Health & Wellness: Pertinent medicare questions answered by Debra Sephton

As an independent broker we have many clients, each have different needs and circumstances, and all are unique. Here are the most common questions we’re asked on a day-to-day basis.
Q: Do I need to enroll with Medicare if I have a Group Health Plan?
A: If you have medical insurance coverage under a group health plan based on you or your spouse’s current employment, you may not need to apply for Medicare Part B or Part D at age 65. You may qualify for a “Special Enrollment Period” (SEP) that will let you sign up for Part B and Part D during:
Any month you remain covered under the group health plan and you, or your spouse’s employment continues, and/or the 8-month period that begins with the month after your group health plan coverage or the employment it is based on ends, whichever comes first.
However, if based on your or your spouse’s group health plan, are not currently employed, and you decide to later enroll with Medicare after this 8-month period, you may incur a penalty when you do enroll with Medicare Part B and Part D.
Bottom line: if you or your spouse are not currently employed and collecting a paycheck, you do not have creditable coverage that avoids a Medicare Part B or Part D penalty should you decide or need to enroll with Medicare Part B and Part D in the future. Keep in mind that once you end your group health plan, you may not be able to get it back. There are many options to consider.
Q: Is there a cost for original Medicare?
A: Yes, the cost of your Medicare Part A (hospital insurance) and Part B (medical insurance) depend on your income and the length of time you were employed.
Q: As a broker, what do you charge and how are you paid?
A: As an independent broker, we never charge the client a fee. The insurance carrier pays us directly, if and/or when you decide to enroll with a secondary plan to accompany your original Medicare.
Q: When you are turning 65, Medicare is so confusing, why do they make it so difficult?
A: There are many options to consider when you are turning 65 or are newly eligible for Medicare. Having a broker is helpful. Find an independent, reputable broker – one who offers several insurance companies. These brokers/agents can compare prices and benefits for you based on your individual needs.
Q: When may I change my secondary plan?
A: Annual Enrollment Period (AEP) aka Open Enrollment is every October 15th through December 7th. This is the time you may change your Medicare Advantage Plan (Part C) and Prescription Drug Plan (Part D) to another plan that may suit your needs more effectively. Sometimes doctors drop in and out of the network or your prescriptions have changed, and a different plan may save you money for the following year. Once a change is made during AEP, it will be effective January 1st of the following year.
Q: When should I enroll with original Medicare?
A: If you’re eligible at age 65, your Initial Enrollment Period (IEP) begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday. If you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during the General Enrollment Period (GEP) from January 1 through March 31, however, there are other variables pertaining to delaying Medicare enrollment timing which may incur penalties when you do decide to enroll.
We hope that this helps with your health care planning and please be advised that neither Atlantic Benefit Consultants, LLC nor Debra Sephton is affiliated with the U.S. government or federal Medicare program.