Medicare for Husband, family still on private insurance

[ReginaC957999]

Hi,

My husband will be 65 soon.  He owns his own business, less than 20 employees.  He is not collecting SS yet.  We have private health insurance, it is a family plan with me, his wife, and 2 eligable kids on it. I do not work. 

My question is, what happens if he does go to Medicare coverage?  It seems this would leave my sons and I with no coverage, as he is the main insurance holder.

We would be happy to just keep our private insurance and opt out of him getting onto Medicare. I can't seem to get a straight answer form contacting Medicare directly.

Any help would be appreciatted.

Thank you!

[AARPTeri]

@ReginaC957999   I was able to esclate this question internally and received this answer:

Under Medicare rules, the husband needs to sign up for Medicare Parts A, B, & D when he turns 65 or he will be subject to lifetime penalties. See the summary below. His Part B and D premiums will depend on his income. Unfortunately, the rest of the family will be on their own to find other insurance. They may have to go to the ACA Marketplace exchange to buy insurance and their premiums will depend on whether they qualify for subsidies on the ACA exchange.

Medicare v. Your Existing Insurance

Whether you need to sign up during open enrollment depends on your current coverage

You may think that because you already have health insurance you don’t have to sign up for Medicare when you reach 65. That’s not always the case. If you are still working and have health insurance through your employer -- or your spouse’s -- you may not need to enroll in Medicare yet.

But here’s the catch: It depends on how large your (or your spouse’s) employer is. If the employer has less than 20 employees, you must enroll in Medicare Part B by a certain deadline or face a 10 percent per year higher Part B premium for the rest of your life. That sign-up period, also called the initial enrollment period, has nothing to do with the up-coming open enrollment period and is three months before and three months after the month of your 65^th birthday.

If you get your coverage through the Affordable Care Act (ACA) individual marketplace, a retiree health plan, COBRA or the military’s TRICARE for Life program, you also must sign-up for Medicare Parts A and B during the initial enrollment period to avoid permanent penalties.

[somarco]

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@AARPTeri wrote:

@ReginaC957999   I was able to esclate this question internally and received this answer:

Under Medicare rules, the husband needs to sign up for Medicare Parts A, B, & D when he turns 65 or he will be subject to lifetime penalties. See the summary below. His Part B and D premiums will depend on his income. Unfortunately, the rest of the family will be on their own to find other insurance.

Correction and amplification below

Medicare Part A does not have a late enrollment penalty.

Medicare Part B penalty clock starts when you are first eligible but did not enroll. The clock stops when the indivdual enrolls in Part B. The penalty lasts as long as the "gap". I the individual delayed enrolling in B for 18 months and did not have creditable coverage (EGHP) then that individual would pay a LEP for 18 months, not for life.

Medicare Part D penalties do last for life.

https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-late-enrollment-penalty

The other challenges when enrolling in B past 65 is WHEN you can enroll. Most of the time you can only enroll during the GEP.

Bigger problem for not enrolling in A, B and D when you turn 65 and your employer has fewer than 20 employees is how claims are adjudicated. Your EGHP assumes you have A, B and D in place and only pays the amount they normally would under COB rules.

[ReginaC957999]

Hi all,

I just wanted to follow up from yesterday about my question.

After speaking to our Insurance Agent, (Empire Blue Cross)I have the answers I need.

My husband will go on Medicare, Part A and B, as we have less than 20 employees.  Blue Cross will be his secondary insurance for the 20% that Medicare does not cover.  He will still use the Blue Cross for perscription coverage.

Our 2 dependants (sons)who work for our company as wel, and myself, will stay on the family plan as usual. They can stay on until thier 30th birthday.  No change for us.  Great news.  The family plan is over 25k a year, vs a single plan at 13k is much better! Phew.

Thanks to all who took the time to answer my questions.

[somarco]

My husband will go on Medicare, Part A and B, as we have less than 20 employees.  Blue Cross will be his secondary insurance for the 20% that Medicare does not cover.

