REMEMBER THE OLD sayings that “the cobbler’s children have no shoes” and “the carpenter’s house is falling down”? That’s how I felt last month as I frantically tried to enroll in Medicare.
My 65th birthday was in early September. Medicare has an initial enrollment period that lasts seven months. It starts three months before you turn age 65, includes your birth month, and ends three months after the month you turn 65. Suppose you were born on Sept. 15. Your open enrollment period would begin June 1 and last until Dec. 31.
If, say, you’re still working at age 65 and have health care coverage through your employer, special rules apply to Medicare enrollment and to when benefits begin. What if you aren’t covered by one of the exceptions? If you’re currently receiving Social Security benefits, you should be automatically enrolled and you’ll receive your Medicare card before your 65th birthday. This happened to a friend of ours—a widow—who was receiving Social Security survivor benefits.
What if you aren’t yet receiving Social Security? You’ll need to apply for Medicare and, if you want coverage to start in the month you turn age 65, you should submit your application no later than the month before. I understood that timeline. Problem is, I got hung up researching and choosing among Medigap plans, those add-on insurance policies that help cover what Medicare doesn’t.
My previous employer’s pension plan offers a Part B supplement plan and a Part D drug coverage plan. About three months prior to my 65th birthday, the company sent me a detailed package and enrollment forms. Unfortunately, I misplaced the package. I requested another one, but it took time to arrive.
My mistake: I should have applied for Medicare while I waited for the information and before I settled on a Medigap and Part D drug policy. The fact is, you need to enroll in Medicare before you can apply for these supplement policies. I wised up and, on Aug. 25, applied for Medicare Parts A and B through my online Social Security account. This should have ensured my coverage would start Sept. 1.
But things didn’t go smoothly. A few days later, I received a letter requesting an original birth certificate to verify my date of birth. I could mail it or drop it off at a local office. The Social Security Administration (SSA) would then return the birth certificate once it had verified my date of birth.
Recent articles talked of long lines and extensive waits as the SSA reopened offices this past April. I learned that offices were still observing COVID-19 protocols. Despite this, I drove to a local office to drop off my birth certificate in person. I reasoned I could speak to an agent to make sure there was nothing else required.
The line outside the local SSA office was a dozen deep. The office allowed just six people in at a time. When one person left, the friendly security guard let another person in. After about 30 minutes, the security guard came out and asked if anyone was only dropping off documents. He explained that I could enter the office, place my document in a special envelope and drop it in a secure box.
Three days later, I received another letter from the SSA, returning my birth certificate, and requesting that I mail in or bring to an office my birth certificate and ID. Yes, the SSA was asking for the same document it had just returned.
This confused me. The letter supplied a phone number for the local office, so I called to get clarification. Amazingly, an agent answered on the third ring. I explained my confusion and she looked up my file. I was concerned when she let out a perplexed “huh.” She told me that my first name was misspelled on my online Social Security account. I’ve had that account for at least a decade. Somehow, my first name was spelled with an extra “D” at the end.
She apologized and said this should have been communicated to me. She told me I needed to come to the office with two forms of identification, plus an original birth certificate, and apply for a replacement Social Security card. This was on a Friday afternoon. The office was open for a few more hours. I thought that maybe it wouldn’t be too crowded.
I rushed over and joined a substantial queue. An hour later, the line hadn’t moved. It was obvious I wasn’t getting in that day. I returned Monday morning 30 minutes before the office opened. I was fourth in line. Twenty minutes later, they let six of us in. About 15 minutes after that, I was at a window talking with a live agent.
She was polite and helpful. She took my documents and created the application for my replacement Social Security card. She then reviewed my Medicare application and said it had been approved. I should receive a new card, as well as my Medicare ID card, within a few weeks, the agent said.
When I got home, I checked my online Social Security account. Sure enough, the Medicare application section of my account had been updated to say my application had been approved. I was able to create an account on Medicare.gov and print an ID card.
Waiting in line at the office, I heard horror stories from my queue-mates. One woman had received benefits as a child when her father died prematurely. She had recently received a letter from the SSA saying she had to repay some of those benefits—benefits she’d received in the 1970s.
Still, I have to say that the SSA employees I dealt with at the office were very professional. They’re on the frontline of an enormous bureaucracy and deal with people who are frustrated, confused and scared. I don’t envy them.
Over the next few weeks, it all came together. I enrolled in Medigap and Part D supplement plans. I received my official Medicare ID card, a new Social Security card and the supplement plan ID cards. I’ve been able to register my new insurance information with all of my doctors.
The lesson of my saga is clear: Don’t wait. If you don’t yet have an account on Social Security’s website, create it now. It’s easy to apply for benefits online and monitor the progress of your applications. Do your research before your enrollment period begins. After all, you never know what gremlin is lurking in the system that’ll hold things up. Take it from me—your friend Richardd.
