Janie Slaven: TONI SAYS: Applying for a Medicare Supplement at the right time is essential

Janie Slaven, The Times-Tribune, Corbin, Ky.
·3 min read

Sep. 10—Dear Toni,

I retired last June when my employer offered a great retirement package with COBRA at no cost for me and my husband for 18 months, which ends this December 31. I am 62 and will not be enrolling in Medicare for a while. My husband, John, is 72, and he enrolled in Medicare Part B in June of 2022 when our COBRA began, because he was having heart surgery due to a heart attack. He enrolled in Medicare Part A in 2018.

John needs help with applying for a Medicare Supplement, but he is being denied for health issues because he must answer underwriting questions. Why is it so complicated to apply for a Medicare Supplement? What did we do wrong when I retired?

Please explain what John's Medicare options are.

—Sarah from Pearland, Texas

Hello Sarah:

I have good news for you and John because there is a Medicare Supplement rule which can keep him from answering underwriting questions despite his heart issues.

Since John is losing his COBRA "company" benefits, he qualifies for the 63-day guaranteed issue period to apply for a Medicare Supplement/Medigap plan without medical underwriting. He will need your company benefits termination letter to prove to the Medicare Supplement plan that he is in a guaranteed issue period. Isn't it amazing how complicated Medicare rules can be?

The Medicare & You handbook explains Medigap Guaranteed issue rights, and because John has "Original Medicare and an employer group health plan (including retiree or COBRA coverage) that pays after Medicare pays and that the plan is ending," John is eligible for a Medicare Supplement without medical underwriting.

With guaranteed issue, an insurance company:

—Must sell you a Medigap/Medicare Supplement policy. "You have the right to buy Medigap/Medicare Supplement plan A, B, C, F, G, K or L that's sold in your state by any insurance company." John is not eligible for Plan G but is eligible for Medicare Plan F or C with guaranteed issue rights since his Medicare Part A began in 2018. (Plans F and C are only available to those who were eligible for Part A prior to January 1, 2020.) Those whose Medicare Part A began after January 1, 2020, are eligible for Plan G (and not Plan F or C) for a guaranteed issue plan. Additionally, there are only 63 days to apply for a Medicare Supplement/ Medigap from the date the coverage ends. Include a copy of the termination letter to attach to the application to be approved. Do not delay enrolling on time.

—Must cover all your pre-existing health conditions.

—Cannot charge you more for a Medicare Supplement/Medigap policy, regardless of past or present health problems.

Sarah, when you and John attended the Zoom Toni Says personalized Medicare consultation, I could see the relief on both of your faces when I was able to design a plan to meet your financial needs. John's prescriptions for his heart issues were expensive and he could wait to enroll in a Medicare Part D plan to begin January 1, 2024, since his COBRA would end December 31. John has time to discover if there are any generics that can be substituted for the brand name medications that he now has an affordable co-pay for.

You have to wait 3 years to enroll in Medicare, Sarah, and will need an under-65 health insurance plan to meet your needs until then.

America does not realize that enrolling in Medicare Part B is as valuable as GOLD and should be treated with kid gloves. With Medicare, it's what you DON'T know that will HURT YOU!

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.