How, when, if & should does one sign up for Medicare Part B – Doctor Visits?
Please note, if you already have Part A, you can’t enroll online, you have to fill out a form OMB No. 0938-1230 !
Please note also, that it’s been reported that your Social Security number is required, even though there is NO PLACE on the form for it!
If you are new to medicare, be it, you are turning 65, qualified through SSDI or are losing employer coverage, this page is for you.
See our page on How to sign up for Medicare?
Here’s the Social Security & Medicare ONLINE Enrollment and Benefit Calculator
Standard Premiums is $148.50 for 2021 with a $203 Part B deductible and if you are fortunate to have a high income there is a surcharge see our webpage on high income. If you have low income, check out our webpage on Medicare Savings Programs.
Here’s the Late Enrollment & Premium Penalty Calculator if you don’t sign up when you are supposed to and don’t have a valid exemption – reason, like having employer coverage, not including COBRA or Cal COBRA.
#General Enrollment Period (GEP)
If you didn’t sign up for Part B Doctor Visits on time, then you have to wait for the General Enrollment Period from January 1 to March 31 to enroll in Part B. Coverage will start July 1 of that year.
See page 13 Publication 11036 Enrolling in Medicare it’s at the right on a full screen monitor or scroll down for smartphone. See also Medicare & You
Please note, if you already have Part A, you can’t enroll online, you have to fill out
#application for Part B OMB No. 0938-1230 !
You can mail it in, but be sure to follow up that Social Security has the form. If not, go to your local Social Security Office and enroll. Make sure you get a receipt!
Please note also, that it’s been reported that your Social Security number is required, even though there is NO PLACE on the form for it!
Eligibility & Premium Calculator
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Medicare #Enrolling in Parts A & B # 11036
Our Webpage on Enrolling in Medicare A & B
Enroll ONLINE for Medicare Part A Hospital & B Doctor Visits
- Part A Hospital rules for zero premium
- Part B – Doctors – How to sign up – Benefits
- How to apply for Part B during your special enrollment period # 10012
- Fact Sheet
Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65 15 pages - Here's the CMS form to fill out L 564 E to get a special enrollment period, when you retire. VIDEO
- Here's the actual form to get Part B, if you already have Part A OMB No. 0938-1230 !
- If you need both, see our main webpage on Medicare Enrollment.
#Should I get Parts A & B?
FAQ's from Medicare.Gov
Most people should enroll in Medicare Part A (Hospital Insurance) when they're first eligible, but certain people may choose to delay Medicare Part B (Medical Insurance). In most cases,
it depends on the type of health coverage you may have.
- You must pay your Part B premium every month for as long as you have Part B (even if you don’t use it).
- I'm currently working, and I have coverage through my job.
- I have coverage through my spouse who is currently working.
- I have retiree coverage (from my former employer or my spouse’s former employer) or COBRA coverage.
- I have TRICARE, and I'm a retired service member.
- I have TRICARE, and I'm an active-duty service member.
- I have CHAMPVA.
- I have End-Stage Renal Disease (ESRD).
- I have Marketplace Covered CA or other private insurance.
- I don't have any of these.
- medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/should-i-get-parts-a-b
How to apply for Part B during your special enrollment period # 10012
Fact Sheet
Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65 15 pages
Eligibility & Premium (Penalty_ #Calculator
- Amplicare.com
Part D Rx Late Enrollment Penalty Calculator - VIDEO How Part D Late Enrollment Penalty is calculated
Visit Our Web Pages on:
- Late Part D Rx Penalties?
- Premium Surcharge if you have High Income?
- Part B Late Enrollment
- Enroll ONLINE for Medicare Part A Hospital & B Doctor Visits
Anthem Medicare Supplement - Get Quotes, Information and ONLINE Enrollment - No extra charge for our help
You cannot buy additional coverage through #Covered California
if you have premium-free Medicare Part A Hospital
Medicare complies with Health Care Reform, so you do NOT need to get a an Individual policy or a subsidized one from Covered CA. It fact, it's illegal for anyone to sell you a policy! Kaiser Health News * Covered CA Medicare Fact Sheet * Medicare.Gov Medicare & Market Place #11694 * CMS.Gov FAQ Medicare & Marketplace * HealthCare.Gov when - how to change from Covered CA to Medicare * Social Security §1882 * Health Care.Gov
NOTE: This information also applies to people younger than 65 whose benefits begin the first month they receive disability benefits because they have Amyotrophic Lateral Sclerosis (ALS), better known as Lou Gehrig’s Disease, and to people younger than 65 who have Medicare because of a disability and are receiving SSDI Social Security Disability Insurance.
There are a lot of ands, if or buts in this complex issue. Please refer to the source material below. There are some exceptions, but they are very complex. Don't even think of getting a 1/2 correct answer over the phone. If you have to pay for Part A Hospital, then are options, like subsided Covered CA Plans. Email us [email protected] or ask a question below.
