Category

Understanding Medicare

Posted on: January 4th, 2018 by Lawrence A. Friedman

Medicare is a health insurance program sponsored by the federal government. Medicare is available to most people at age 65, but younger people may qualify for Medicare when collecting Social Security Disability Insurance (SSDI) or due to contracting end stage renal disease or Lou Gehrig’s Disease (ALS).

If you become eligible for Medicare at age 65, you can enroll in Medicare during your initial Medicare enrollment period of 3 months before to 3 months after the month in which you reach age 65. After receiving Social Security Disability Insurance (SSDI) for 24 months you should automatically receive Medicare. If you have group health insurance through your current employment or your spouse’s current employment, you may be eligible for a Medicare Special Enrollment Period.

As discussed in greater detail in the  Medicare section of specialneedsnj.com, you also can enroll in Medicare late. However, delaying Medicare can lead to Medicare late enrollment penalties and may leave you without sufficient health insurance (especially if Medicare would provide primary health insurance coverage).

While you may be tempted to save on premiums by deferring Medicare, over a long lifetime, Medicare late enrollment penalties can dwarf Medicare premium savings from deferring Medicare. Your Medicare Part B premium may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. In addition, you may have to wait until the Medicare General Enrollment Period (from January 1 to March 31) to enroll in Medicare Part B, but Medicare coverage won’t start until July 1 of that year.

You also may face a Medicare prescription late enrollment penalty if, for any continuous period of 63 days or more after your initial enrollment period is over, you go without Medicare prescription insurance or other creditable drug coverage. Large employer drug plans typically are creditable but check with your employer to make sure.

A Medicare late enrollment penalty should not apply if you are covered by an employer or union group health plan based on your own or a spouse’s current employment. Because COBRA and retiree health plans are based on former employment, Medicare late enrollment penalties apply if you delay enrolling in Medicare Part B because you have COBRA or retiree health coverage but not current active employment coverage.

Finally, delaying Medicare enrollment can leave you uninsured. Medicare may be primary or secondary depending on various factors. If Medicare is primary, Medicare rather than other health insurance (such as COBRA or retiree coverage) pays first. Where Medicare normally would be primary but you don’t sign up for full Medicare coverage, other health insurance typically won’t pay costs Medicare normally covers. When through no fault of the secondary insurer, you fail to obtain Medicare that would be primary insurance, the secondary coverage may pay little or nothing on your claim leaving you liable for costs Medicare normally would cover!

Medicare usually is primary to small employer health plans, retiree health plans, COBRA, Medigap insurance, and some other coverages. For instance, if you are eligible for Medicare but don’t take Medicare because you are covered by your spouse’s retiree health insurance, your spouse’s plan may not cover you for most costs.

For further information on Medicare, see the elder law section of SpecialNeedsNJ.com. However, Medicare rules are extremely complex and errors can prove catastrophic. Since, this site provides only general information on Medicare, it is important to obtain individual legal counsel on your own issues

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