Part B or Not Part B…That is the question

One of the most commonly asked questions I receive is, “I am turning 65 and I have employer health insurance, do I need to sign up for Part B of Medicare?”

To start, let me explain what Parts A and B are.  Part A of Medicare covers inpatient care in a hospital or skilled nursing facility, while Part B covers doctor’s visits and other outpatient care.

For most Medicare beneficiaries, the Part A decision is easy because it doesn’t cost anything.  Therefore, most people will sign up for Part A as soon as they turn 65.  But the Part B decision can be a little more complicated, since you have to pay a monthly premium for Part B which is $104.90 for most individuals.

When deciding whether to sign up for Part B, the first question you need to answer is whether you have employer health insurance through your employer based on your active employment or if you are covered under your spouse’s employer plan based on his/her active employment.  The key word here is “ACTIVE.”  If your health coverage is based on active employment, then whether you decide to delay Part B will depend on the number of people employed by the employer providing the insurance.

If there are 20 or more employees at the company where you or your spouse work, then the employer insurance pays first and Medicare pays second.  If this is the case then you may want to delay enrolling in Part B as long as you are happy with the employer coverage and the cost is not too high.

If there are fewer than 20 employees then Medicare pays first and the Employer plan pays second.  In this scenario you should not delay enrolling into Part B.  If you decline Part B you will have no primary insurance for doctor office visits or outpatient services, which is usually like having no insurance at all.

In either case, as long as you have coverage from active employment, you will have a Special Election Period to enroll in Part B when you retire with no late enrollment penalty.  It is important to remember that COBRA and retiree insurance are not considered current employer insurance and you will not have a Special Enrollment Period.  If you have COBRA or retiree insurance and delay enrollment in Part B you may have to pay a penalty when go to sign up.

Medicare is a big animal with a lot of rules, so it is important to discuss your personal situation with an expert before you make these decisions.

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