of an overall Medicare insurance program, he probably should consider his window for all of Medicare to be 63 days, not eight months.

Finally, to drop Medicare coverages, SHIP notes, Social Security will require two documents to be signed and sent in showing the person has obtained employer coverage (forms CMS — 40B, and CMS – L564). Further information is available from the Washington SHIBA (Statewide Health Insurance Benefits Assistance) at 800-562-6900.