If I don’t sign up for Part B when first eligible,
what happens?
How do I enroll?
How do I appeal the penalty?
Late Enrollment Penalty
In most cases, if you don’t sign up for Part B when you’re first eligible, (FAQ Calculate the dates) for Medicare, during the 7-month Initial Enrollment Period to sign up for Part A and/or Part B. you’ll have to pay a late enrollment penalty. You’ll have to pay this penalty for as long as you have Part B.
Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.
Resources
#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
No Penalty Reasons?
Usually, you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period, namely loss of employer coverage.
Employment Coverage vs Medicare Parts A, B & D
If you have limited income and resources, your state may help you pay for Part A, and/or Part B.
You may also qualify for Extra Help LIS to pay for your Medicare prescription drug coverage.
The New York Times:
Why You Shouldn’t Wait To Sign Up For Medicare Part B
[George Zeppenfeldt-Cestero] should have signed up for Medicare Part B three years earlier when he turned 65. By delaying, he had missed the best window — the so-called Initial Enrollment Period — to apply for Part B, which covers much of what we consider health care: doctor visits, tests, injectable drugs (including chemotherapy), ambulances, physical therapy and other non-hospital services.
As a result, he has to pay permanently higher premiums, and he had to endure an unsettlingly long period — from December to July — before the coverage actually kicked in. (Span, 10/26) New York Times:
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.
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:
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
Related Pages in Part B – Doctors – How to sign up Section
Steve, how high can the Part A Hospital, part b Doctor Visits & D Rx penalty be?
My parents have green cards since 2005, continuous residence since 2012 and they never enrolled in Medicare
My Dad is 80 and Mom is 72.
Really high – Here’s a video where I used the Medicare Calculator, but didn’t get a full bottom line answer, yet.
Immigration status and enrollment
To enroll in either Part A or Part B, an individual must either be a U.S. citizen or be lawfully present in the
United States. In most cases, as discussed in detail below, a non-citizen who does not qualify for premium-free Part
A must be a lawful permanent resident (LPR) with five years of continuous residence in the U.S. immediately prior to Medicare enrollment. Justice in Aging Older Immigrants & Medicare
***So, the penalties wouldn’t start till 2017 based on the start of continuous residence of 2012.
More from the Medicare Calculator
You may not be able to get premium-free Part A (Hospital Insurance) based on the work history of you or your spouse (living, deceased or divorced). You can buy Part A for a monthly premium.
If you paid Medicare taxes for less than 30 quarters, the standard Part A premium will be $471.00. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium will be $259.00. Some people pay a higher premium if they don’t enroll when they’re first eligible.
Part A Late Enrollment Penalty
If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up.
***So they would pay 10% more for the next 10 years.
Part B Late Enrollment Penalty
If you don’t sign up for Part B when you’re first eligible or if you drop Part B and then get it later, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.
***So, that would be 50% more.
2021 Part B premium (most people pay this amount)
$148.50
You can get coverage here as a new immigrant besides or in addition to the Bridge Plan.
See this page for the Part D Rx Penalty
So I foolishly did not pay my Medicare premiums and my part B got cancelled.
Can you tell me how to get it back?
I am at a loss as to where to start.
Fortunately, we are in the General Enrollment Period, till March 31. So, you can sign up now, see the application above and be effective July 1st.
The 2nd problem you may have, is that Medi Gap and Medicare Advantage policies require that you have Part B, so you might be getting cancellation noticies…
Here’s our page on guaranteed acceptance for Medi Gap plans
Medicare Advantage – Special Enrollments
If we don’t have an answer spelled out on those pages, just ask and we’ll research it.
So, after I get Part B back, then I can enroll, check out, etc. Medi Gap and/or Medicare Advantage?
You should get notice of Part B Approval, enrollment well before the July 1st effective date.
So, I would suggest enrollment as soon as April, as long as you have approval.
Medi Gap has a special guaranteed enrollment when you get back on both Parts A AND B. Please enroll early… as I don’t think the written rules are 100% clear, but I’ve written people in the same situation and have checked with my Regional Sales Managers.
Medicare Advantage is a little different!
You have Medicare Part A coverage, and you get Part B for the first time by enrolling during the Part B General Enrollment Period (January 1–March 31). Publication 11219
I’ll check further…
I checked and getting Part B under General Enrollment in July, would not allow one to get Medicare Advantage.
One might try to get in under the 5 star program.
disability secrets.com/social-security-office-lost-my-appeal-paperwork-what-do-i
just answer.com social-security-office-losing-paperwork
We did have a client who reported that her local Congressperson helped her out and got the problem resolved.
house.gov/find-your-representative
nytimes.com/how-senators-and-representatives-can-help-constituents.html
medicare.gov/get-help-with-your-rights-protections
I was incarcerated and wasn’t able to pay my Part B Premium. Is there any way, I can avoid the late penalty?
It is usually best to keep Medicare Part A and Part B coverage while you are incarcerated. Although Medicare will not cover your care, keeping it will ensure that you avoid late enrollment penalties and gaps in coverage when you are released. Medicare Interactive
https://marketplace.cms.gov/technical-assistance-resources/incarcerated-and-recently-released-consumers.pdf
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Items-Services-Furnished-to-Beneficiaries-in-Custody-Under-Penal-Authority-Fact-Sheet-ICN908084.pdf
There is a way to argue about the Part D Prescription LEP Late Enrollment Penalty
https://medicare.healthreformquotes.com/part-d-rx-prescriptions/maximus-appeals/
Check out research I did on another case about “Good Cause!”
