Enrolling in Part B After Turning 65? 2 Things You Must Know: Especially Veterans
Becoming a Medicare Advantage agent and a veteran’s specialist has taught me quite a bit about how Medicare works and the mistakes to avoid as a veteran on either VA benefits or TRICARE For Life. As I speak with them, I am learning those who have not taken Part-B (the medical insurance portion of your Medicare benefits that Social Security deducts $148.50 in 2021, per month, from your check) and now realized they need it, are having a hard time getting it in a timely manner.
This is troublesome, because (as in one instance with a vet that has already accrued 50% lifetime penalties), the longer it takes to get it, the higher the penalties continue to accrue (to learn more about penalties, click here).
So, let’s take a look at what you must do in order to receive your Medicare Part-B enrollment, if you did not take it when you should have, during your initial enrollment period (IEP).
Medicare gives you seven (7) months for your IEP. It starts three (3) months before your birthday month, plus your birthday month, and ends three months after your birthday month on the last day of the month. For example: If your birthday were December 15th, your IEP would start on September 1st and end after March 31st.
Special note: If your birthday is the first day of the month, like December 1st, your effective date will be the month prior to your birthday. Instead of a December 1 effective date, your Medicare benefits will start one month early on November 1st.
Now why is this important when it comes to Part B? Some people get enrolled automatically, due to their circumstances. However, many have to enroll themselves. Why? Well, if you are still working and receiving health insurance from a group of 20+, you don’t need to take it right away. If you receive health insurance from your spouse’s job, with the same criterion, you don’t need to take it right away. Therefore, the onus is on you to make sure you are enrolled.
If you procrastinate and decide to enroll on your birthday month, it won’t be effective until the following month. But here’s where it gets tricky.
This table was part of the Medicare and You handbook for 2012. In the Medicare and You 2022 handbook, it only states that if you enroll in Part B in the last three months of your IEP, it will be delayed. So, beware!
While this has not triggered any Part-B premium penalties (because you are under 8 months past your birthday, it has triggered Part-D penalties (if you’re not a veteran on VA benefits) for your prescription drug plan.
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This is where most veterans fall. Since we have VA benefits (for those who do), often the mistaken belief is, ”I don’t need Medicare; I have VA for my insurance.” The problem with that statement is that your VA benefit is NOT insurance; it’s a benefit. Therefore, it does not meet the threshold of creditable coverage (insurance provided by an employer group with 20 or more beneficiaries), because you are not employed by the VA. Since it doesn’t meet the criterion, the vet starts to accrue penalties each year for Part B.
If you are in this category, you must wait for the Open Enrollment Period, which runs January 1 through March 31, in order to enroll. To enroll, you must submit CMS Form-40B, which you can download here. Once your enrollment has been approved, it will not be effective until July 1st.
If you have creditable coverage, you get a special election period (SEP) to enroll in Part-B when you get ready to lose your group coverage. You will have 8 months in which to enroll, and it will be effective the following month. You will want to enroll no later than the last month of your group coverage, so that you won’t have any break in coverage.
In order to enroll in Part B, you will need to submit the two following forms:
This will make it that you don’t have to wait the extended periods for your Part B to be effective.
If you’re a veteran and are trying to get your Part B, keep in mind these timeframes. Not only may it add to your penalties, it may also delay you receiving whatever care you need that’s not being provided by the VA. Make sure you download the forms and read them carefully. Understand what you need to do and provide in order to not slow down the process with a denial and having to resubmit.
If you’re a veteran who is turning 65 soon, make sure to get your Part B on time. Remember, even the VA says you should take it. And, when in doubt, reach out to us to answer any questions you may have. We are your advocate.