By Reg Jones
Q. I have just retired from federal government (age 67) and have Blue Cross/Blue Shield insurance. I signed up for Medicare Part A at 65, and am trying to decide whether to sign up for Part B. (I gather I have eight months from time of retirement.)
I gather many doctors do not take Medicare, but if they do, I understand that they are governed by Medicare rules and payment schedules, whether or not the patient has signed up for Medicare. Is this correct?
I have read that the insurance company cannot pay more than the Medicare payment schedule allows, but if Medicare does not cover a procedure and the doctor/facility participates in Medicare, is the doctor allowed to provide the service and, if so, will BC/BS, as primary insurer, be able and willing to pay if Medicare would not?
If neither the doctor nor the patient is enrolled in Medicare, will BC/BS, as primary insurer, provide any coverage?
A. You don’t have eight months after you retire to elect Medicare Part B.
Instead, there is a seven-month enrollment period, which begins three months before you turn 65 and ends three months after that month. If you don’t sign up within that time frame, the premiums increase.
Even if a doctor doesn’t take Medicare, he is governed by Medicare’s payment limits, which are somewhat higher than those that they pay doctors who do accept Medicare. If Medicare doesn’t pay for a benefit and your Federal Employees Health Benefits plan does, the amount they cover will be governed by their rules. You’ll have to check your plan brochure to see what those are.
April 1st, 2013 at 12:33 pm
I thought Medicare B could be delayed until retirement if that person was covered by health insurance and had 8 months to sign up without penalty.
April 1st, 2013 at 2:23 pm
Jim is correct.
http://www.fas.org/sgp/crs/misc/R40082.pdf (pages 6 & 7)
Exemptions to Penalty:
Under certain conditions, select beneficiaries may be exempt from the delayed enrollment penalty. Beneficiaries who are exempt include working individuals (and their spouses) with group coverage, some military retirees, some international volunteers, and those who based their nonenrollment decision on incorrect information provided by a federal representative. Individuals who are permitted to delay enrollment have their own special enrollment periods (SEP).
A working individual and/or the spouse of a working individual may be able to delay enrollment in Medicare Part B without being subject to the delayed enrollment penalty. Delayed enrollment is permitted when an individual 65 or over has group health insurance coverage based on the
individual’s or spouse’s current employment (with an employer with 20 or more employees).
About 1.5 million of the 2.7 working aged population are enrolled in Part A only, with most of the rest enrolled in both Parts A and B. Delayed enrollment is also permitted for certain disabled persons who have group health insurance coverage based on their own or a family member’s current employment with a large group health plan. For the disabled, a large group health plan is defined as one which covers 100 or more employees.
Specifically, persons permitted to delay coverage without penalty are those persons whose
Medicare benefits are determined under the Medicare secondary payer (MSP) program. Under
MSP, an employer (with 20 or more employees) is required to offer workers aged 65 and over
(and workers’ spouses aged 65 and over) the same group health insurance coverage that is made
available to other employees. The worker has the option of accepting or rejecting the employer’s
coverage. If he or she accepts the coverage, the employer plan is primary (i.e., pays benefits first)
for the worker and/or spouse over age 65, and Medicare becomes the secondary payer (i.e., fills in
the gaps in the employer plan, up to the limits of Medicare’s coverage). Similarly, a group health
plan offered by an employer with 100 or more employees is the primary payer for its employees
under 65 years of age, or their dependents, who are entitled to Medicare because of disability.
Such individuals may sign up for Medicare Part B (or Part A) anytime that they (or their spouse)
are still working, and they are covered by a group health plan through the employer or union
based on that work. Additionally, those who qualify for Medicare based on age (i.e., over 65), may sign up during the 8-month period after employment or group health plan coverage ends, whichever happens first. Disabled individuals whose group plan is involuntarily terminated have six months to enroll without penalty.
April 1st, 2013 at 2:28 pm
And from AARP:
So it’s important to know when your personal deadline for enrolling in Part B expires, and when the late penalty clock starts ticking, according to different circumstances:
•If you turn 65 and are not covered by group insurance provided by an employer for whom you or your spouse is still working: Your deadline comes at the end of your seven-month initial enrollment period (IEP), which expires at the end of the third month following the month in which you turn 65. For example, if your 65th birthday is in July, your IEP ends October 31.
•You can usually delay signing up for Part B beyond age 65 if:
(a) You are covered by a group health insurance plan from your employer or union and you are still working, or
(b) You are covered by your spouse’s group insurance and your spouse is still working.
If you lose this insurance or retire (or, if it’s your spouse who has the employer plan, when he or she retires), you’ll get an eight-month special enrollment period (SEP) to sign up for Part B without penalty at that time.
April 1st, 2013 at 3:41 pm
Once you become a federal retiree, BC/BS is no longer the primary insurer if you have both Medicare Part B and BC/BS.
Medicare is primary. If you have only Medicare Part A and BC/BS, Medicare is the primary insurer for Part A and BC/BS would be the primary (and only) insurer for claims that would otherwise be payable under Part B.
I agree with Jim on when the period for enrollment in Part B without penaly starts.