Avoid The Lifetime Penalty

[CLLBGone]

Hopefully this information helps those in the US, over 65, avoid some of the trauma and drama I faced when trying to enroll in a Medicare Supplemental Plan.

Bumper sticker version:

Avoid the Lifetime Medicare Part B Penalty and put in for Medicare Part B as soon as you know you won’t be covered under a Group Medical Plan, such as the one you might have from your employer. Do not wait to apply for Part B!

Enrollment in a Med Supp plan is not possible until you have Medicare Part B.

Gory details:

If you have medical coverage under a Group Medical Plan (often through you or your spouse’s employer) you most likely did not enroll in Medicare Part B Medical when you first enrolled in Medicare Part A Hospitalization.

You did not need Part B, because you were covered at work, and Social Security said you could enroll in Part B at a later time as long as you had Part A.

And that was me.

In 2014 I enrolled in Part A and didn’t need Part B. I’d delay getting (and paying for) Part B as I was already covered under a group plan. I was in compliance: enrolled in Group A by age 65 and didn’t need Part B.

I knew that at some point my group coverage was going to go away when my wife retired. My medical coverage was through her employer.

My wife planned a September 30, 2020 retirement. She knew back on Oct 2019 that she would be retiring and we talked about it. This meant I’d need to enroll in Medicare Part B and purchase some kind of a med supp plan before Oct 1, 2020.

But hey, it’s October 2019, I’ve got a plate full of things, commitments, life, this & that, and an O&V treatment trial that included me was due to ramp up mid-October and I was nervous a bit about the trial. Anyway I’d have a ton of time to enroll in Part B.

I assumed enrolling in Part B would be simple; quick and easy. No need to rush things; I’d be covered through the end of September 2020. Everything is online these days. The websites are streamlined and Part B online enrollment would be an efficient cinch.

Not quite. Anybody ever read “Catch 22”?

Okay, let’s flash forward to the beginning of August 2020.

O&V treatment went, and continues to go, fine, numbers are great, plenty of energy, a bit bummed about the Covid, but hey why not spend ten minutes and enroll in Part B.

How hard can that be?

So at the beginning of August 2020 I went online to enroll in Medicare Part B.

And YES you can enroll in Part A and Part B online IF you never enrolled in Medicare previously.

I had been covered under Medicare Part A since 2014. Online enrollment for Part B would not be possible as I was considered previously enrolled in Medicare.

This had to be a mistake. I called the Social Security office. No mistake, online enrollment for Part B is not possible if you already have Part A.

Enrolling in Part B would now require paperwork and a visit to the local SS office. But wait; there are no offices open due to the Covid. This meant my paperwork had to be mailed (not emailed) and/or faxed in. There are no drop boxes either.

But wait there’s more.

You can’t buy a supp policy until you have Medicare Part B

And it turns out there is a Lifetime Monthly Part B Penalty if you can’t prove that you had existing medical coverage when you applied for Part A, way back when.

To avoid the Part B enrollment after the fact lifetime penalty, you need to submit two forms: CMS-40B (easy to fill out) and CMS-L564 – “Request For Employment Information”. The CMS-L564 requires an employer’s signature and includes the dates of coverage regarding the group plan. I was lucky. My wife was able to get the 564 in a few days from her HRD department.

Once you’ve completed the forms you mail or fax or both to Social Security and then you wait and you wait and you wait and you wait and you wait ……. did I mention that they are short staffed, that they let mail sit for a week to decontaminate before messing with it (I am not making this up) and there are a jillion people ahead of you?

Meanwhile the group policy termination date, along with the possibility of a lifetime penalty loom ever closer.

My advice:

As soon as you know that your group plan is going away apply for Part B.

Ask the employer to complete form CMS-L564 and get it back to you; you need this form to avoid the lifetime penalty

Prepare a cover letter and fax and mail the two required forms. Note: Social Security doesn’t wait a week for fax decontamination, but there will be tons of faxes ahead of you.

Get the address and telephone numbers, voice and fax for your local SS office and call frequently to determine the status; you will be on hold. I mailed and faxed to the local office on August 6, 2020

And, if you are up for it, take a drive over to the local office and determine if there are any drop boxes. In my case there weren’t any drop boxes.

