Janie Slaven: TONI SAYS: I've been laid-off … What are my husband's Medicare options? [The Times-Tribune, Corbin, Ky.]

Times-Tribune (Corbin, KY)

Jun. 17—Hello Toni,

I have been laid-off. My husband, Art, who is 70, has been covered under my company's insurance for the past 15 years. I have opted not to take my company's COBRA offer, because I can get an equivalent monetary pay out that should cover my insurance premiums for more than a year. (I am 64 and have gotten quotes from the insurance marketplace in my state.)

We have been told that Art will get a Part B penalty because he is over 65 and never enrolled in Part B. Is this true? Please explain what our Medicare enrollment options are since we are different ages and have different enrollment situations. Thanks.

— Jen from New York

Great question, Jen:

There are 2 different rules regarding enrolling in Medicare Parts A and B in your household and I will keep how to enroll in Medicare for both you and Art SIMPLE!

Art needs to apply for a Special Enrollment Period ("SEP") by downloading the form CMS-L564 (Request for Employment Information) and CMS-40B (Application for Enrollment in Medicare Part B) from www.SSA.gov or email [email protected] and we will email you a form.

Have your human resources department complete and sign the CMS-L564 form and attach it to CMS- 40B. Write "Special Enrollment Period" across the top of each page, then file both forms with your local Social Security office. Art should advise the Social Security representative that he is losing your company benefits and needs his Part B to begin ASAP. Write the effective day as the first of the month in number 12, the "Remarks" section of his Part B application.

Jen, your way to enroll in Medicare is simple and quite different from Art's because you are turning 65 in a year. Go to www.SSA.gov/benefits/medicare at least 90 days prior to turning 65 and apply online for an effective date of the first day of the month that you turn 65.

Readers, if you need help filing for Medicare Part B, you may call your local Social Security office directly for help filing the forms. Most Social Security direct phone numbers can be located by searching online for that specific office's 800-number; or call Social Security's 800-number at 800-772-1213. (Chapter 1 of Toni's Medicare Survival Guide Advanced edition explains various ways of enrolling in Medicare in detail. Or you can call the Toni Says Medicare hotline at 832-519-8664 or email [email protected] for Medicare help.)

Here is a checklist for those enrolling in Medicare:

1. Original Medicare Part A: Covers in-patient hospital stay, skilled nursing/rehab stay, blood transfusions, home health and hospice.

2. Original Medicare Part B: Covers virtually everything else that is not in-patient services or prescriptions. (i.e., doctors' visits, outpatient procedures, physical therapy, durable medical equipment, blood tests, x-rays, CAT scans, MRIs, chemotherapy, etc.)

3. Original Medicare/Medicare Advantage: Discuss with your healthcare facilities and medical professionals which Medicare plans they accept such as Original/Traditional Medicare with a Medicare Supplement or a Medicare Part C (Medicare Advantage plan such as HMO, PPO or PFFS). Research the Medicare Advantage plan's hospital/provider online directory. Call to verify they are currently in-network.

4. Medicare Prescription Drug plans: Research drug plans every year to see if your standalone Prescription Drug or Medicare Advantage Plan with prescription's formulary covers all your brand name or generic prescription drugs.

5. Always make copies of every document given to the Social Security office or received from the Social Security office.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email [email protected] or call 832-519-8664.

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