Oh No! I Don’t Even Have Medicare?

The following situations are real and very sad.  As everyone knows Medicare can be quite confusing especially for people working past age 65.  Imagine a 67 year old following exactly the correct process by gathering Social Security, Medicare and insurance information 2 1/2 months prior to retirement. Then at two months before retirement getting proper documentation from their employer and enrolling in Medicare Part B.  When he received his new Medicare number, he enrolled in a Medicare Advantage Plan.  All should be good – right?

Well no, in a subsequent trip to the local Social Security concerning his payment of Medicare Part B premiums, the Social Security staff member told him the he needed a Medicare Part D (prescription plan) and sent him to a local organization for a navigator to enroll.  Navigators are not insurance agents but are trained in Medicare and oftentimes Obamacare.  He followed the Social Security staff member’s recommendation. The navigator enrolled him in a Part D Plan.  However, the navigator did not ask any questions about his current coverage. Here is the problem; the new Medicare Part D enrollment terminated his Medicare Advantage Plan he had enrolled in a week earlier.  

The bottom line is that this person could have gone the entire 2020 calendar year without medical coverage other than original Medicare.  It would appear that the staff member for Social Security may have overstepped her bounds and the navigator’s lack of fact finding could have proven very costly for this person.  In this case further action was taken by our office to appeal this case and the person was put back into the plan he originally wanted.

Another case:  Could you imagine paying a 60% Medicare Part B penalty and a 72% Part D penalty for late enrollment?  Further to discover you cannot enroll in Medicare until their General Enrollment Period from 1/1 – 3/31 for a 7/1 effective date.  If one discovers this problem in July, they could be required to wait almost a year for Medicare coverage.  The aforementioned penalties will be paid by this person the rest of her life.  This being said, the biggest fear is going from now until July 1 without Medicare coverage. She did not seek a professional opinion but listened to friends and others.  Medicare enrollment can be confusing.  The best advice is to get qualified professional help.

 So, what are some this issues you need to know:

  • Gather information as to whether you should apply for Medicare Part B  2-3 months before you turn age 65..  Question: are you working (or spouse) and have a large group employer plan of 20+ employees? (check with HR)
  • COBRA is NOT considered group coverage – the person or spouse must be actively working.
  • Faith based plans are NOT creditable coverage (like a 20+ group plan) under Medicare rules. The person paying a 50% Part B premium penalty ($72.30 per month) was told the faith based plan would be considered creditable under Medicare.  This is not true. (author’s note: there is a time and place for these plans, this just is not one of them)
  • Gather information on Medicare – the types of plans, your options, how they work and what type of plan may work best for you.  
  • Be sure your medical providers and prescriptions are covered.

In summary: Be sure to get the advice of a qualified professional.  If you are not the “cookie cutter” case, actions or non-actions could prove quite costly.  Worst yet, you may not be able to obtain the medical care you need.

To have some fun:  We will answer Medicare and/or insurance questions in future articles.  If we use your question we will give you a $5 Starbucks gift card.  Feel free to email “Stump the Medicare Guy” at [email protected] or visit our website contact page https://www.mrms-inc.com/contact-mrms/.

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