NYSUT Social Services is increasingly concerned about members or their dependents who are incurring astronomical financial costs because they did not enroll in a timely fashion in Medicare Part B. Medicare is the federal health insurance program for people who are age 65 and older or, regardless of age:
- are disabled and have been receiving Social Security Disability Insurance for 24 months;
- have end-stage renal disease and have completed Medicare's waiting period up to three months and 30-month coordination period when Medicare is the secondary payer; or
- have amyotrophic lateral sclerosis and are receiving Social Security Disability Insurance benefits.
Most health plans require participants to sign up for Medicare Part A (inpatient hospital insurance) and Part B (outpatient medical insurance) with coverage generally effective the first of the month before their 65th birthday.
And so doing, one avoids late enrollment premium penalties.
Those who are actively employed over age 65 may enroll when they retire without having to wait for an open enrollment period or incurring a late enrollment premium penalty.
There is generally no additional premium charge for Medicare Part A, but the Part B standard premium ($99.90 for 2012) is normally deducted from the participant's Social Security check. People with a higher income (over $85,000 single and $170,000 couple) will pay an income related adjustment in addition to the $99.90 standard Part B premium.
If you or your dependents are eligible for Medicare primary benefits, most health plans will not pay for any hospital and medical expenses Medicare would have covered. This applies even if you or your dependents were eligible for Medicare primary coverage and failed to enroll. Your private insurance generally pays secondary or after Medicare has paid.
Will my former employer pay for Medicare Part B?
Each NYSUT local's benefits are unique regarding retiree health insurance and the employer reimbursement of the Part B premium.
Members should sign up for Part B at their first available date and under no circumstances opt out of Part B to save monthly premiums. When you do sign up for Part B, you should also inform your employer if they are paying the Part B premium as part of your retiree health insurance.
An exception would be a member over age 65 who is still actively employed who can enroll in Medicare Part B upon retirement.
Members with limited income and resources may be eligible for an assistance program to pay for the Part B premium.
What does Medicare Part B cover?
Part B covers a wide range of medical services for retirees and their dependents at age 65, and those of any age, 24 months after being approved for Social Security Disability.
Medicare Part B services include: facility fees for ambulatory/outpatient surgery, physician charges, clinical laboratory services, routine costs for persons enrolled in clinical trials testing the effectiveness of new cancer drugs, injectable or infusion drugs used in the treatment of cancer and other diseases and colorectal, prostrate, cervical and vaginal cancer screenings.
Also, diabetes screenings and monitoring supplies, mammograms, bone mass measurement (bone density), second surgical opinions, home health skilled nursing services, kidney dialysis service and supplies either in a facility or at home, transplant services to include immunosuppressive drugs under specific conditions.
Cardiovascular screening and rehabilitation, defibrillator (Implantable Automatic), limited chiropractic services, flu, hepatitis B and pneumococcal shots, foot exams and treatment, glaucoma tests, HIV screening, physical therapy, tobacco use cessation counseling and mental health care (outpatient) are all covered under Medicare Part B.
Medicare Part B and Retirement
If you or your spouse is planning to retire at 65 and you are both on the same or separate private insurance plans, you should visit your local Social Security office to sign up for Medicare Parts A and B. This should be done three months before active employment ends.
Though you are automatically eligible for Part A when you turn age 65, you must opt for Part B or otherwise risk being uncovered for the spectrum of outpatient services.
Medicare B and Social Security Disability
Recipients of Social Security Disability are eligible for Medicare after receiving 24 monthly benefit payments.
It is important to note that a number of these payments may be made in a lump sum and calculated from the date of disability determination. Thus, one may be eligible for Medicare shortly after receiving the first benefit payment.
If the initial enrollment is missed, the private company may continue to pay health benefits, in error, for an extended period of time, possibly years, until a specific charge triggers the private carrier's recognition that you previously had an option to enroll in Medicare Part B and did not.
The company then will go back to the date the disabled member was eligible for Medicare and request refunds of the payments made to medical providers, who will in turn bill you personally.
At that point you may not be able to enroll in Medicare Part B until the next open enrollment period and may be subject to a permanent late enrollment premium penalty in addition to the standard premium for each year beyond the date of initial eligibility.
The key is for prospective Medicare recipients to take the initiative in getting enrolled in Part B.
- Do not rely on information provided by the employer's human resource department, friends or colleagues.
- Do not expect notices to alert you to dates you should enroll.
- Do not be dissuaded from enrolling in Medicare Part B because your employer is not one who reimburses the standard Part B premium.
Failure to enroll in Part B could be costly because the private carrier converts to secondary coverage once one is eligible for Medicare Part B primary benefits and will not pay even as a secondary until you enroll in Part B.
If a serious illness occurs while you are not covered by Medicare Part B and are waiting for the next open enrollment period, you will be expected to pay your hospital and medical bills out-of-pocket. Participants will also be subject to a late-enrollment premium charge.