Why enrolling in Medicare the right way is so important

Dear Toni: I am retiring in February when I turn 65 and will need to enroll in Medicare Parts A and B with a supplement and a Part D prescription drug plan.

My husband, James, is 72 and has heart issues, so he enrolled in Parts A and B when he turned 65 and remained on my company benefits to have his heart surgery. He is taking Eliquis for blood clots.

The manager at James’ cardiologist’s office expressed concern over my husband’s insurance changes. Since their office accepts few Medicare Advantage plans, she suggested that Medicare with a supplement would be the right choice for James.

Please explain what James and I need to do to get Medicare supplement coverage. — Paulina, Mobile, Alabama

Dear Paulina: Many people do not realize how confusing it is to enroll in Medicare when retiring and leaving employer benefits. When you enroll in Part B the wrong way, it can lead to you failing to qualify for the Medicare benefits you want.

Medicare has special rules for employees or spouses who are still working with true company benefits and are covered by the employer’s group health insurance.

Paulina, you will be in your Medigap open enrollment period, a six-month window that begins the first month that you have Medicare Part B (medical insurance) and are 65 or older.

In your open enrollment period, you can have your Medicare supplement Plan G with a Part D prescription drug plan begin Feb. 1 when your Medicare Part B starts without answering any health questions.

James’ Medicare situation is different because he enrolled in Part B when he turned 65 over seven years ago. Now he must answer underwriting questions to qualify for a Medicare supplement.

That’s why enrolling in Part B the correct way and at the correct time is important.

James’ saving grace for bad underwriting is that you are leaving your employer benefits. He will receive a 63-day guaranteed-issue period to apply for a Medicare supplement/Medigap plan. Keep the employer benefit termination letter to show the Medicare supplement insurance company that James 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.

■ Must cover all your pre-existing health conditions.

■ Cannot charge you more for a Medigap/Medicare supplement policy, regardless of past or present health problems.

Most people don’t realize the value of delaying enrollment in Medicare Part B until they are in a situation like James’. They apply for a Medicare supplement and learn they may not qualify because they are no longer in their Medigap open enrollment period.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.