Ask the Medicare Expert

Hi Sarah, The type of questions you have will determine who you call. If you are not yet on Medicare or have questions about your enrollment you will contact the Social Security Administration at 800-773-1213 as they handle Medicare Enrollment or online at https://www.ssa.gov/.

If you have questions concerning your ongoing coverage and options, you can call the Centers for Medicare and Medicaid Services at 1-800-633-4227 or online at https://www.medicare.gov/.

Regards, Ron

Hi James, Yes, you can have both Medicare and Medicaid. If you qualify for both programs they can work very well together. There are Medicare Advantage Plans that are called D-SNP (Dual Special Needs Plan) which are specially formulated for those qualifying for both programs. If you’re on Medicare and full Medicaid, you may enroll at no cost and your Part B monthly premium paid by your state. In addition, most of your medical care, if not all, will be zero copay.

Regards, Ron

Mary, Medicare is not mandatory; however, there are penalties for failure to enroll when you first become eligible. For every year you fail to enroll in Part B and are eligible for it, you will incur a 10% penalty. This penalty is recalculated each year by Social Security and is based on the Part B premium at the time.

Regards, Ron

John, If you meet the enrollment qualifications, you cannot be denied coverage under Original Medicare Parts A and B. The only impact on enrollment in Original Medicare caused by previous health concerns is the possibility that you may be able to enroll in Medicare before turning 65. There are no preexisting condition requirements for Original Medicare enrollment.

Regards, Ron

Hi Michael, No, Medicare Part B is not mandatory. However, if you do not sign up for Part B when you are first eligible you may incur penalties when you sign up later. If you qualify for one of the two Part B Special Election Periods (SEP), you may defer Part B and avoid penalties or delayed coverage.

The first Part B SEP is for the working aged. To be eligible for this SEP, you must be 65 or older and either you or a spouse must be working and covered by a group health plan that is based on current employment.

The second Part B SEP is for international volunteers. If you volunteer internationally for at least 12 months for a tax-exempt non-profit organization and have health insurance during that time, you will have a six-month SEP to enroll in Medicare without gaps or penalties. This SEP begins once your volunteer work stops or your health insurance outside of the U.S. ends, whichever is earlier. Coverage must be through the organization you are volunteering for or the national healthcare of the county in which you are volunteering.

Regards, Ron

Hello Denise, There are several factors which may make a difference in how you handle your health insurance going forward.

First: Many employer plans will not allow the employee to drop their company insurance and allow the spouse or family to maintain coverage. If he can drop and keep you insured, we must look at the cost differences if he moves to Medicare. This will depend on the type of plan he chooses and the amount of your combined yearly income while he is working.

Second: you have a ways to go before you reach Medicare age and if your husband’s plan is as good as you say, it will be difficult to replace at the current rate.

Third: As long as your plan is not an HSA plan to which you are contributing, he should take out Part A when he turns 65. Many employers require Part A when the employee turns 65. You will not get any kind of notification from BCBS, however, your employer may and he may pass it to you.

Fourth: As long as the employer coverage is considered creditable by Medicare, (good plans most often are) your husband will have a penalty free Special Enrollment Period (SEP) to enroll in Part B any time while working and for 8 months after his coverage ends, whether by his choice or the company’s. He will also be able to choose a Supplement or Advantage plan, and Drug plan during this time.

One last caution: If he retires and is allowed to keep the insurance, he must enroll in Part B at that time or risk incurring penalties. Retirement and COBRA coverage are not considered creditable for the Part B SEP.

Regards, Ron

Jim, You just asked the $64,000 question. This is a disputed area by many, however I can tell you that while CMS does not say Plan N does not have Guaranteed Issue Rights, it does not include it in its list of plans that do.

CMS tells you to call your SHIP office to see if it qualifies. I believe your local SHIP office is the next call you should make. SHIP offices are government sponsored and of no charge to the customer. Call 1-800-252-8966.

Good luck, Ron

Hi Nora, Medicare provides coverage for most cancer treatments and testing with various cost sharing. Cost sharing depends on the treatment and Medicare plan you have in place. It will cover breast exams, mastectomies, and reconstruction, with different parts of Medicare covering different areas of the treatment.

The doctors’ visits, consultations, and outpatient services or surgeries are covered by Medicare Part B. Part B also covers some oral chemotherapy and other medications administered by a doctor. The hospitalization and inpatient surgery are covered by Part A, as well as most medications administered while an inpatient. If the decision for reconstruction is made, Part A will cover surgically implanted prosthetics and Part B will cover external prosthesis and related bras. If you need other medications, you will need to have Part D prescription drug coverage.

Preventive mastectomies are not guaranteed by Medicare. However, if you have a cancer diagnosis that requires a mastectomy, and you have a family history of breast cancer you should ask your doctor to provide the needed information and documentation and to support your claim for the preventive surgery.

If you are denied, the process is in place to appeal any decision made by Medicare. Be sure to enlist the aid of your doctor.

Regards, Ron

Hi Rebecca, In general, you are eligible for Medicare Part A if you are age 65 or older and a U.S. citizen or permanent legal resident for at least five consecutive years. You are eligible if you are already receiving retirement benefits from Social Security or Railroad Retirement benefits, if you were a state or local government employee after March 31, 1986, or a federal employee any time after December 31, 1982.

You are eligible if you are disabled and receiving disability benefits. Medicare is automatic after you have been on Social Security disability for 24 months. Everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage. You are eligible for Part A and B if you have end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS). Contact the Social Security Administration at 800-772-1213 to learn if you have enough work history to qualify for ESRD Medicare.

You are eligible if you have been married to a qualified beneficiary for at least one year before applying, if you are divorced from a qualified beneficiary whom you were married to for a minimum of 10 years and you are single at the time of application. Or you are widowed by a qualified beneficiary to whom you were married for at least nine months before their death, and you are single at the time of application.

Regards, Ron

Tom, The upside of any Plan G is the fact that it is a Supplement Plan. Supplement Plans pay secondary to Medicare. This means that the provider, whether doctor, clinic, hospital, or lab, has a contract with Medicare, not the Supplement carrier. They bill Medicare and simply attach the Supplement information with it, Medicare pays their part and passes the remainder to the Supplement carrier. If Cleveland Clinic accepts Medicare, they should accept any Supplement Plan.

Regards, Ron

Jim, If you buy a Medicare Supplement policy when you have a guaranteed issue right (also called Medigap protection), the insurance company cannot refuse to sell you any supplement policy offered, charge you more for a Medigap policy than those with no health problems, or make you wait for coverage to start (except in certain circumstances).

Under certain circumstances, an individual can be denied a Supplement Plan. You may be denied coverage if you are not enrolled in both Part A and Part B of Medicare at the time of application. In most states, if you are under 65, you are not eligible for Medigap policies even if you are on Medicare because of disability or other health reasons. You may be denied coverage if you are on a Medicare Advantage Plan or a Medicare Medical Savings Account (MSA) Plan, unless you schedule disenrollment from these plans. You may be denied coverage if you are not within your Supplement Open Enrollment, or other Special Enrollment Period granting guaranteed rights, and have pre-existing health conditions.

If you qualify for guaranteed issue rights, insurance companies cannot turn you down or charge you more for a Medicare Supplement policy despite past or current health problems.

Please let me know how this turns out.

Regards, Ron

Hi Robert,

Yes, you may work and receive Medicare at the same time. Work has no bearing on your ability to enroll in Medicare when you are eligible.

Regards, Ron