How to Avoid the Medicare Part B Penalty

Medicare Part B is optional and covers outpatient expenses such as lab tests, outpatient surgeries, doctor visits and limited outpatient prescription drugs (typically not drugs you would administer yourself). 

Coverage begins after you meet an annual deductible of $147 (2015) as well as paying a monthly premium of $104.90. After meeting the deductible, you must also pay a coinsurance of 20 percent of the Medicare-approved charges for most doctor services.

You may be wondering whether you should sign up for Part B at the same time as Part A. Naturally, you are concerned about paying premiums for Part B if you don't need the coverage. But the timing for enrolling in Part B is a bit trickier and the stakes much higher, since late enrollment can cause you a permanent premium increase.

One thing you should consider: If you don't have employer group coverage, then this is a no-brainer. You should apply during their seven-month initial enrollment period.

If you are covered under a group health plan based on your current employment -- whether it's your employer or your spouse's -- you may qualify for a Special Enrollment Period, often abbreviated as SEP. If so, you may delay enrolling in Part B until your group health coverage is terminated, and avoid the late enrollment penalty.

The eight-month special period starts the month after the end of either your employment or the group health insurance coverage based on that employment -- whichever happens first. I'll remind you periodically regarding your Part B coverage.

Keep in mind that COBRA coverage does not qualify as employer coverage, and so it won't allow you to escape the penalty for delayed enrollment. Be sure to educate yourself so you don't make this common mistake.

There are other considerations as well. Some smaller employers require Part B coverage to be integrated with their existing insurance plans, for instance, while larger employers may not. Talk to your human resources department to find out whether Part B coverage is necessary for yourself.


Contact me if you have any questions, (773) 614-3201 or leave them below. Comments are welcome.

What You Need to Know About Medicare Now and into 2016

One of the most important decisions seniors will make is choosing the right Medicare coverage when they become eligible for the federal health insurance program.

Your first year of Medicare eligibility is one of the most critical times because of the variety of choices you have to make and the potential for costly mistakes that may last your lifetime. That’s because there are recurring penalties you will have to pay if you don't sign up for certain types of Medicare coverage when you first become eligible.

If you do not have creditable coverage that is as good or better than Medicare, there are penalties that you will have to pay once you finally do enroll and will have to continue to pay for as long as you have Medicare. There also are "some complex choices" that can impact your entire family. For example, if your employer's insurance plan provides coverage for your spouse and dependents and you leave the plan to enroll in Medicare, your family could be left without coverage. So it's important to choose Medicare plans that match your health needs and financial resources. It's all driven by cost and how the benefits are going to work.

The second thing is, can I still see my current doctor? What about my medications? Are they covered and how are they going to be covered?"

Generally, if Medicare beneficiaries want to change their coverage, they must wait until the next Open Enrollment Period (OEP), which runs from October 7^th through December 15^th

Here's what you need to know.

THE BASICS

Medicare has four parts:

• Part A is hospital insurance. It covers inpatient care at hospitals, care at skilled nursing facilities, hospice care and home health care.
• Part B is medical insurance. It covers services from doctors and other health care providers, outpatient care, home health care, durable medical equipment and some preventive services.Together, Part A and Part B make up Traditional or Original Medicare.
• Part C referred to as Medicare Advantage Plans are Medicare approved private health insurance plans for individuals enrolled in Original Medicare, Part A and Part B. When you join a Medicare Advantage Plan, you are still in the Medicare plan and must continue paying your Part B premium
• Part D is prescription drug coverage. It is offered through private Medicare-approved insurance companies. The monthly premium for this coverage depends upon the extent of the coverage and can vary between companies.

Medicare Advantage is significant because it provides all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. They generally offer additional benefits, such as vision, dental, and hearing, and may include prescription drug coverage. Call (773) 614-3201 if you are interested in a Medicare Advantage Plan.

If you have any Medicare questions or comments, leave them below.