Video about Covered CA – if no Premium Free Part A – jump to 2:30 Medicare & the Marketplace (Covered CA
Links & Resources
- Medicare Publication # 11694 Medicare & Covered CA
- Covered CA Medicare Fact Sheet
- InsureMeKevin.com
(3)(A)
(i) It is unlawful for a person to sell or issue to an individual entitled [no premium] to benefits under part A or enrolled under part B of this title (including an individual electing a Medicare+Choice plan [MAPD] under section 1851)—
(I) a health insurance policy with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled under this title or title XIX,
(II) in the case of an individual not electing a Medicare+Choice plan, [aka MAPD Medicare Advantage] a medicare supplemental policy with knowledge that the individual is entitled to benefits under another medicare supplemental policy or in the case of an individual electing a Medicare+Choice plan, a medicare supplemental policy with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled under the Medicare+Choice plan or under another medicare supplemental policy, or
(III) a health insurance policy (other than a medicare supplemental policy) with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled, other than benefits to which the individual is entitled under a requirement of State or Federal law.
(ii) Whoever violates clause (i) shall be fined under title 18, United States Code, or imprisoned not more than 5 years, or both, and, in addition to or in lieu of such a criminal penalty, is subject to a civil money penalty of not to exceed $25,000 (or $15,000 in the case of a person other than the issuer of the policy) for each such prohibited act. Sec. 1882. [42 U.S.C. 1395ss]
Our webpages that touch on this Issue:
Hi, I have turned 65 on last month.
however, i’m still working in the motion picture business and plan to do so for another year or so.
i am fully covered right now.
I was told I should enroll for plan B.
i am very confused…
See our webpage on the Motion Industry Plan for Medicare Eligible.
There it says that if you are eligible for Medicare, you must have Parts A Hospital & B Dr. Visits.
Generally, if one has employer coverage, over 20 employees, they can delay Part B enrollment. See our webpage on Employer Coverage and Part B enrollment.
I guess one could argue that the Motion Picture Plan can’t make you take a Medicare Plan, since your still working… Read their benefits guide… talk to them… get it in WRITING!
See our webpage on Employer Plans and Part B – the section about it being illegal for employers to encourage one to take Medicare and drop their employee plan…
I just got Medicare Part B and the ID card. They said I would get a bill immediately. I don’t have it. What do I do? Should I worry?
Here’s Medicare’s webpage on paying A & B premiums
What if my premium payment is late?
If your First Bill payment is late, you’ll get a Second Bill. Your Second Bill will include both past amounts and next month’s premium. If you don’t pay the total amount due by the 25th of the month, you’ll get a Delinquent Bill. If you get a Delinquent Bill and you don’t pay your total amount due by the 25th of the month, you’ll lose your Medicare coverage.
What if I have questions about my bill or the status of my coverage?
Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778)
If you’re having trouble paying your premiums now or if you have any questions about your Medicare premium bill, call us at 1-800-MEDICARE. TTY: 1-877-486-2048.
When should I get my bill?
On or about the 10th of the month. Medicare.gov
Sample Bill
How about setting up an ONLINE Medicare & Social Security Account? https://medicare.healthreformquotes.com/seminar/get-online-account/
What and how are any prescriptions or infusions paid under Part B Outpatient – Doctor Visits, as opposed to Part D Rx?
We’ve answered that on our Donut Hole Page https://medicare.healthreformquotes.com/part-d-rx/donut-hole/#comment-24984
What if you don’t pay or are late on paying your Medicare Advantage (Part C) or Part D Rx premiums?
See the official publication:
what happens if a person with Medicare doesn’t pay the premiums for his or her Medicare Advantage Plan (like an HMO or PPO) or Medicare Prescription Drug Plan.
Publication 11338
How can I tell if the Part B application went through correctly?
Do you have Part A Hospital?
Didn’t you get some kind of confirmation, when you completed your application?
When was Part A effective?
Do you have a copy of this form? https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdf
Try this link:
https://www.medicare.gov/find-a-plan/enrollment/check-enrollment.aspx
and or try setting up a Medicare and Social Security Account
https://medicare.healthreformquotes.com/sign-medicare/id-cards-new-confidential-no-social-security/
What are the payment options to pay the Part B Premium?
How can I pay my Part B premium?
If you get Social Security or Railroad Retirement Board (RRB) benefits, your Medicare Part B (Medical Insurance) premium will be deducted from your benefit payment.
If you’re a federal retiree with an annuity from OPM and not entitled to RRB or SSA benefits, you may request to have your Part B premiums deducted from your annuity. Call 1-800-MEDICARE (1-800-633-4227) to make your request. TTY users can call 1-877-486-2048.
