Leaving employer’s benefits after age 65 is puzzling

Hello, Toni:

My husband, Jay, retired 6 years ago when he turned 65. He enrolled in Medicare Part A only and decided to delay Part B since I put him on my employer’s group health plan. Recently, I read an article about failure to enroll in Medicare Part B when turning 65 and the additional cost for each year that one delays enrollment.

I plan to keep my husband on my policy until my retirement in 3 years when I turn 65. I spoke with a representative at the Social Security office and asked if Jay would receive a penalty for delaying enrollment in Part B. The rep said he would not but that Jay will need to provide evidence that he has been enrolled in my employer health insurance.

I am overwhelmed because I do not know what to for Jay’s Medicare when I retire at 65.

--Shirley from Dallas

Hi Shirley:

I have good news for you because the Social Security representative gave you excellent advice about your husband’s Medicare. I have written about the famous form to verify employer benefits for those enrolling in Medicare past 65 called CMS L564 “Request for Employment Information.”

Form CMS L564 is filled out and signed by your Human Resources department, and Jay will fill out CMS 40B form “Application for Enrollment in Medicare Part B.” Under #12 Remarks of CMS 40B, state which month Jay wants his Medicare Part B to start. Across the top of each form write “Special Enrollment Period” to claim the Medicare enrollment period he wants to enroll in to keep from receiving a Part B penalty.

Avoiding a Medicare Part B penalty when past 65, as you discovered, Shirley, is stressful. But initial enrollment is not the only stressful issue. A reader recently visited the Toni Says office for a consultation because his wife is retiring. The husband, 72, has been enrolled in Medicare Parts A and B since he turned 65 in 2018.

The wife, who qualified for the Medicare Supplement Open Enrollment (6-month enrollment period) because her Medicare Parts A and B began February 2024, can pick whichever Medicare Supplement plan she desires without having to answer one health question.

But the couple is experiencing the pain and agony of trying to enroll the husband in a Medicare Supplement as he has health issues. He is currently on both spousal company benefits and Medicare Parts A and B. However, because he has been enrolled in Medicare since 2018, he can only apply for a “guaranteed issue” Plan F, not G, Medicare Supplement policy, as he has heart and cancer issues that keep him from qualifying medically. (Chapter 3 of Toni’s Medicare Survival Guide Advanced edition discusses the enrollment rules for Medicare Supplements.)

Readers, you must have a current company benefit termination letter to prove to the Medicare Supplement insurance company that you are in a “guaranteed issue” period in order to avoid having to answer health underwriting questions. If you do not have a current termination letter and you have health issues, then you will not qualify medically due to those issues and will have to choose a Medicare Advantage Plan HMO or PPO.

I have written about this special 6-month window many times and have stressed the importance of enrolling in Part B at the correct time and the correct way. Remember that if you leave employer benefits and decide to enroll in a Medicare Advantage plan, you should verify that your medical providers are in the network for the Medicare Advantage plan you are interested in.

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. The “Medicare Survival Guide Advanced” edition and her new “Confused about Medicare” video series are available at www.tonisays.com.