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The government isn’t forcing you to take Medicare

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POSTED March 8, 2013 10:41 p.m.

Q: Why does the government force me to take Medicare? I have been getting Social Security for a couple years. I will be 65 next month and just got a "Medicare Enrollment Package" in the mail. I don't need Medicare. I've got excellent health insurance from my former employer. Is this part of Obamacare — forcing folks like me to take Medicare when I don't need it?

A: I'm afraid you're mixed up on any number of issues. Nobody is forcing you to do anything. The Medicare enrollment package has nothing to do with Obamacare. And I think you better take a second look at the "excellent health insurance" provided by your former employer. Let me take this step by step to help you understand what is going on.

First, some basics. There are two main parts to Medicare. Hospital insurance, usually called Part A, covers inpatient hospital costs. It was paid for by the Medicare payroll tax deducted from your salary while you were working. So there is no cost to you once you reach 65. Medical insurance, called Part B, covers doctor's visits, lab tests and most other medical expenses not covered by hospital insurance. Part B is paid for by a monthly premium (currently $104.90 per month for most people) deducted from your Social Security check.

If you are getting Social Security benefits before you reach age 65, then you are automatically sent a Medicare Enrollment Package in the mail a month or two before your 65th birthday. (These enrollment packets have been mailed to seniors for decades now, so they have absolutely nothing to do with the recent Affordable Health Care Act, more commonly called "Obamacare.")

The government automatically enrolls you in both Parts A and B of Medicare because something like 97 percent of senior citizens take Medicare at 65 and automatic enrollment saves them the hassle of contacting the Social Security Administration to apply for the program.

If you would have taken the time to read the material sent with the enrollment package, you would have learned that you can decline Part B. They just assume you want Part A hospital insurance because you've already paid for it. But because Part B will cost you about a hundred bucks monthly, they give you the option of turning it down.

However, before you turn it down because you think you have excellent health insurance from your former employer, I STRONGLY recommend you talk to them. What I am almost sure you will learn is that they require you to take Part B Medicare coverage, and then they will probably fix you up with some kind of Medicare supplement policy. If you think about it from their perspective, it makes sense for them. Why should they continue to provide you with full coverage when the government is willing to do so via Medicare?

If you make the mistake of declining Part B Medicare coverage and then later learn your employer's insurance required you to take it, you are going to have to go a whole year without full insurance. You won't be able to sign up for Part B until January of next year — and you will pay a 10 percent monthly premium penalty for the rest of your life.

So to recap: The government was doing you a favor by automatically enrolling you in Medicare. If you don't want Part B Medicare, you don't have to take it. But DO NOT decline Part B until you talk to your employer's health insurance representative.

There is one other important Medicare enrollment note I must make. It doesn't apply to you, but it does impact millions of Americans who are turning 65. If you reach that Medicare age and you are not yet getting Social Security benefits, then the ball is in your court, so to speak. You will not be sent a Medicare Enrollment Package. Instead, you must take the initiative and make an appointment to file for Medicare yourself.

And if you are still working and you are covered by your employer's health insurance, you generally do not need to take Medicare Part B. You should take Part A (because it's free), but you can save yourself $104.90 per month by declining Part B. Your employer's insurance will cover you as long as you are working. And when you stop working and lose your employer's active health insurance coverage, then you can apply for Part B Medicare and you will NOT be charged with the delayed enrollment penalty. These same rules apply if you are 65 and are married to a person who is still working and you are covered by your spouse's employer's health insurance.

Q: I just learned that I will be required to pay 146.90 for Medicare this year when all of my friends are paying $104.90. This isn't fair!

A: Do you want the good news or the bad news? The good news is that you must be richer than all your friends. The bad news is that rich people pay more for Medicare.

Most people don't know this, but the Medicare Part B premium ($104.90 for most people) pays only 25 percent of the cost of running that part of the Medicare program. The taxpayers pick up the other 75 percent. A while back, Congress said that was too much of a burden on working Americans. They originally wanted to raise the premiums on all Medicare beneficiaries, but ended up only doing so on wealthier people. So now, the richer you are, the more you pay for Medicare Part B. Just be glad you're not among the super rich. They pay $335.70 per month for their Medicare coverage!

If you want to learn more about this, here is a link to a government fact sheet that explains these rules: www.socialsecurity.gov/pubs/10536.html.

 

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