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Should I take Medicare Part B even though I still work full-time and have health insurance from work?

2 answers | Last updated: Jan 30, 2013
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A fellow caregiver asked...
I am 66, should I take Medicare Part B even though I still work full time and have health insurance at work?
 

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Barbara Steinberg is the CEO and founder of BLS Eldercare Financial Solutions, which specializes in helping families pay for long-term care for their...
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If you're satisfied with the coverage from your health insurance at work, you don't need to take Medicare Part B now -- but there are some benefits to signing up. See also:
Do You Have to Be Bankrupt to Get Medicaid?
The advantage to taking Part B now is that it will pay for any services that aren't covered by your employer's health insurance (in other words: your employer's health insurance would be your primary insurance and Medicare would be the secondary.) However, if you don’t need this additional protection, you can avoid paying the monthly premium for Part B, which will be a minimum of $96.40 in 2008 (depending on your income, this could be higher).

Although there is a penalty for late Medicare enrollment, it doesn't apply to you because people over the age of 65 who have insurance through their employer are exempt from the late enrollment penalty. If you don't have health insurance through your employer, you must enroll in Medicare during the initial enrollment period (which starts three months before your 65th birthday and ends seven months later), or you can't enroll until the next general enrollment period (January 1-- March 31 of the following year) and coverage won't begin until July 1st of that year. In addition, you'll pay an extra 10 percent on the premium for every 12 months of late enrollment.

 

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An anonymous caregiver answered...

I would just like to add that the answer to this question depends upon the size of the business you work for. As per Federal guidelines, as a general rule, if your employer has fewer than 20 employees then Medicare is automatically the primary payer of claims and your employer-sponsored health plan is secondary. You do not have a choice in this.

Because of this, it is imperative that you sign up for Part B as soon as you become eligible. (Part A covers facility charges, Part B covers physician charges.) IF YOU DON'T, YOUR EMPLOYER'S INSURANCE POLICY MAY DENY PAYMENT FOR ANY PART OF YOUR CLAIM THAT WOULD HAVE BEEN PAID BY PART B! AND, you may have missed your opportunity to sign up for Part B and could have to wait til the open enrollment period (Jan 1 to March 31 each year), and your coverage will be effective the following July 1, leaving you with a gap in coverage for Part B services.

If you work for a larger employer (generally 20 or more employees), then your employer-sponsored health plan will be primary and you do not need Part B. This rule is called Medicare as Secondary Payer and is part of a Federal law called TEFRA/DEFRA.

As a licensed health insurance broker I see this all the time. "I didn't sign up for Part B because I have insurance through my job."

Check with your employer's Human Resources Dept or your employer's health insurance broker and ask if your employer is subject to TEFRA (Medicare as Secondary Payer) rules, and/or call your local Social Security office before making a decision about Part B.

And heads up, I've seen situations where the SS representative failed to ask the individual about the size of their employer, resulting in misinformation and no coverage!!

 

 
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