The WasteWatcher: The Staff Blog of Citizens Against Government Waste

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The WasteWatcher is the staff blog of Citizens Against Government Waste (CAGW) and the Council for Citizens Against Government Waste (CCAGW). For questions, contact blog@cagw.org.

Individuals who are not on Social Security at age 65 are supposed to sign up for Medicare anytime between three months before their 65th birthday and three months thereafter.

I turn 65 on January 9, 2018, and thought I should get an early start by checking everything out exactly three months before that date. 

After spending more than 34 years in an organization that focuses on government spending, including Medicare, I thought it would be easy to sign up. But I was clearly delusional in believing that could be true. The information was confusing, contradictory, and incomplete. 

Since I am still covered by my employer’s group health insurance, I searched for how or when someone should sign up under such circumstances.

I was first led to the Medicare website, which states that if you do not sign up for Part B when you are first eligible, you will have to pay a penalty, unless you qualify for a special (delayed) enrollment period that includes the time you are covered by your employer. 

You can wait to sign up if your employer has 20 or more employees, but you should sign up if your employer has less than 20 employees:

https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-3156

However, a second search for the same information led me to the Social Security Administration website, which says that if your employer provides group coverage, you can wait to sign up under the special enrollment period exception, and there is nothing about the size of the employer:

https://www.ssa.gov/hlp/isba/10/hlp-med003-partb2.htm

I then decided to ask CAGW’s insurance agent about what I should do. 

She wrote, “The website does contradict itself. I believe it’s because there is old information and new information and the government hasn’t done a good job at pulling the old information off.

Prior to ACA, small group employers (less than 20) received a discounted rate for of age employees who signed up for A&B, because Medicare was primary and the group policy was secondary. However, since ACA, this discounted rate is no longer available, so most employees opt to stay on the group health plan and not enroll into A&B immediately.

A special enrollment period is what you would be eligible for if you stayed on the group health plan and did not opt for A & B at this time. You will not be penalized for not signing up because your group health plan pays at least the Medicare allowed amounts for all services.

If you decide to take A&B and keep the group health plan, Medicare pays first, and the group health plan becomes secondary.”

The ACA was signed into law on March 23, 2010, more than six-and-a-half years ago.

I searched the 960-page bill for “Medicare” and “group health plan” and did not find anything that verified the information from our insurance agent, although I presume she is correct.

The Social Security Administration website made two suggestions to get further information, one of which I had already done: 

https://www.ssa.gov/planners/retire/justmedicare.html

Note: If you have a Health Savings Account (HSA) or health insurance based on current employment, you may want to ask your personnel office or insurance company how signing up for Medicare will affect you.

https://www.ssa.gov/pubs/EN-05-10043.pdf

Due to limits on the delay in enrolling in Medicare Part B, “we strongly advise you to contact the Centers for Medicare and Medicaid Services (CMS) for more information.”

Stay tuned for the results of my call to CMS.

My best guess is they will tell me to speak to my insurance agent or employer to determine if the group health plan meets the Medicare-allowed amounts for all services.

And I know something about this … imagine what other people go through when they try to sign up.

 

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