20 Aug Do we need to pay a penalty for Medicare Part B?

Q. My husband and I are both retired. He is covered under my private health insurance plan and veterans medical benefits. He wants to enroll in Medicare Part B — he already has Part A. We had previously been told if my husband was covered under my private plan, he did not have to take Medicare Part B and that he could begin enrollment at any time without penalties. But now we’re told he has to wait until open enrollment in January and that coverage won’t kick in until July 2021 and there will be penalties. He is a disabled veteran with metastasized cancer. What can we do?
— Wife

A. We’re sorry to hear about your husband’s health.

Here’s what you need to know.

Medicare becomes available to most at age 65 and provides coverage for many medical needs through Part A (hospital insurance) and Part B (medical insurance).

The enrollment period is a seven month window that begins three months prior to the month you turn 65, and it ends three months afterwards, said Claudia Mott, a certified financial planner with Epona Financial Solutions in Basking Ridge.

She said if enrollment in Part B takes place after this period will usually result in a lifetime penalty that is applied to the premium.

Having both an employer health plan and veteran’s medical benefits may provide additional coverages, but it is recommended that enrollment in both Part A and Part B take place as soon as you are eligible, she said.

Mott said there are Special Enrollment periods (SEP) that apply to individuals who did not enroll in Part B because they were covered under their spouse’s group health insurance plan.

“If your husband became eligible for Medicare while you were working and providing insurance coverage, he may have been able to delay Part B if your employer had 20 or more employees,” Mott said. “For smaller employers, enrolling in both Part A and B when age-eligible is recommended on Medicare.gov.”

She said when you transitioned from active employee to retiree, there was likely an eight month SEP window that would have enabled him to enroll in Part B and avoid penalties.

“The information you received about his delaying enrollment was likely correct at the time you were employed,” she said. “Now that you are receiving retiree benefits, your husband will need to enroll during the open enrollment period which occurs from January to March of 2021.”

She recommends you contact Social Security by phone to discuss your circumstances and the process of filing for equitable relief. In the event you were given misinformation by a federal employee that caused your husband to delay his Part B enrollment, they may waive the penalty, Mott said.

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This story was originally published on Aug. 20, 2020.

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