UNITED STATES—Dear Toni: I have decided to retire when I turn 65 in September and will need to enroll in Medicare Parts A and B with a Medicare Supplement and Part D prescription drug plan.

My husband, Tom is 67 and he enrolled in Medicare Parts A and B when he turned 65 because he has a heart condition. Tom remained on my company benefits when he had heart surgery.

Now, he is taking Eliquis for blood clots and he needs to apply for a Medicare Supplement because his cardiologist’s office manager expressed concern over my husband’s insurance changes since their office is accepting very few Medicare Advantage plans and suggested that he enrolls in a Medicare Supplement.

Please explain what I need to do to get Medicare Supplement coverage for both me and my husband? We need your help. Thanks, Pat-St. Petersburg, FL.

Hello Pat: America does not realize that Medicare Part B is as valuable as GOLD and should be treated carefully. When you enroll in Part B the wrong way, it can cause you to not qualify for the Medicare Supplement you desire. Medicare provides special rules for employees or spouses who are “still working” with “true” company benefits and are covered by the employer group health insurance.

Pat, you are in your Medigap Open Enrollment Period and in the 2023 Medicare & You handbook it states, “The best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period. During that time, you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the first month you have Medicare Part B (Medical Insurance) and you’re 65 or older. It cannot be changed or repeated. After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more due to past or present health problems.”

Your husband, Tom, is not under the same Medicare rule as you are because he enrolled in Medicare Part B when he turned 65 over 2 years ago. Now he must answer underwriting questions to qualify for a Medicare Supplement.

That’s why enrolling in Part B when an enrollee or spouse is “still working” full-time with true company benefits in a timely manner is so important. You want to not only avoid receiving a Medicare Part B penalty. You also want to be able to enroll and be accepted in any Medicare Supplement/Medigap plan due to medical underwriting.

Tom’s saving grace, if he cannot pass underwriting, is that Tom and Pat are leaving her company benefits.  Because Tom was covered under those benefits, he will receive a 63-day “guaranteed issue” period to apply for a Medicare Supplement/Medigap plan. Keep the company benefit termination letter to show the Medicare Supplement insurance company that Tom is in a guaranteed issue period.

According to your rights under the Guaranteed Issue Period an insurance company must:

  • Sell you a Medigap/Medicare Supplement policy. “You have the right to buy a Medigap/Medicare Supplement plan A, B, C, F, K or L that’s sold in your state by any insurance company.
  • Cover all your pre-existing health conditions.
  • Cannot charge you more for a Medigap/Medicare Supplement policy, regardless of past or present health problems.

No one realizes the value to first receiving Medicare Part B until they are in Tom’s situation. They want to apply for a Medicare Supplement and may not qualify because they are no longer in their Medicare Open Enrollment period.

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Email Toni Says® at info@tonisays.com or call 832-519-8664 with your Medicare questions.