Late Medicare Enrollees Pay a Price, by Lisa Zamosky

Kudos to Lisa’s excellent article in today’s Los Angeles Times describing the tricky nuances of Medicare eligibility and enrollment.  While mostly accurate, even policy wonks sometimes get it wrong, as when Lisa writes “You can’t delay enrollment and avoid the [Part B late enrollment] penalty if you work for a firm with fewer than 20 employees.”

The fact is, there is no Part B penalty1 while a Medicare-eligible person has employer-sponsored coverage, regardless of the number of employees.  Lisa may have been thinking about whether Medicare is primary payor or secondary payor for enrollees of group health plans. For employers with fewer than 20 employers, Medicare is almost always primary, and if the employee does not enroll in Part B they will have no primary coverage! Yikes!!!

Therefore, it’s usually not a good idea to delay enrollment in Part B if your company has fewer than 20 EEs–but not because of any penalty.


Sources 

Show 1 footnote

  1. If you don’t sign up for Part B when you’re first eligible or if you drop Part B and then get it later, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.

Obama signs Medicare bill changing how doctors get paid

For LA Times story by Noam M. Leavy see http://www.latimes.com/nation/la-na-medicare-doctors-pay-20150415-story.html

  • Instead of annually ignoring a reimbursement system that by this year threatened to cut physician fees by more than 20%, lawmakers finally put a new payment system in place that gives physicians an annual 0.5% increase over the next four years.
  • In 2019 performance-based financial incentives begin for physicians, rewarding doctors whose patients get better.
  • The Children’s Health Insurance Program (CHIP) is extended until 2017, as well as funding for Community health centers serving more than 23 million low-income folks.

Unfortunately the usual pander-to-the-base prohibition on using federal dollars for abortion is included in the bill.

People with Medicare and the Health Insurance Marketplace

Frequently Asked Questions

HOW WILL THE HEALTH INSURANCE MARKETPLACE THAT STARTS IN 2014 AFFECT MY MEDICARE COVERAGE?

The Health Insurance Marketplace is designed to help people who don’t have any health insurance. You have health insurance through Medicare. The Marketplace won’t have any effect on your Medicare coverage.

Your Medicare benefits aren’t changing. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now, and you won’t have to make any changes.

The Marketplace provides new health insurance options for many Americans. If you have family and friends who don’t have health insurance, tell them to visit HealthCare.gov to learn more about their options.

DO I NEED TO DO ANYTHING WITH MARKETPLACE PLANS DURING MEDICARE OPEN ENROLLMENT (OCTOBER 15 – DECEMBER 7, 2013)?

Medicare’s Open Enrollment isn’t part of the new Health Insurance Marketplace. It’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan.

Medicare Open Enrollment (October 15 – December 7, 2013) is the time when all people with Medicare are encouraged to review their current health and prescription drug coverage, including any changes in costs, coverage and benefits that will take effect next year. If you want to change your coverage for next year, this is the time to do it. If you’re satisfied that your current coverage will continue to meet your needs for next year, you don’t need to do anything. For more information on Medicare Open Enrollment, visit Medicare.gov or call 1-800-MEDICARE.

NOTE: The Health Insurance Marketplace Open Enrollment period (October 1, 2013 to March 31, 2014) overlaps with the Medicare Open Enrollment period (October 15 – December 7, 2013). Therefore, people with Medicare who are looking to make Medicare coverage changes should make sure that they are reviewing Medicare plans and not Marketplace options.

WHAT SHOULD I DO IF I’M CONTACTED ABOUT SIGNING UP FOR A HEALTH PLAN? „„

  • The Medicare open enrollment period is a time when there’s a higher risk for fraudulent activities. „„
  • It’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan. „„
  • DO NOT share your Medicare number or other personal information with anyone who knocks on your door or contacts you uninvited to sell you a health plan. „„
  • Senior Medicare Patrol programs are teaching people with Medicare how to detect and report fraud, and protect themselves from fraudulent activity and identity theft. „„
  • To learn more about health care fraud and ways to protect against it, visit StopMedicareFraud.gov or the Senior Medicare Patrol (SMP) program in your area (locate your SMP at SMPresource.org).

This information is provided by the United States Department of Health and Human Services. August 2013