I won’t have 40 quarters until I’m 68. When is my initial enrollment period? I don’t want any penalties.
Use this tool to determine when you are eligible for Medicare.
Your Initial Enrollment Period based on your age Your Initial Enrollment Period based on your age contextual help
October 1, 2019 – April 30, 2020
Am I eligible to enroll?
Medicare is for people age 65 and older and those who have special condition or disability. You’re not eligible to enroll in Medicare now because you don’t meet the special condition/disability requirements.
If you’re a U.S. citizen or you meet the lawful presence and residency requirements, the Initial Enrollment Period (IEP) is your first chance to sign up for Medicare. It starts 3 months before your 65th birthday, includes the month you turn 65, and ends 3 months after the month you turn 65.
Sign up for Medicare
Costs for Medicare since you won’t get it for free…
Costs for Medicare… How does that compare to the under 65 plan you have now?
The “SSA international operations” number (in Baltomore) was 410-965-2356. Zero wait time. It seemed to me that because my application had an overseas address, it could only be handled by this office.
Presumably, if you cancel your Part B, if you to reinstate Part B later it will not come with guaranteed issue rights for MediGap?
We will go into that on our Part B – Medi Gap Guaranteed Issue Page
If I have Part B and move out of country or go back to work and have employer coverage, how do I cancel Part B?
Voluntary Termination of Medicare Part B
You can voluntarily terminate your Medicare Part B (medical insurance). It is a serious decision. You must submit Form CMS-1763 to the Social Security Administration (SSA).
You’ll need to have a personal interview with Social Security before you can terminate your Medicare Part B coverage. To schedule your interview, call the SSA or your local Social Security office.
USA.Gov ssa.gov
Form you get back from CMS Medicare when they confirm they got your request to cancel Part B Doctor visits. Note the FAQ’s!
Here’s what Anonymous reported to us in an email about cancelling a pending application for Part B
How do I compare, since I’m not currently residing in the USA, the Part B late enrollment penalty, having to enroll in January – March and not having coverage till July, then being able to get a Medi-Gap plan guaranteed issue
vs
paying $134/month now for Part B and say $180/month for a Medi Gap Plan F or $61/month for Hi F?
This is an interesting and perhaps a more complex question than one might think. We will respond on a full webpage, so that we can get more detail on information on it. Click here for the new webpage.
If I live outside of the USA, do I need to sign up for Part B when I turn 65 or is there a guaranteed enrollment period when I return to USA – California?
Living outside the U. S.
(Excerpt copied from publication 11036 Enrolling in Parts A & B)
I live outside the U. S., and I don’t have Part B. Can I get Part B and will I pay more?
It depends on your situation:
Situation #1: If you’re over 65, currently getting Social Security benefits and Part A, and you didn’t take Part B when you were first eligible, (our webpage on eligiblity) (Medicare Eligiblity Tool) you may only apply for Part B during the General Enrollment Period. This period runs from January 1 – March 31, and you may have to pay a late enrollment penalty for as long as you have Part B.
Situation #2: If you live outside of the U.S., you’re over 65, and you’re eligible for Social Security benefits, you may file an application for monthly benefits and Part A. You’ll have to file for Part B during the General Enrollment Period. This period runs from January 1 – March 31, and you may have to pay a late enrollment penalty.
Situation #3: If you’re a U. S. citizen, you’re over 65, you’re not eligible for Social Security benefits, and lived in a foreign country when you turned 65, you must live in the U. S. to file for Part B. You’re first eligible to enroll in Part B the month you return to the U. S. to establish your new residence.
You won’t have to pay a late enrollment penalty if you enroll in Part B when you first return to the U. S. Although you may be able to enroll, in most cases, you won’t be able to get Medicare-covered services while living outside the U.S. Medicare generally can’t pay for any of your hospital or medical bills unless you get your medical care in the U.S. (including Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa). Under certain limited circumstances, medical services provided in outside of the United States also may be covered by Medicare, but only if you’re living in the U.S.
Excerpt of Email from Ted W
Steve —
I learned a few things today that I thought I might share with you.
1) Because I enrolled for Part A from abroad (Italy), and declined Part B, I became a candidate to receive an unsoliticed phone call from a US government employee in Rome who handles SS/Medicare issues!! This person wanted to make sure I understood the issues with respect to Part B penalties. This person was very helpful, but knew nothing about MediGap. He didn’t even know what it was.
2) Medicare Part B penalties increment after each full year in which you could have had Part B but chose not to. What then is the date in which you could have had Medicare? You can sign up for Medicare for 3 months before eligibility, and since if you do so your coverage date begins on the first day of the month of your birthdate (unless your birthday is the 1st of the month). For example, if you decline Part B in your initial enrollent period in 2018 but opt for Part B in the first general enrollment period of 2019, your coverage will start July 1, 2019. If your birthday is in July, your full-year penalty clock will start on July 1 and will have traversed a full year. If your birthday is in August, the clock will start on August 1 and it will have been only 11 months … hence no penalty for that year.
Cheers,
Ted W