Long story short: my Part B came through today, penalty free, and I enrolled in a Med Supp Plan F and a Part D Drug Plan. I would be remiss by not giving a super huge shout out to wizard166, who posts here, and who helped me tremendously by offering plenty of advice as well as spending a lot of time explaining and deciphering the various supp plans.

[AmericanRonin]

Wow! Thanks!

[MsLockYourPosts Passed Volunteer]

Be sure to apply well before your 65 th birthday if 65 is when you need your Medicare to start. I applied during my birthday month. No part B for a month.

[Justasheet1]

Government at its finest. Great post and glad you got it sorted out.

Jeff

[lankisterguy Volunteer]

You can apply for Medicare 3 months before your 65th birthday and coverage will start the first day of your birth month (e.g. BEFORE your birthday).

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When you first apply for a supplemental plan- all the questions about pre-existing conditions - i.e. the CANCER questions can and should be ignored.

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Also when you choose supplemental plans, check to make sure they are available in all the states you plan to live in during retirement, changing plans or companies due to relocation will trigger the CANCER question.

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Len

[CLLBGone in reply to lankisterguy]

Correct. Great information.

And for those turning 65 it looks like the application process can be handled online.

My problem which many others will face invplves getting Part A at or three months before turning 65 AND suspending Part B.

Therefore, you have A and not B at 65. Obtaining Part B at some point in the future can not be done online. It is a slow uphill slog.

You'd delay Part B due to medical coverage in an existing health plan.

When that, in most cases, employer sponsored group coverage goes away some years later, often due to retirement, you'll need to get Medicare Part B in a timely manner as well as avoid the lifetime Part B penalty.

Initiating form CMS-L564 and then getting your docs and request into, and processed, by the Social Security office during the new covid abnormal, moves like molasses in winter.

[Hidden]

I also found that you must be continuously covered with a Rx plan or you have to pay extra for the medicare ones for the rest of your life...

[Big_Dee]

Hello CLLBGone

Oh yes the Social Security office. I was aware that I needed to enroll in Part B even though I am covered by my wife's insurance and had enrolled in Part A at 65 has required. I get grant from Leukemia & Lymphoma Society which pays my Part B.

I needed to renew my drivers license and DMV would not accept my laminated SS card. So off to SS office, of course office was closed. Called number on SS building. They would have to verify my original drivers license, birth certificate and home addresses for new SS card. They would not verify in person , I would have to mail original documents by USPS and be without drivers license until they mailed documents back to me. As work around solution I would have to apply for MVD ID card and mail that to SS office in place of drivers license. All I needed was new SS card to get my drivers license renewed. I feel sorry for people who actually needed something important. Government knows no bounds.

[CLLBGone in reply to Big_Dee]

Wow ... Incredible.

I had a funny experience when I drove to the SS office looking for a nonexistent drop off box .... parking lot was empty and building was dark, deserted and locked.

Around back was an electronic gate. I saw a key code gate activation box and an intercom that listed a phone number on a hand printed sign.

I figured I'd call and perhaps someone would open the gate and take my documents.

I punch in the phone number listed on the sign and explain what I'm after and the voice comes back with:

"Where'd you get this number?"

[Big_Dee in reply to CLLBGone]

Hello CLLBGone

And rest assured that all the Social Security staff were being paid, even though on lay-off. However a boat manufacturing plant which manufactured recreational boats was not laid off because the boats were classified as essential transportation unlike the SS staff.

[CLLBGone in reply to Big_Dee]

After many phone calls to Social Security using both the national, main number as well as the local one, it was explained that employees are working and not on a lay-off. Arriving mail sits for a week before it is allowed to be touched by human hands and faxes pile up and the subsequent document processing can be a bit haphazard.

I checked the newsfeeds and this is from May 5, 2020:

"The coronavirus pandemic has forced many people to work from home, and that includes employees of the federal government. The numbers vary by agency, but at the Social Security Administration, some 53,000 workers are doing so.

Social Security field offices are closed. But the shutdown hasn't stopped the agency from processing claims for new benefits and appeals of benefit denials. And according to statistics that the SSA sent its workers, the agency has been doing so at a faster pace than before."

npr.org/2020/05/05/85010677...

All I know is that if someone has an existing Part A and no Part B. they will, most likely, have to obtain Social Security Part B at some point. And that Part B process can take some time.