A client asked, “Do I have to accept Medicare coverage when I turn 65?” As with most answers you might get from an attorney, the answer to her was the not-so-simple, “No, but you should.”
To make things easier, let’s talk about Medicare Part A: Medicare Part A covers your basic hospital care. It’s also usually free coverage. If it is not free, you can buy in for a premium of up to $506 per month in 2023. This premium will increase by 10% for twice the number of years you could have been covered but were not. Normally, you automatically become enrolled in Medicare Part A when you apply for Social Security retirement benefits. If you are 65 and not yet receiving Social Security retirement benefits, you can still enroll in Medicare Part A by filing a form with your local Social Security Office. So, if you are still working or don’t plan on applying for your earned Social Security benefits, you do not have to enroll in Medicare Part A. The problem is that you can’t opt out of Medicare Part A and continue to receive Social Security retirement benefits. In fact, if you are already receiving Social Security retirement benefits, you’ll have to pay back all the benefits you’ve received so far in order to opt out of Medicare Part A coverage. That’s not usually an option as most people rely on those monthly payments to cover their bills.
The more important question, and what the client was really asking, was, “Can I opt out of Medicare Part B and not have to pay those premiums?”
“Yes, but…”
First, the “Yes” part: Medicare Part B is what most people consider the “health insurance” part of Medicare. Part B has premiums that are deducted from your Social Security retirement benefits every month. In 2023, the standard premium is $164.90 per month, with a possible upward adjustment based on your income. You are not required to have Part B and are allowed to opt out of it. You will need to do that right when you get your Medicare card in the mail, otherwise you will have to pay the premium for all the months you were covered.
Second, the “but…” part: If you don’t have other health insurance coverage (usually from your employer or your spouse’s employer), Part B will be your primary health insurance. You will need to enroll during the seven months surrounding your 65th birthday, or during a Special Enrollment Period. A Special Enrollment Period opens up when employer sponsored group health coverage ends, as long as it is through the employment of you or your spouse. If it is a retiree plan based on previous employment like a COBRA plan that is ending, VA coverage, or marketplace coverage, a Special Enrollment Period will not apply. If you don’t enroll when you are first eligible, or during a Special Enrollment Period, you will pay a penalty. That penalty could increase your premiums by 10% for each 12 months that you could have had Part B coverage but didn’t. This means that if you opt out of Part B at 65, but decided to enroll at 68, your premiums could be 30% higher for the rest of your life.* If you are worried that you won’t be able to afford the Part B premiums because you will need your entire Social Security retirement check to cover your monthly bills, it is possible that you can receive assistance from your State in paying those premiums.
The information that these recommendations are based on is located at www.medicare.gov, which was initially accessed on October 10, 2019. Please be aware that rules and laws may change.
For more information, you may find the following sites informative:
*This article does not cover potential penalties that may arise due to lack of health insurance coverage
Rev 11/23
The information presented on this website is general in nature and not intended to be legal advice. No attorney-client relationship will exist with Jones, Kuriloff & Sargent, LLC unless agreed to in writing. Please contact us to discuss your particular situation.
