Working Past 65: Delayed Medicare Enrollment

People can delay enrollment in Medicare Part B if they are working beyond their 65th birthday or are covered by their spouse’s employer health insurance. But once they want to get their Medicare started there can be some confusion.

Steps to take to get Part B:

If people plan ahead, they can take care of their delayed enrollment in Part B by mail. But everybody I have spoken with waited until the last minute and wanted their coverage to begin on the first of the next month. So they needed to move quickly to get their paperwork in order.

Katherine, who is 66, called Social Security to tell them she wants her Part B to begin on June 1st. She asked about getting the necessary paperwork on-line and was told the forms are not on the Social Security website. (I wonder why?) She was told to google the following:

CMS-40B     This form is used to apply for Part B using a special enrollment period.

CMS-L564   This form must be signed by the person’s employer to certify that he/she has had employer group health insurance.

These two completed forms can be taken to the local Social Security office and the enrollment in Part B can be in the system in just a day or two. It’s a good idea to call Social Security (800-772-1213) to see if you can make an appointment at the local office. When talking to Social Security, ask if  there are any other documents you need to provide. I have heard of some people being required to provide a birth certificate.

Part B is required to apply for Medicare Advantage or Medigap.

A person cannot submit an application for Medicare Advantage or Medigap until their Part B is in the system. Last year I worked with Fred, who waited until Monday, April 23rd to submit his forms to Social Security. He did this in-person at the local Social Security office.  Two days later, we sent in an application for a Medicare Advantage plan with a start date of May 1. I was worried the application would be rejected because his Medicare record would not show he had Part B.  My fears were unfounded because he was in the system – just two days after submitting his paperwork for Part B.

Medicare Advantage: When a person has delayed enrollment in Part B because he had employer health coverage, a specific code must be put on the Medicare Advantage application. If the wrong code is used, Medicare will reject the application. (Note to new insurance agents: This is not an IEP or ICEP.)

Medigap: A person who has had employer health coverage can get a Medicare supplement with “guaranteed issue”, no matter what his age or what health problems he has.  The Medigap application has some confusing questions that actually pertain to guaranteed issue. (Experienced insurance agents know what I’m talking about.)

I have been pleasantly surprised at how efficiently the local Social Security office performed for people who waited until the last moment to submit their paperwork for Medicare Part B.  If a person takes care of this two months before they want Part B to begin, they can receive and submit their paperwork by mail. But it seems like a lot of people are not aware of what they need to do to get their Part B started if they delayed enrollment for good reasons.