Richard Connor is a semi-retired aerospace engineer with a keen interest in finance. He enjoys a wide variety of other interests, including chasing grandkids, space, sports, travel, winemaking and reading. Follow Rick on Twitter @RConnor609 and check out his earlier articles.
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Richard another reason to register with Social Security on their web site is that when you do that it prevents someone else from registering under your name. A Social Security employee gave me that suggestion.
Richardd very Kafkaesque. I always tell people to sign up for Medicare 3 months early “just in case”. Your “just in case” shows it could be anything.
This all sounds very similar to my own experience when I first enrolled in Medicare. What helped was a copy Medicare for Dummies, which provided a lot of very good information for the initial sign up and election process. Unfortunately, I don’t see many people doing much homework in preparation for this very important moment in their lives.
Way back when my only contact with the Social Security bureaucracy was the annual mailed “Your Social Security Statement” I was surprised and initially amused when I found my birth year changed from 1953 to 1955. I ignored this for a few years but as my actual 65th birthday approached, and prompted by my spouse, I decided to have this corrected. As Richardd discovered, multiple trips to the Social Security office with increasing numbers of original (no copies please) documents were required to correct what was obviously a data-entry error. But as the gatekeepers to benefits of significant monetary value I would expect this kind of diligence, so I cannot fault the bureaucracy for this.
I’m 19 months out and plan to use one of the many brokerages that evaluate and sell Part C and D plans. The two I am interested in are: MedicareSchool.com and SeniorSavings.net Both have YouTube channels and educate people concerning signup periods and helping to choose the right Part C plan- supplement or MA and Part D. Although licensed brokers, they function like an ombudsman to tailor a Part C and D plan to your specific needs. If you’re in a MA plan that you don’t like and still in your first year, you contact them and under the law they can utilize the onetime change option in the law to move you into a Part C and D plan that’s more suited to your needs. The best part is that these brokerages are totally free and they earn commissions selling Part C an D plans. The two brokerages I’ve listed are nationwide and have large followings and seem to show a greater measure of integrity in their actions.
I am sure any broker will be happy to sell you a Part C plan. Before signing up for that I highly recommend reading “Medicare for Dummies” and considering the significant advantages of a Medigap Plan G instead. Part C (i.e. Medicare Advantage) is fine when you are healthy, not so much when you inevitably develop conditions needing treatment. Your YouTube advisors don’t seem to be reliable – you can change Medicare Advantage plans once a year, you can change from Medicare Advantage to Original Medicare plus Medigap without medical underwriting during the first year of coverage.
The local SS office in my town is staffed by surprisingly helpful and friendly staff. Calling for an appointment is the easiest way to avoid lines.
Thanks for the upddate Richardd! Seriously, now you need to write about your saga of picking a Medigap plan, and why. Since it seems there’s no end to our continually changing health insurance landscape, I’m sure there’s plenty to write about!
Good story Richardd! You cannot make this stuff up. Government bureaucracy. What else can I say.
My wife is 2 years older than me. I enrolled her in Medicare, Medigap and Part D Prescription. Part of my job was contract administration, so I was used to dealing with complex contracts. However, I found out that making decisions about Medicare options was pretty complicated. Fortunately, there were no glitches in the process, but it was still challenging. A good BCBS agent helped us navigate our choices.
Fast forward 2 years for me. I worked until age 66 and had the option of using my employer’s retirement health and prescription plan or choosing publicly provided Medigap and prescription plans and getting reimbursed by my employer. I seriously considered public plans but the rules for doing this were complicated because I was doing this 1 year past age 65 enrollment. Each program had its own rules and they were opaque and well hidden in their online documentation. SHIIP, which is usually a great resource had difficulty advising me with my situation. I called the NC state office and it was obvious they were reluctant to give me an opinion because they were not sure either.
I finally gave up and went with the safe choice of retirement benefits from my employer.
All of these opaque Medicare rules need a serious streamlining and do over.
The rules are ambiguous and complicated. I intend to utilize one of the many brokerages that offer Part C and D plans as they are skilled in navigating you into the right plan for your specific needs. I’m in a state retirement health insurance plan that will automatically steer me into a MA plan. If I want traditional Medicare, I have some legal hurdles to pass through and having the free assistance of a licensed brokerage will definitely help in navigating through it.
Scary stuff Richard, but as someone said, not the norm, but aggregation for sure. You mention your former employer offering supplemental coverage.
All I can say is don’t count on it lasting much longer if there is any employer contribution to the coverage. Employers are dropping that coverage every day, mine did in 2020 even for retirees for which the coverage was negotiated for many years.
