Dear Toni,
I have decided to retire when I turn 65 in September and will need to enroll in Medicare Parts A and B with a Medicare supplement and Part D prescription drug plan.
My husband, Tom, is 67. He enrolled in Medicare Parts A and B when he turned 65 because he has a heart condition. Tom remained on my company benefits when he had heart surgery.
He is now taking Eliquis for blood clots, and he needs to apply for a Medicare supplement because his cardiologist's office manager expressed concern over my husband's insurance changes. Their office is accepting very few Medicare Advantage plans and suggested he enroll in a Medicare supplement.
Can you please explain what I need to do to get Medicare supplement coverage for both me and my husband? We need your help.
-- Pat from St. Petersburg, Florida
Hello, Pat,
Medicare provides special rules for employees or spouses still working with true company benefits and covered by the employer group health insurance. Few people realize the value to first receiving Part B until they are in your situation, and then, when they want to apply for a Medicare supplement, they find they can only get certain plans because they are no longer in their initial Medicare open enrollment period.
Pat, you will also be entering your Medigap open enrollment period. The best time to buy a Medigap policy is during your six-month Medigap open enrollment period. You generally will get better prices and more choices among policies. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the first month you have Medicare Part B and you're 65 or older. It can't be changed or repeated. After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more due to past or present health problems.
Your husband, Tom, is not under the same Medicare rules as you are, because he enrolled in Medicare Part B when he turned 65 more than two years ago. Now, if he does not enroll the correct way, he must answer underwriting questions to qualify for a Medicare supplement.
That's why enrolling in Part B in a timely manner when an enrollee or spouse has company benefits is so important. You want to not only avoid receiving a Medicare Part B penalty but also want to be able to enroll in any Medicare supplement or Medigap plan without going through medical underwriting.
Tom's saving grace, if he cannot pass underwriting, is that you, Pat, are leaving your company's benefits. Because Tom was covered under those benefits, he will receive a 63-day "guaranteed issue" period to apply for a Medicare supplement or Medigap plan. You will need to keep your company benefit termination letter to show the Medicare supplement insurance company that you are in a guaranteed issue period.
According to your rights under the guaranteed issue period, an insurance company must:
-- Sell you a Medigap or Medicare supplement policy. You have the right to buy a Medigap or Medicare supplement plan A, B, C, F, K or L that's sold in your state by any insurance company.
-- Cover all your pre-existing health conditions.
-- Not charge you more for a Medigap/Medicare supplement policy, regardless of past or present health problems
Most Americans do not realize that Medicare Part B is as valuable as gold and should be treated with kid gloves. If you enroll in Part B the wrong way, you might end up not qualifying for the Medicare supplement you desire.
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Toni King is an author and columnist on Medicare and health insurance issues. She spent more than 27 years as a top sales leader in the field. For a Medicare checkup, email info@tonisays.com or call 832-519-8664. You can visit seniorresource.com/medicare-moments to listen to her Medicare Moments podcasts and get other information for seniors.