If you don’t get these benefit payments, you’ll get a bill. If you choose to buy Medicare Part A (Hospital Insurance), you’ll always get a bill for your premium. There are 4 ways to pay these bills:
1. Pay by check or money order. Write your Medicare Number on your payment, and mail it with your payment coupon to:
Medicare Premium Collection Center P.O. Box 790355 St. Louis, MO 63179-0355
2. Pay by credit/debit card. To do this, complete the bottom portion of the payment coupon on your Medicare Premium Bill, and mail it to the address above. Payments submitted without the bottom portion of the payment coupon may not be processed.
3. Sign up for Medicare Easy Pay. This is a free service that automatically deducts your premium payments from your savings or checking account each month. Visit Medicare.gov or call 1-800-MEDICARE and to find out how to sign up.
4. Make an online bill payment. This is a more secure and faster way to make your payment without sending your personal information in the mail. Ask your financial institution if it allows customers to pay bills online. Not all financial institutions offer this service and some may charge a fee. You’ll need to give your financial institution this information:
• Account number: This is your Medicare Number. It’s important that you use the exact number on your red, white, and blue Medicare card, but without the dashes.
• Biller name: CMS Medicare Insurance
• Remittance address:
Medicare Premium Collection Center P.O. Box 790355 St. Louis, MO 63179-0355
Note to RRB Annuitants: If you get a bill from the RRB, mail your premium payments to:
RRB Medicare Premium Payments P.O. Box 979024 St. Louis, MO 63197-9000
If you have questions about your premiums or need to change your address on your bill, call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. If your bills are from the RRB, call 1-877-772-5772. TTY users can call 1-312-751-4701.
If you’d like more information about paying your Medicare premiums, visit Medicare.gov to view the brochure “Understanding the Medicare Premium Bill Form (CMS-500).”
If you need help paying your Part B premium, see pages 86–88.
Copied from Page 23 https://www.medicare.gov/sites/default/files/2018-09/10050-medicare-and-you.pdf
What if you don’t pay or are late on paying your Medicare Advantage (Part C) or Part D Rx premiums?
See the official publication:
what happens if a person with Medicare doesn’t pay the premiums for his or her Medicare Advantage Plan (like an HMO or PPO) or Medicare Prescription Drug Plan.
Publication 11338
How do I show “Good Cause?” for not paying the premium on time?
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c29.pdf
240.2 – Conditions and Examples That May Establish Good Cause for Late Filing by Beneficiaries
Good cause may be found when the record clearly shows, or the beneficiary alleges, that the delay in filing was due to one of the following:
• Circumstances beyond the beneficiary’s control, including mental or physical impairment (e.g., disability, extended illness) or significant communication difficulties;
• Incorrect or incomplete information about the subject claim and/or appeal was furnished by official sources (CMS, the contractor, or the Social Security Administration) to the beneficiary (e.g., a party is not notified of her appeal rights or a party receives inaccurate information regarding a filing deadline);
NOTE: Whenever a beneficiary is not notified of his/her appeal rights or of the time limits for filing, good cause must be found.
• Delay resulting from efforts by the beneficiary to secure supporting evidence, where the beneficiary did not realize that the evidence could be submitted after filing the request;
• When destruction of or other damage to the beneficiary’s records was responsible for the delay in filing (e.g., a fire, natural disaster);
• Unusual or unavoidable circumstances, the nature of which demonstrates that the beneficiary could not reasonably be expected to have been aware of the need to file timely;
• Serious illness which prevented the party from contacting the contractor in person, in writing, or through a friend, relative, or other person;
• A death or serious illness in his or her immediate family;
• A request was sent to a Government agency in good faith within the time limit, and the request did not reach the appropriate contractor until after the time period to file a request expired; or
• Delay due to additional time required to produce the beneficiary’s Medicare documents (such as an MSN) in an accessible format (e.g., large print, Braille, etc.);
• Delay as the result of an individual having sought and received help from an auxiliary resource (such as a SHIP or senior center), due to his or her disability, in order to be able to file the appeal.
Following are examples of cases where good cause for late filing is found. This list is illustrative only and not all-inclusive:
• Beneficiary was hospitalized and extremely ill, causing a delay in filing;
• Beneficiary is deceased. Her husband, as representative of the beneficiary’s estate, died during the appeals filing period. Request was then filed late by the deceased husband’s executor;
• The denial notice sent to the beneficiary did not specify the time limit for filing for the redetermination; and
• The request was received after, but close to, the last day to file, and the beneficiary claims that the request was submitted timely.
42 CFR § 478.22 – Good cause for late filing of a request for a reconsideration or hearing.
Our Medicare Appeals Page
CMS FAQ’s Technical on the process
I don’t like to cite non official sources, but here’s Q1Medicare
Just to make sure, is renewal automatic?