The press, politicians and poorly informed seniors make Medicare seem more complicated than it is. It all boils down to basic Medicare, plus taking Medigap Plan G. That combination will give the retiree coverage equal to or better than most pre-retiree coverage. Part D is a different matter and is very confusing and costly if a person is taking expensive meds, all unnecessarily so. Make the wrong choice and your out of pocket can be hundreds of dollars extra a month. If an employer drops that supplemental coverage it can be devastating.
Medicare Advantage plans are what cause confusion because retirees seek to eliminate all their cost sharing and overall it doesn’t work that way.
Between my wife and I over 12 years we have used Medicare too many times. Our out of pocket costs have not exceeded the Part B deductible.
I chose not to enroll in my former employer’s Medicare plans. It seemed expensive and the company they employed to administer the plan did not inspire confidence. I enrolled in a commercial Part B & Part D plan. I only take 1 prescription that is not expensive, so I chose a low cost plan.
Do you mean Medigap? There is no commercial Part B, that’s basic Medicare.
My former megacorp has been downsizing its retiree contributions for many years. Fortunately I was grandfathered under the original plan, but medical benefits have shrunk progressively over the years, and this year my pension was converted to two annuities. Also this year, the annual subsidy which allowed me to use Medigap Plan G and a Part D plan has been dropped in favor of a version of Medicare Advantage. The MA plan currently looks good, I only hope that if it changes significantly in the future that will count as a status change to allow me to get back on Medigap without medical underwriting.
The law allows a onetime exit from an MA or from traditional Medicare during the first year. If that’s not utilized, then you’re subject to medical underwriting.
I am well aware of that. A status change allows you to change without underwriting. And you can sometimes avoid underwriting without a status change. I was able to change from Medigap Plan F to Plan G last year without underwriting because Humana was temporarily waiving it. However, that’s not something you can rely on.
I thought I was grandfathered too as did my fellow 6,000 retirees, but that promise was simply ignored. It was very disturbing to me because I was the person who negotiated all the benefits over more than twenty years. I felt and still do feel like I betrayed retirees.
I would recommend that if you are close to Medicare and thinking about changing your PCP, do it now. A lot of primary practices , at least in Massachusetts will only accept you as a Medicare patient if you were already their patient. Although you are not required to have a PCP if you have Original Medicare, there are many good reasons to retain one.
I would also recommend you get very familiar with Medicare coverages. My PCP’s office frequently makes erroneous statements such as ” PAP smears aren’t done for Medicare patients because Medicare doesn’t pay for them” . Totally false. How many of their patients don’t know that Medicare does pay? So I self referred to a gynecologist.
Also , please know that you have more vision coverage under Original Medicare than magazine articles would lead you to believe. The only things Medicare doesn’t pay for is eyeglasses and the refraction test, which is a very cheap test. My eye doctor does not charge us for the refraction test. We are not diabetics or have other illnesses but all of our eye tests are covered.
Medicare only pays for eye exams and treatment of diabetic retinopathy or if the patient is at high risk for glaucoma. In other words when there are underlying medical reasons. People absent those reasons typically don’t receive more than the purely routine – not covered – care.
Physicians offices are frequently not familiar with patient coverage, Medicare or otherwise. If a doctor – not staff – says a procedure is not done simply because it’s not covered by any insurance, but is nevertheless good medical care, it’s time to find a new doctor.
But keep in mind that what Medicare pays or does not pay is largely based on the coding used by the provider to file the claim – need I say more?
Medicare pays for eye care for a number of eye conditions beyond those you state, including cataracts and a new pair of (simple) glasses after cataract surgery. Both my partial cornea transplants were fully covered under Medicare Plan B. For regular care I recommend the very cheap insurance available from VSP for those on original Medicare.
Yes, but it’s all based on a medical condition, all the things not typically covered by a pure vision plan. My wife had hundreds of thousands in vision care including retina attachment, but the result of an eye injury.
Very helpful info about PCPs. Thanks!
Your experience was way outside the norm but I always advise friends and family against doing their own Medicare insurance research, for the very reason you mentioned: “I got hung up researching and choosing among Medigap plans, those add-on insurance policies that help cover what Medicare doesn’t.” I refer F & F to independent brokers who do most of the leg work for you and get paid by whatever insurance company plan you select. A good broker will help sort out the myriad of confusing options available (literally hundreds of plans in our county), explain the differences, answer questions, and keep you on track with the deadlines. Of course, everyone’s mileage will vary.
David, thanks for the suggestion. I found an independent broker through a friend’s recommendation and had a very good experience with them.
Instead of a broker, I’ve advised friends who can’t do it themselves to see the SHIP counselor in their state. (Called SHINE in Massachusetts). They are unbiased , highly trained and will help you pick the right plan as well as prescription coverage .
Agree. I also highly recommend reading “Medicare for Dummies”.