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Dear Toni:

I have decided to retire when I turn 65 in June and will need to enroll in Medicare Parts A and B. My husband, Seth, is 70 and he enrolled in Medicare Parts A and B when he turned 65 and remained on my company benefits due to having health issues.

He recently began taking heart meds for blood clots and his cardiologist’s office manager expressed concern over my husband’s insurance changes from group insurance to Medicare since he may have to have serious medical needs.

Please explain how we enroll in our Medicare plan. Thanks, Sheila from Tulsa,OK

Hello Sheila:

When you enroll in Part B the wrong way or may be too soon, it can cause you to not qualify medically for the Medicare Supplement you desire.

Medicare provides special rules for employees or spouses who are “still working” and are covered by an employer group health insurance.

Sheila, I know how worried you are about Seth’s health issues but there is a Medicare answer to his Medicare Supplement enrollment. He enrolled in Medicare Part B when he turned 65 over five years ago and he must answer underwriting questions to qualify for a Medicare Supplement.

Therefore, enrolling in Part B, the correct way, when “still working” full-time with true company benefits is so important. Not only to keep from receiving a Medicare Part B penalty, but also to be able to enroll and be accepted in any Medicare Supplement/Medigap plan due to medical underwriting. Seth may not be able to pass Medicare Supplement underwriting due to heart issues.

There is a Medicare Supplement rule which can keep him from answering underwriting

Questions. Since he is leaving your company benefits, he qualifies for the 63-day guaranteed issue

period to apply for a Medicare Supplement/Medigap plan without medical underwriting. He will

need your company benefit termination letter to prove to the Medicare Supplement plan that he

is in a guaranteed issue period.

With guaranteed issue, an insurance company must:

• Sell you a Medigap/Medicare Supplement policy. “You have the right to buy Medigap/Medicare Supplement plan A, B, C, F, K or L that’s sold in your state by any insurance company. Seth is not eligible for Plan G with guaranteed issue plans since his Medicare Part A began prior to January 1, 2020. Those that Medicare Part A begins after January 1, 2020 are eligible for Plan G not Plan F or C for a guaranteed issue plan.
• Cover all your pre-existing health conditions.
• Cannot charge you more for a Medigap/Medicare Supplement policy, regardless of past or present health problems.

Sheila, I have great news for you! You are “turning 65” and have a less stressful

Medicare enrollment than Seth because you are in your Medicare Supplement/Medigap Open Enrollment Period and in the Medicare & You handbook it states, “The best time to purchase a

Medicare Supplement/Medigap policy is during your Medigap Open Enrollment Period. This six-month period begins on the first day of the month in which you are 65 or older and enrolled in Medicare Part B. After this enrollment period, you may not be able to buy a Medicare Supplement/Medigap policy. If you are able to buy one it may cost more”.

America does not realize that enrolling in Medicare Part B is as valuable as GOLD and should be treated with kid gloves. Take your time and explore your Medicare plan options. Remember to discuss your Medicare needs with your medical providers to assist in finding a Medicare plan. 

Email Medicare questions to info@tonisays.com or call 832/519-TONI (8664). Toni King, author of the new 2021 Medicare Survival Guide® Advanced edition offers a “Thank You to Toni Says® Medicare column readers” with a $5 discount available at www.tonisays.com.