First, everyone should understand that Medicare Part A covers inpatient hospital and skilled nursing care. Medicare Part B covers all outpatient needs, doctors services such as office visits and surgery, MRIs, chemotherapy and the list goes on.
Second, to qualify for Medicare at all, one must work and pay taxes for 10 years or 40 quarters. If you do that, you now qualify for Part A at no cost. It’s a version of health insurance for all but only starts when you turn 65. That’s the earliest qualifying age. If you don’t have enough quarters when you first become eligible at 65, you might qualify if you have a working spouse with enough quarters.
Many Federal employees and Veterans have other options. But they may come with a price to pay. If time passes after turning 65 and you now want Part B, there may be issues to overcome.
Everyone otherwise qualified has an initial “General Enrollment Period” for signing up for Parts A and B. It lasts for 7 months, starting 3 months before you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. That’s the 7 month window for the initial sign up.
If you didn’t sign up for Medicare Part B during your initial sign up period, the 7 months, you subject yourself to a late enrollment penalty. This penalty is 10% for each full 12 month period when you were not signed up. Every year has an open enrollment period that runs from January 1 thru March 31. The real cost of waiting may be the extra 10% per year penalty, for every month for the rest of your life. If you do this at age 70, for example, you’re looking at a 50% per month penalty charge. Or the real cost of waiting may be having to pay 100% if you want a specific specialized care physician/surgeon taking care of your medical crisis.
If you’ve been using VA hospitals for your primary care for years and years, there is an obvious temptation to continue that until the day you die. Or you may not.
I recently read about a retired Veteran who developed a heart condition requiring surgery. She wanted care from a specialist outside the VA. Without Medicare Part B, this woman was told she’d have to pay 100% out of pocket, potentially $100,000, since she didn’t have Part B.
Her choice, assuming she couldn’t afford that, was to have the procedure and care as provided by the VA. I don’t doubt she’s receive exceptional care, but her choice was voided when she opted not to sign up for Part B.
I’ve been paying Part B monthly premiums for over 13 years. Each year the premium has increased and I’m now paying $144.60 every month. That seems a reasonable price if I don’t have to worry about who is going to provide specialized care if I need it.
If any of this resonates with you, Medicare.gov is an exceptionally easy website to navigate. You can find all the above and more, including free enrollment periods and info about special circumstances at https://tinyurl.com/ybyfppjy
Tony Kendzior \ 24 FEB 2020