Dear Toni: I need your assistance to enroll in Medicare because I am past 65 and still working full time with employer benefits. My doctor’s office manager said my employer’s health plan denied the recent claim for my cancer treatment. The health plan considers it to be “experimental” and will not pay for this care.
The specific cancer treatment costs me over $15,000, which I had to pay from my 401(k). This amount will drain what I need for retiring. To remain as a full-time employee, I am having to use my 12 weeks of vacation time for this treatment and receive my full pay.
The doctor’s office currently has patients on original Medicare with a supplement that is paying for this cancer claim. The office manager files their claims without a problem. I need to know how to begin my Medicare benefits as quickly as possible. — Brent, Nashville, Tennessee
Dear Brent: A doctor advised me that many of the new cancer procedures are not approved by individual and employer group health insurance plans. These procedures are generally approved with original Medicare, according to the doctor. He agreed that enrolling in Medicare past 65 and employed is complex, especially when an employee has health issues.
Here are scenarios for enrolling in original Medicare past 65. They are the same whether you’re still working, laid off or retiring:
— Health issues are not covered by an employer health plan: You (or your spouse) are still working, with health issues (like Brent), and the employer health insurance plan is not covering the doctor’s procedure. Even though you are not retiring, you need to enroll in Medicare.
— Laid off: You (or your spouse) are laid off and need to enroll in Medicare.
— Retiring past 65: You (or your spouse) decide to retire past 65 and need to enroll in Medicare.
The process to enroll in Medicare past 65 must be followed correctly:
— There are two Social Security forms to file: The Medicare Request for Employment Information (CMS-L564) must be signed by the employer’s human resource representative. (If you have had two or more jobs since turning 65, then each of those companies must sign a CMS-L564 form.) The request for Enrollment in Medicare Part B (CMS-40B) must be filled out and signed by you. These forms are available at ssa.gov.
— At the top of each form, write “special enrollment period” to inform Social Security that you are signing up at the right time and to prevent a Medicare Part B penalty.
— Always make copies of your completed forms.
— Deliver the original forms to your local Social Security office, especially when you want your Medicare to begin as soon as possible. There can be a delay in processing the forms when they are emailed or faxed.
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.