Yes, everything Parts A Hospital, B Doctor Visits, Medi Gap, Medicare Advantage and Part D Rx automatically renew.
I’m having trouble finding citable sources. I don’t count other agent websites, as it seems I’m the only one, who cites a source.
https://www.medicare.gov/pubs/pdf/10050-medicare-and-you.pdf
Didn’t you get a January bill for Parts A & B? Just pay it.
What happens if you don’t pay Medicare Advantage or Part D Rx? #11338
I currently have a good group health care plan and will be retiring. I will retire about 6 months before I turn age 65. I plan on extending my current plan through COBRA for the 6 months between retirement and age 65. At age 65 I will enroll in Medicare part B, D etc.
My question is:
When I turn 65, will I be have different and potentially better part B choices because I am on a high quality group PPO plan at age 65 (not a covered California, conversion or HIPPA plan).
Could my part B policy potentially be different, especially a higher quality part B plan, if I am enrolled in a high quality group plan when I turn age 65 (in terms of benefits and provider access)?
Or does it not matter, everyone is in the same pool and all choices are available to everyone, regardless of whether or not you were on a group plan?
Part B Doctor Visits is exactly the same for everyone. To get the “best” greatest selection of MD and providers you would want to sign up for a Medi Gap plan. Plan F has the most comprehensive benefits. This would be most similar to PPO and not the restrictive provider lists in a Medicare Advantage Plan (MAPD). MAPD though generally has zero premium.
If you are thinking of keeping your COBRA beyond age 65 and not getting Part B, that won’t work, see Medicare Publication 11036 Enrolling in A & B page 13.
See link above to use our Blue Cross and Blue Shield affiliate sites to view benefits, pricing and enroll online. We also have tons of detail on each page in our website.
Where and how do I shop all the Insurance Companies to get the best coverage and premium for Part B Doctor Visits?
The Federal Government – Medicare is the ONLY place to get Part B Dr Visits. I guess one could argue though that if they have employer coverage available, that would be “Part B.”
The decisions on getting Part D Prescriptions, Medi Gap or Medicare Advantage are separate and give you additional coverage on top of Medicare Part A Hospital and Part B Dr. Visits.
Probably the first decision is if you want a Medi Gap Plan which allows you to go to any MD or Hospital that accepts Medicare, which most do or a Medicare Advantage plan with oftentimes zero premium.
Here’s our page on helping you make that decision
https://medicare.healthreformquotes.com/medi-gap-supplements/coverage-choices-medicare/
Our page on how most all doctors take Medicare and if they don’t the limit on what they can charge over Medicare allowance and how if they don’t take Medicare at all, they must have you sign a form that you understand that.
https://medicare.healthreformquotes.com/medi-gap-supplements/coverage-choices-medicare/medicare-assignment-doctor-participating-or-not/
Hello Steve
I have a question I hope you can answer.
1. My father has only Medicare Part A [hospitalization] combined with VA healthcare benefits. he did not enroll in Part B [doctor visits] when first eligible because of VA benift among other factors.
2. In November he received a letter from orange county social services that he was eligble for medicaid [Medi-Cal in CA] and that he was also eligible for Medicare QMB [Qualified Medicare Beneficiary] effective November 1, 2015
3. I was told by railroad retirement board that despite his eligibility for QMB that he can not elect immediate enrollmet with a November 1, 2015 retroactive date. That he can enroll now through the open enrollment period but must wait until July 1 to begin benefits.
4. I read somewhere online that Part B enrollment becomes effective the same day as QMB eligibility.
http://www.medicarerights.org/fliers/Part-B-Enrollment/Using-MSPs-to-Enroll-in-Part-B.pdf?nrd=1
Do you have knowledge on this matter?
4. Thank you SO MUCH for including a link to Medicare Rights.org. They are talking about automatic enrollment in Part B, IF one enrolls in a Medicare Savings Program, which includes QMB’s. Which it sounds like you are doing with Orange County Social Services. So, it sounds to me like you are OK. Apply and see what happens. Here’s the link or have Social Services help you. According to your reference on Medicare Rights.org enrollment is automatic when you are approved for the QMB.
3. Normally what you heard from the Railroad Retirement Board is correct. Having VA coverage is not employement based coverage that would give you a special enrollment period, as mentioned in Medicare and You page 26. They are talking about the General Enrollment Period page 25 where one can sign up January 1 to March 31 and be effective in July. There might even be a financial penalty for late enrollment.
Be sure to read the entire page from CA Health Care Advocates on this subject. They know what they are talking about! See also our page on Cal Medi Connect. Check back with us in a few weeks and we will know more as we will be attending a Blue Cross seminar on Medicare Advantage Plans for those on Medi-Cal on the 17th.