You might want to read this from Medicare.gov before celebrating . . .

https://www.medicare.gov/Pubs/pdf/02179-medicare-coordination-benefits-payer.pdf

Page 6 explains

[fffred]

My experience is that I was a salaried employee, not the business owner (this happened to be a small business as well). I retired last year at my  FRA of 66 (to give you an idea of the time frame I am talking about).

My understanding was that I was required to enroll for Medicare Part A when I turned 65. Which I did. There is no cost for Part A (and at the moment I couldn't even tell you what it is, there are a number of "Parts"). My understanding was that there would/could be financial consequences to me if I did not enroll in Part A at this age...so this was certainly an inducement to me to do so.

As I was still working and covered under insurance at my employment I was exempt from the requirement to enroll for Medicare Part B. My wife (10 years younger than me) and I remained covered under my employer's medical plan.

When I retired at 66 I enrolled for Medicare Part B, which is paid for by premiums. Because I did not enroll in Part B at age 65 I had to complete forms for Medicare to show that I had been covered by other insurance, and a form completed by my employer was required as well.

Now I am covered under Medicare both Parts A and B. We obtained private insurance through the ACA for my wife.

I would imagine that your situation would be similar... your husband should enroll for Part A at 65, then continue on the current medical plan which includes his dependents until he retires or is no longer covered by that plan.

[somarco]

@fffred 

Your SS FRA has no bearing on when you can/should enroll in Medicare.

You are not REQUIRED to enroll in Part A at 65. If you have an HSA and want to contribute past age 65 you should delay enrolling in any of the Medicare parts. If you don't have an HSA, or don't plan to contribute past age 65 there is no harm or benefit to enrolling in Part A alone.

There are no "financial consequences" to delaying enrolling in Part A.

The forms for enrolling in Part B past your 65th birthday are outlined in this post.

https://community.aarp.org/t5/Medicare-Insurance/Medicare-delaying-Part-B/m-p/2111072#M5442

Concerning your closing comment suggesting the OP's husband enroll in A only could result in a significant financial issue if a claim arose. See my earlier post in this thread regarding Medicare as a secondary payer when the EGHP has fewer than 20 employees.

[fffred]

@somarco

Hello Friend!

Wow! You really have it in for me, I guess!

I'll reply with just this first point (as I don't want to waste any more time with this):

Nowhere did I say or imply that the concept of the "Medicare age" was related to or a function of the "Social Security Full Retirement Age (FRA)" (...which varies with date of birth). My only point was to describe my own personal situation and the ages at which this affected me personally.

Have a Great Day!

[somarco]

@fffred nothing personal against you or anyone else on this forum. I contribute to a number of public forums and see many well intentioned people offer incorrect/incomplete or confusing advice.

My reading comprehension skills are at least above average.

Have a nice day.

[ReginaC957999]

Thank you. So you are saying in your experience, you went on Medicare Part A, and your employer covered your B part, and your wife's full medical insurance?

Thanks again.

[fffred]

My employer had a company plan (there were more than 20 employees, which I think is the break point at which companies are required to provide a plan...but I am not an expert on this).

So, my wife and I were covered under the regular company plan. It is not that the company paid for my Medicare Part B premiums. And I also had Part A, for which there are no premiums due.

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@ReginaC957999 wrote:

Thank you. So you are saying in your experience, you went on Medicare Part A, and your employer covered your B part, and your wife's full medical insurance?

Thanks again.

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[ReginaC957999]

Ok, many thanks.

[fffred]

Let me add that it may make a dfference if the "private" insurance you are covered under is an employer's plan or a private/personal plan. Some small companies are exempt from providing insurance to employees. You may want to research this point of employer's plan versus a private plan and how it may affect requirement for Part B enrollment.

[ReginaC957999]

It is a company plan, it covers 2 owners and 3 employees. My husband has a family plan, the others are individual plans.
Thanks for your reply.

[fffred]

Be sure to review this recent thread, especially Gail's reply:

https://community.aarp.org/t5/Medicare-Insurance/Medicare-delaying-Part-B/td-p/2110590

[ReginaC957999]

Thank you.