How do I refuse Medicare?

A fellow caregiver asked...

I am alone, no children or husband. I had to take Social Security early at 62 due to no jobs available. I'll be 65 in 2010. The money I receive from Social Security in very minimal. Without getting cost of living raises for the next two years, I'll be really strapped to pay the cost of Medicare. I've gone two years without medical insurance, and therefore my medical problems have gone untreated for that time, simply because I cannot afford it. I either pay for groceries or pay for medical insurance. So, do I have to have Medicare? If so, which part do I absolutely have to have? If not, what do I need to do to NOT be automatically signed up?

Expert Answer

For most people, Medicare Part A, which covers inpatient hospital bills, has no monthly premium and so there is no reason not to sign up for it. Medicare Part B, which covers doctors bills and other outpatient costs, does charge a monthly premium of $96.40 per month. You don't have to sign up for Medicare Part B if you don't want it. But it provides excellent coverage, and if you would have a hard time paying the premium, there are several programs that might be available to pay the premium for you.

Medicaid is a program of comprehensive medical coverage for people with low income and few assets other than the home they live in. If you're only income is from a small Social Security check, and if you have not more than a couple of thousand dollars in savings, you are likely to qualify for Medicaid. If you are eligible for Medicaid, Medicaid would pay the full amount of your Medicare Part B monthly premium once you reach age 65. Medicaid would also pay most of the costs Medicare Part A and Part B do not pay for Medicare-covered care (for example, the 20 percent coinsurance amount you would owe for each doctor's bill). To find out about Medicaid eligibility in your state, and to begin the enrollment process, you can contact a local Medicaid or county social services office. To find a local office, you can go to your state's Medicaid Web site by using any online search engine and entering "Medicaid" and the name of your state. Or, you can call the Eldercare Locator toll-free at 800-677-1116 and ask for contact information for a local Medicaid office near you.

Even if you have slightly too much income or assets to qualify for Medicaid, you might be eligible for another program that would pay Medicare premiums, deductibles and coinsurance amounts, or at least Medicare Part B premiums. One of these programs is called Qualified Medicare Beneficiary (QMB). If you are eligible to be a QMB, the program will pay all of your Medicare Part A and Medicare Part B premiums, deductibles, and coinsurance amounts. If you have slightly too much income or assets to qualify as a QMB, you might still qualify as a Specified Low-Income Medicare Beneficiary (SLMB) or a Qualifying Individual (QI). If you qualify as a SLMB or QI, the program will pay your monthly Medicare Part B premium, though not your Medicare deductibles or coinsurance amounts. You can apply for the QMB, SLMB or QI program when you enroll in Medicare at your local Social Security office.