Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Lawley Medicare Solutions Learning Center:

Ask Janell!

 

QUESTION: I am preparing to retire at the end of the school year. My insurance covers both myself and my spouse. My spouse may be eligible for Medicare, but he will still have the retiree health coverage. What else might he need to do?

 

ANSWER: Congratulations on your retirement!

In this situation, you and your spouse have slightly different options. You both can keep the retiree health insurance, but your spouse has an extra step.

When an individual is eligible for Medicare (like when they turn 65 years old or certain other situations involving disability) and their health insurance is a retiree benefit, they MUST sign up for Medicare Part A & B, also known as “Original Medicare.”

If your spouse is collecting Social Security (SSI), they already have Medicare Part A. Whenever a Medicare-eligible individual collects SSI, they are automatically signed up for Medicare Part A – so they may not realize it, but they have Part A. You cannot decline Medicare Part A if you collect SSI. If this is your spouse’s situation, then they must sign up for Medicare Part B.

If your spouse is not collecting SS benefits they need to contact the Social Security Administration (SSA) to request that their Medicare Part A be started. This can be done by logging onto the www.SSA.gov website and creating a login and password. Once completed, your spouse can sign up for Medicare Part A relatively easily. Creating the login and password will be more complex than most websites, but that added security is important to your financial security. If they don’t want to use the website, you can call or go to the local SSA office to sign up for Medicare Part A only. This can take a bit of time, so don’t put this off or delay getting started.

The process for signing up for Medicare Part B involves two forms, the CMS 40B and the CMS L564. The CMS 40B is for your spouse to complete, and it is simply a request to start Medicare Part B. It does ask for the Medicare ID number, and if your spouse doesn’t know what that is, he could call the SSA or go to his local SSA office to get that number. When completing this form, he should also indicate when he wants the Medicare Part B to begin. Medicare always starts the first of the month, so it could be July 1, or August 1 or September 1, depending on his retirement date. He would not want a gap in coverage.

The second form, CMS L564 is completed by the employer that provided the health insurance you have. On this form, your spouse only completes the boxes 4, 5, 6 & 7. You can then take the form the employer who provided the health insurance. Their Human Resource staff will complete the remainder of the form.

Once completed, both forms CMS 40B and CMS L564 are delivered to the SSA office for processing. This is how to get the Medicare Part B started in a timely manner. You can turn these forms in up to 90 days prior to needing the coverage, but time is ticking away, so don’t delay.

SSA staff will process these forms, call you with any questions, and then issue your spouse a new Medicare card. This new card will now list both Medicare Part A & B. It is important to keep all Medicare cards and anything with your Medicare number on it safe and private.

Your spouse will also have retiree health insurance options that could be different from your options. That is important to evaluate. Up to this point you have both had the same insurance product that was tied to your employment. Your retiree health benefits can continue, but your options (with and without Medicare) are different. Now you could have different insurance products because you are retired and the choices are different.

Again, Congratulations on your retirement. New adventures await both of you, as you step into the next exciting phase of your life!

Read all Inside Medicare articles HERE.

 

LAWLEY HAS A TEAM DEDICATED TO MEDICARE INSURANCE!

Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur.

For questions, concerns, or to reach Lawley Medicare Solutions, fill out the contact form below or call 716.849.1540.