Medicare Part B… Do I need it?

As the Office for Aging Services Medicare Health Insurance Coordinator, I am asked many questions about Medicare and all its “parts” (A, B, C, and D). As time goes on, you would think that the questions I receive would become less and less as our aging population is becoming more computer-savvy and more informed about health insurance since many of the new Medicare beneficiaries have helped their own parents with Medicare and health insurance navigation. But if fact, I have noticed an INCREASE in not only the amount of questions we get on a daily basis at the Office for Aging Services, but also the TYPES of questions have gotten much more detailed and difficult to answer with a simple reply.

The plain fact is, Medicare is difficult to understand and while we think we know everything we need to know, inevitably, something comes up that makes us question our decisions. So, while I can’t answer every question in one article, I would like to begin with a question that comes up almost daily that continues to be a misunderstood issue when people are getting ready to enroll into Medicare for the first time OR have employer coverage OR are leaving an employer insurance coverage. So, here is my best effort at explaining some of the main points you may need to know in order to make a decision on whether you need to enroll into Medicare Part B or not when the time comes.

WHEN YOU ARE TURNING 65 and working… Do I Need Medicare Part B?

It depends on how you get your health insurance now and the number of employees that are in the company where you (or your spouse) work.

Generally, if you have job-based health insurance through your (or your spouse’s) current job, you don’t have to sign up for Medicare while you (or your spouse) are still working. This is called ACTIVE employer coverage. You can wait to sign up for Medicare Part B until you (or your spouse) stop working or you lose your health insurance (whichever comes first).

If you are self-employed or have health insurance that is not available to everyone at the company: Ask your insurance provider if your coverage is an employer group health plan coverage (as defined by the IRS). If it is not, sign up for Medicare A & B when you turn 65 to avoid a monthly Part B late enrollment penalty.

If the employer has less than 20 employees: You might need to sign up for Medicare A & B when you turn 65 so you do not have gaps in your job-based health insurance. Check with the employer.

If you have COBRA coverage: Sign up for Medicare A & B when you turn 65 to avoid gaps in coverage and a monthly Part B late enrollment penalty. If you have COBRA before signing up for Medicare, your COBRA will probably end once you sign up.

WHEN YOU ARE ALREADY 65 and RETIRING… Do I Need Medicare Part B?

Ask the employer or benefits administrator how its retiree coverage works with Medicare. You’ll want to know if your (or your family’s) current benefits will change, if they offer retirement coverage or other supplemental coverage that works with Medicare, and if any drug coverage they offer is creditable drug coverage

Check when your current coverage ends and sign up for Medicare Part B about a month earlier. Signing up for Medicare before your current coverage ends can help you avoid a gap in coverage.

Ask the employer to fill out the employment form. You will need this extra form to qualify a Special Enrollment Period to sign up without penalty for Medicare Part B.

While this may not answer every question you may have about enrolling into Medicare Part B, I hope that it helps to make your Medicare journey a little easier! For more information or health insurance assistance, contact the NY Connects Helpline at 716-661-7582.


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