Active employee has stayed with his wife’s retiree health insurance group plan, which was superior to his at the time that he turned 65 years old. He decides to forego enrolling in Medicare Part B. All good so far. She then turns 65, and there are no retiree health benefits offered to her at that time, so she enrolls in Medicare Part B (with no problem).
The man then immediately (no lapse in coverage) goes to his own employer’s group plan, again without enrolling in Medicare Part B, because there is no such requirement. However, after one further year of working, he then decides to retire, and the employer’s retiree health benefit plan is worse than Medigap. He then correctly chooses Medigap.
A week after the 1st date of Medicare eligibility, he is sent a letter by the Social Security Administration office, which informs him that he is not eligible for Medicare Part B, and must wait for the General Election Period, and his Medicare Part B effective date will be July 1, 2013. At that point, he will also be assessed a penalty for 2 years.
This is completely, utterly wrong.
If both the wife’s plan and the husband’s employer plans constitute creditable coverage, then the husband is eligible to enroll for Medicare Part B at anytime, for up to 63 days after cancellation of his employer’s group health plan. He has been misinformed by the Social Security Administration.
Bottom Line: The Social Security Administration is NOT the same thing as Medicare. SSA decides on eligibility; Medicare decides on benefits. If you do not agree with the determination made by the SSA, then you can go to another office in your area and get another opinion. This Happens.
This is a true example: Maximize Your Medicare goes through many situations, all called “This Happens,” so that you are properly informed, and can secure the coverage and benefits according to current law.
Further information can be found on the official website: https://maximizeyourmedicare.com