Who MUST Enroll in Medicare at Age 65?

[unic.consulting]

I am new to Medicare sales and just trying to learn as much as I can. No offense, I learn tons on here, but always want to be able to consult the CMS source material and don't want to have to say "I read about it on an online forum" if there ever is an E&O claim. The documents given so far, while very helpful, are not making it 100% clear to me that my particular client would be assessed LEP for part B when he does retire.

This client is an attorney who is going to want to see it in writing if he has to fork out 300+ dollars a month for part B coverage for years to come (and lose his open enrollment for supplements), and I need to be really sure I am advising him correctly.

Dropping off the work plan and going on Medicare+Supp+D would cost him a LOT. He is high income and would be assessed a LOT of income adjustments.

PLUS, he has a non-working spouse who is 60 and needs 5 more years of coverage at $1000+ a month (at least) for the same level of coverage as now. Right now 100% of their insurance is paid by the firm. I am not a CPA, but as far as I know he would be paying for all of this new insurance with after-tax dollars, since he is still employed (not self-employed) and makes so much money and the premiums, even at that high rate, would not be above 10% of income.

On the other hand, if I advise him to waive and he retires in say 3 years, a 30% part B penalty for life adds up as well if I have advised incorrectly. He does not want to take the B if he doesn't "have to".

The group agent that he is currently under (with our agency), has called the group carrier to be sure and they have said in writing they do not require him to take out part b in order to pay standard claims. I think that this may be the situation that sman is describing above.

Yes. As long as you have it in writing that they will pay claims as primary, you are all set.

 

[yorkriver1]

One more confirmation that a small group Medicare beneficiary was not penalized when applying for Medicare B. I had one that had fewer than 5 on the plan when they disbanded it. The Medicare B was issued, no penalty. The hardest part was verifying years of prior coverage due to many years of spouse on SSDI/Medicare prior to enrolling in Part B.

 

[Gulfman]

Yes. As long as you have it in writing that they will pay claims as primary, you are all set.

Wow...so if the Employer plan says "they're first" then no penalty?


Interesting..

 

[yorkriver1]

Here is a tax favored plan for the under 65 spouse, if the elder does go off group: This works best if the spouse is in relatively good health, but could still work if not, the numbers would need to be run.
His spouse could be covered by a high deductible health plan (HDHP) that is HSA compliant. The annual limit allowed for HSA contributions for one person could be put into her account, + $1,000 if she is 55 or older. Currently annual amount is
$3,350 for 2016. So they could shelter $4,350 a year for the # of years before she goes on Medicare, if necessary, at 65. (probably is, given facts here)
The funds can be spent on many more expenses than the health plan covers, and alternatively, can be left in the plan to pay for expenses after she is 65. The funds can be used for older spouses's coverage (you would have to check if that works for group coverage, I know it's good for individual), including Medicare B premiums, only Medicare Supplements are excluded.
Check out this link http://healthequity.com/ed/resources/docs/HSA_guidebook.pdf
or go to www.firstambank.com/hsa Their customer service reps are very informative, and they work with brokers, not for compensation but to help us make sales of health plans.