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.
Moeller is a research fellow at the Center on Aging & Work at Boston College and co-
author of “How to Live to 100.” He wrote his latest book, “How to Get What’s Yours: The Secrets to Maxing Out Your Social Security,” with Making Sen$e’s Paul Solman and Larry Kotlikoff. He is now working on a companion book about Medicare. Follow him on Twitter @PhilMoeller or e-mail him at firstname.lastname@example.org.
Your Medicare Questions
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. The nonprofit Medicare Rights Center is also providing ongoing help.
Tom – California: I am 65, and my husband is 35. I am employed part-time as a pastor and plan to work until I am between 70 and 72. I signed up for Medicare but recently married and am now covered by my husband’s health insurance. Do I even need to keep Medicare if I’m covered under my husband’s plan? If so, must I use Medicare as my primary health insurance?
Phil Moeller: Congratulations on your nuptials! Same-sex spouses in California and most other states now get to wade through Medicare’s regulatory swamp, too! Seriously, you may not even need Medicare right now, and contrary to folklore, it is perfectly legal to leave the program if you become newly entitled to employer group health insurance, either through new employer coverage from your own or your spouse’s health plan. Ask your husband to make sure his coverage is the first in line, or primary payer of your covered medical needs, and that Medicare would be the secondary payer. Only in employers with fewer than 20 employees is Medicare considered the primary payer and thus required even with the employer group plan. Still, it can’t hurt to check. Also, if you’re eligible for Social Security, as a recent Ask Phil explained, it means you’re also eligible at age 65 for “free” Part A hospital coverage. This is usually a good idea. Finally, for the truly detail-oriented among us, you also might compare the cost of your Medicare coverage with what your husband is paying to carry you on his plan. It probably isn’t cheaper but might be better, and this is the time to find out, not after you leave Medicare.
Nancy – Pennsylvania: In February of 2014 my husband had emergency surgery to remove a large blood clot from his brain as a result of a subdural hematoma. He was on short-term disability until May of 2014, worked two weeks, and then went out on severance, which included one year of health benefits. He was speaking with the company’s human resources representative in August 2014 and asked about when to sign up for Medicare. He wrote down that he was told he should sign up for Part B close to the time his severance ends, as that is when his healthcare benefits would be ending. When he went to Social Security in March 2015, he was told that he had missed his opportunity for open enrollment for Part B and that he actually had been enrolled in Part A in 2013. Social Security based his eligibility from the last day he worked (June 2014)—not when severance ended (June 2015). We’ve tried to work through the Social Security representatives to determine if we have an appeal situation based on his medical condition, but with no success. My husband worked for this company for over 33 years and he is 71 years old. The only option we have is private insurance for one year, and once he does sign up for Part B, he will pay a lifetime penalty. Are there any appeals or special circumstances that may help us get him Part B coverage after his severance ends in June?
Phil Moeller: Nancy, I’m so sorry that you and your husband have been through the wringer twice—once when he had the emergency surgery and a second time while trying to navigate the gauntlet of Medicare rules governing sign-ups for the program. It is true that there is an eight-month window to sign up for Medicare after someone who is at least 65 has lost access to his company’s group health insurance. And neither severance coverage nor being on COBRA health insurance qualifies as employer group insurance.
GOT MEDICARE QUESTIONS?
Possibilities come to mind that might provide you some relief, but they seem to me to be long shots. The first is to contact his old employer and see if what’s called his “current employment status” might have extended beyond the last day he actually worked. Was his departure actually a severance from the company or, in legal terms, not such a clear separation? He need not be actively working or even being paid to maintain an employment relationship. If this might be the case, and he was still technically employed as of the end of July of last year, then he would squeeze through the eight-month sign-up window.
The second possibility hinges on whether the company’s human resources representative might be viewed as someone who was authorized by the government to give you advice. If so, the bum information you got might be grounds for an appeal. If not, and if you have any written record of this bad advice other than your husband’s notes, you might file in small claims court to get at least some money to help you defray your medical bills.
In any event, you’d need to go back to Social Security and ask for your case to be reconsidered. By the way, in addition to being denied the insurance you rightly think you deserve, you could get socked by Medicare with late enrollment penalties when you finally do get to sign up for Medicare coverage. These penalties might amount to a premium surcharge of 10 percent a year for the rest of your husband’s life. And, while not wanting to pile on, Part B may not be your only problem. People are not legally required to get Part D coverage for prescription drugs, and your note did not mention drug coverage. But if your husband does need drug coverage—and who can afford drugs these days without insurance—he faces an even shorter turnaround of only 63 days to sign up after his active employment ends. And, yes, Part D has its own 10-percent late enrollment premium penalty.
Your husband deserves better, and so do you.
Ronnie – Florida: I recently applied for Social Security and Medicare benefits. I am 65 years old. Social Security recently contacted me to say that after reviewing my online application, it appears I can collect on my former deceased spouse’s earnings which would be higher than mine. I could then wait until I’m 70 to collect on my own earnings at a higher rate. To go this route I must submit a withdrawal application quickly, and I will then be instructed to return the monies received so far. They also said that I must reapply for Medicare, and this is where I am confused. I currently pay Medicare quarterly and mail the check directly to CMS (the Centers for Medicare and Medicaid Services). Why would I have to reapply for Medicare and face a period of no coverage? I assume once they withdraw my Social security they will do the same with Medicare, and who knows how long this process will take? I am concerned I will fall outside of the open enrollment period if I have to reapply after they process my application to withdraw.
Phil Moeller: Ronnie is right on the money here. Increasingly, we have to be our own watchdogs. As it turns out, there is no reason for her to lose Medicare coverage and it’s a shame she has had to endure this worrisome episode. According to the experts at the Medicare Rights Center, “You will not face a period of no coverage… Your Medicare record under your Social Security number should be linked to your Medicare record under your former deceased spouse’s Social Security number. Because your enrollment will be (eventually) linked, you should have continuous coverage and will not need to enroll during the open enrollment period, because you have always been enrolled.” This process, MRC said, is known as “cross-walking.” Make an appointment at your local Social Security office and make sure there is someone there who will be a point of contact for you throughout the entire process. If you run into any further problems, please let me know.
Betty – Texas: I am 44 and on Social Security Disability. I recently moved from Minnesota to Texas to live with my mother and stepfather. I had recently changed my insurance from Humana to Coventry because their package looked reasonable. However, my new coverage is asking me to pay out of pocket 20 percent for my MRI’s, EKG, EMG, etc. I was scheduled for three MRIs just this month, and my 20 percent cost is more than $350. I only get $762 a month in disability income. I am very disappointed in this new insurer and wondered what plan would be more beneficial for me during open enrollment this fall? I have had to cancel all my diagnostic tests because I can’t afford them. Any advice?
Phil Moeller: Betty, I only wish I had one of those frozen yogurt machines that could dispense Medicare benefits! Pull the lever and out would come the benefits that you need. Sigh! In the real world, you will have to wait for a better Medicare policy for next year. I’m assuming here you have been receiving disability payments for more than two years and thus already are on Medicare. Also, might you qualify for Medicaid? I’d suggest you contact the SHIP office in Texas and get help in selecting a new policy this fall for next year, and also see about Medicaid eligibility. In the meantime, if your disability payments are your only source of income, you should work now with SHIP to see if you are eligible for a Medicare Savings Program (MSP) to help defray your insurance costs, including help with premiums, deductibles and co-pays. You also may be entitled to receive help in paying for prescription drugs under Medicare’s Extra Help program.