Transitioning from Obamacare to Medicare Part II

Amira Wazir

Insurance Matters …..


By Amira Wazeer
For coverage starting in 2015, open enrollment for Medicare starts Oct. 15 and lasts through Dec. 7. For Obamacare (ACA) coverage starting in 2015 the open enrollment period starts Nov. 15 and lasts through February 15.
Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events. (Go to and click on Special Enrollment Period and Qualifying Life Event)
If you were born in 1949, then you will turn 65 this year. And if you are eligible for Medicare, you will no longer have to pay for Obamacare once you age in to Medicare. You will pay a new type of premium for part B.
Your Medicare health care coverage will begin in the month you were born in. You have a 7-month window to sign up. You can sign up for Medicare three months before your 65th birthday, the month of your birthday and three months after your birthday.
You want to notify your ACA insurance carrier that you will cancel your plan the last day of the month before your birthday month begins. For example if your birthday is in December, let’s say Dec. 15, then you want to have the plan canceled on Nov. 30, as your Medicare effective date should be Dec. 1, 2014.
Make sure you have received your Medicare card with a Part A and a Part B effective date on it before you do this however. Part A will cover your hospital costs and Part B will cover your doctor costs.
Medicare states that the process is automatic, but I have clients who have had delays and problems getting their part B.  Get your part B clarified before you cancel.
In some cases people will find out that they do not qualify for Medicare. There are a variety of reasons why this can be so. Verify before you cancel your ACA plan.
If you do not have part B, then you may have to file an appeal to stay on Obamacare.  If you are denied, you will need to purchase additional insurance to cover the gap in the medical coverage part B would have covered.
Part A does not have a premium for those who qualify. Eligibility for Part A is determined by your work history or disability approval. For 2015, part B has a premium of $104.95.
Ever since 2007, under a law passed in 2003, people with Medicare have paid a surcharge on their standard Part B premiums, if their modified adjusted gross income, as shown on their latest tax return, is higher than $85,000 for a single person or $170,000 for a married couple filing joint returns.
Currently, fewer than 1 in 20 beneficiaries pay higher-income premiums.
Part B is considered “optional” because you can opt out. But if you opt out, without what is considered creditable coverage (coverage as good as Medicare), you may be liable for a Part B late fee of 10 percent for each full 12 months you are without creditable coverage.
Let’s’s take a person who feels they are perfectly healthy and does not want to pay the $104.95 premium.  For each full year missed, the penalty will be 10 percent, if we project the Part B premium stays the same (we wish), that is a $10.49 monthly late fee.
For  purposes of our example, let’s say that person waits 10 years and then decides to purchase Part B. They will pay 10 x $10.49 or $104.90 per month penalty plus the $104.95 premium or $209.85 per month for Part B.
The law says that a 10 percent penalty is imposed "for each full 12-month period" that people delay enrolling in Part B when eligible to do so (unless they have group health insurance from their own or their spouse's current employer or creditable coverage).
If the delay is less than 12 full months, the penalty should not apply.
Social Security officials explain that the penalty clock starts ticking at the beginning of the month after your 7-month initial enrollment period (IEP) expires and shuts off on the final day of the annual general enrollment period (GEP) that runs from Jan. 1 to March 31, in which you sign up for Part B.
Here's a different example showing how the late penalty can hit. Say your IEP expires at the end of March, and you sign up for Part B the following January during the GEP. That's an actual enrollment delay of only 10 months.
But under Social Security rules, the clock continues to tick until the last day of the GEP in which you enroll. So the delay is considered to be a full 12 months (April 1 through March 31), and you must pay a 10 percent late penalty on all future Part B premiums.
Once you've missed your first deadline for joining Part B (according to the scenarios described below), you can enroll only during a general enrollment period, which runs from Jan. 1 to March 31 each year – with coverage not beginning until the following July 1.
Missing each March 31 deadline means another full 12-month delay and a further 10 percent late penalty. For example, delaying enrollment by five years results in a 50 percent penalty.
In other words, you'd permanently pay half as much again for the same coverage. Even more important is the fact that if you are ill, you cannot access Medicare for months. You will have to pay out of pocket for treatment.
So it's important to know when your personal deadline for enrolling in Part B expires and when the late penalty clock starts ticking, according to different circumstances:
If you turn 65 and are not covered by group insurance provided by an employer for whom you or your spouse is still working:
Your deadline comes at the end of your seven-month initial enrollment period (IEP), which expires at the end of the third month following the month in which you turn 65. For example, if your 65th birthday is in July, your IEP ends Oct. 31.
You can usually delay signing up for Part B beyond age 65 without risking late penalties if:??(a) You are covered by a group health insurance plan from your employer or union and you are still working, or??(b) You are covered by your spouse's group insurance and your spouse is still working.??If you lose this insurance or retire (or, if it's your spouse who has the employer plan, when he or she retires), you'll get a special enrollment period (SEP) of up to eight months to sign up for Part B without penalty at that time. But if you fail to enroll within this SEP, the Part B penalty clock is reset to the time when you retired or your group insurance ended, and not when your SEP expired.

For example, let's say you retire in February, triggering an SEP that lasts through October, but you fail to sign up for Part B until the following open enrollment period in January through March.

Since a full 12 months had elapsed (from the end of February to the end of open enrollment on March 31 of the following year, in this example), you would incur a 10 percent late penalty. open Enrollment 2014-2015 is coming and whether you are going to be in a plan for a few months or a full year you will need to take action.
Now is your chance to get a jump start on comparing health insurance plans and premiums to make sure you're getting the best healthcare you can afford, and the lowest price possible.
You may have heard, 2015 premiums are on the rise and plan options are getting narrower. Don't get stuck in a plan that costs too much, compare health plans and pricing before it's too late. Be sure to check out supplemental insurance as well like cancer and critical illness plans
If you purchased a health plan on the insurance exchange last year the "convenience" of letting your health plan auto-renew could cost you hundreds of dollars.
The reason? If your income changed at all in 2014, or your projections were not accurate when you calculated your subsidy, you could be obligated to pay that money back at tax time! It's time to take 5 min. recalculate your subsidy and perform a low-rate check.
Open Enrollment Begins Nov. 15, 2014 and ends Feb. 15, 2015. Open Enrollment is the perfect time to look at your income, recalculate your subsidy, and shop available health plans to make sure there are no surprises headed your way April 15, 2015.
Health plans change every year, networks grow and shrink, new discounts are offered and you have the opportunity to lower your total costs on health premiums on 2015. Don't wait
(Amira Wazeer is a state licensed and federally certified insurance agent with over 14 years experience.  She specializes in Medicare plans, Affordable healthcare plans, dental and vision plans, Life insurance for diabetics and Janazza (final expense) insurance. Consultations are free. Need a speaker at your upcoming events or have Questions and comments contact a.d.wazeer@ or call 404-202-1926.)


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