TONI SAYS: I've been laid-off ... What are my Medicare options?
Aug. 6—Editor's Note: The Times Tribune is pleased to offer 'Toni Says,' a new column featuring helpful information about Medicare presented in an engaging question-and-answer format.
Hello Toni:
My husband, David, has been laid-off because of what is happening to the economy and rising gas prices. He is 68 and has never enrolled in Medicare. I am turning 65 this September and we both are covered under his employer's health plan which is ending.
We have been told that he will get a penalty because he is over 65 and never enrolled in Part B. I really hope NOT! I will have to enroll in COBRA until I turn 65 in September. Please explain what our Medicare enrollment options are since we are different ages and have different enrollment situations. Thanks
— Paula
Great Question, Paula:
There are 2 different rules regarding enrolling in Medicare Parts A and B in your household and I will keep how to enroll in Medicare for both you and David SIMPLE!
1) David needs to apply for a SEP (Special Enrollment Period) by downloading the form CMS-L564 (Request for Employment Information) from socialsecurity.gov or email info@tonisays.com and we will email you a form.
Have David's Human Resources department sign off on the form and attach it to CMS- 40B (application for Medicare Part B). File both forms with your local Social Security office when applying for Medicare Part B. Advise the Social Security representative that David is losing his company benefits and needs his Part B to begin the day after they end.
2) Paula, your way to enroll in Medicare is simple and quite different from David's because you are turning 65 in September. Go to www.socialsecurity.gov/benefits/medicare at least 90 days prior to turning 65 and apply online for a September 1 effective date.
This is an ALERT to the public because local Social Security offices, which were closed due to the pandemic, recently reopened. The public should call their local Social Security office directly for help filing forms to apply for Medicare Part B. Most Social Security direct phone numbers can be located by searching online for that specific office's 800-number. Generally, the wait while holding is less than calling the main Social Security 800-number.
Below is a checklist for those enrolling in Medicare:
1) Original Medicare Part A: Covers in-patient hospital stay, skilled nursing/rehab stay, blood transfusions, home health and hospice.
2) Original Medicare Part B: Covers primary care or specialist, whether in the office or performing surgery, outpatient surgery, durable medical equipment, x-rays, CAT scans, MRIs, chemotherapy, etc.
3) Original Medicare/Medicare Advantage: Discuss with your healthcare facilities and medical professionals which Medicare plans they accept such as Original/Traditional Medicare with a Medicare Supplement or a Medicare Part C (Medicare Advantage plan such as HMO, PPO or PFFS). Research the Medicare Advantage plan's hospital/provider online directory to be sure your physicians and hospitals are in that specific plan's network. Call to verify they are currently in network.
4) Medicare Prescription Drug plans: Research drug plans every year to see if your standalone Prescription Drug or Medicare Advantage Plan with prescription's formulary covers all your brand name or generic prescription drugs.
5) Long-Term Care (LTC): Consider an LTC option such as standalone LTC policies, hybrid annuities or life insurance with LTC riders, Veterans Affairs aid and attendant benefits or applying for financial help from your specific state's Medicaid for LTC.
6) Always make copies of every document given to the Social Security office or received from the Social Security office.
Toni King is an author and columnist on Medicare and health insurance issues. She spent more than 27 years as a top sales leader in the fields. For answers to Medicare questions, email: info@tonisays.com or call 832-519-8664.