TONI SAYS: Married vs domestic partner with employer benefits and delaying Medicare Part B

By Toni King

Toni: My problem is different than most couples that I read about in your weekly Medicare column. I am finding out that my company’s group health plan is not paying for any Medicare Part B medical expense since my husband is really a domestic partner. We have been together for over 25 years, but never officially married. Richard is 72 and I am a 58-year-old female who now needs to learn the maze of Medicare

Richard has serious health issues with 2 stents in his heart and a recent back surgery, which is now costing us thousands of dollars because my company’s group health plan is not paying for his doctor’s care. Richard has never enrolled in Medicare Part B because I have always been the “working spouse.” Now I am discovering that the group health plan (the company’s self-administered group health plan) does not recognize “domestic partners” as a married couple because we do not have a marriage license

Now, he needs to enroll in Medicare Part B, and with him being 72 if he does not do this correctly the penalty will be over 7 years. From what I have read in your articles, that this could be 70 or 80% penalty forever. The bottom line is, we need HELP!! Thank You, Gabby, Phoenix, AZ

Gabby: Enrolling in Medicare Part B needs to be a rush job! You are in the middle of the maze of Medicare and Richard needs Medicare Part B immediately!

This is a new Medicare question for the Toni Says® Medicare office. America needs to know the rules of Medicare regarding delaying Medicare Part B, when there is an unmarried domestic partner situation (same sex or opposite sex), and they receive health insurance through their partner’s employer.

Always discuss delaying your domestic partner’s Medicare Part B with your company’s health insurance benefits administrator or HR department about what is in the insurance company’s handbook regarding unmarried domestic spouse Medicare rules.

The size of the group may not make a difference. Whether there are less than or over 100 employees on your unmarried spouse’s group health insurance plan, one should verify with HR or the insurance plan if you generally should not delay the non-working domestic partner’s Medicare Part B. As I said earlier in this article, always consult with your benefits or HR department about the consequences that may arise when your domestic partner delays their Medicare Part B and if there could be a possibility of receiving a late Part B penalty, when they need to enroll in Medicare Part B at a later date.

I have written about the “Special Enrollment Period” and having the Social Security form titled CMS L-564 “Request for Employment Information” filled out by your HR or office manager. Richard could have his Medicare Part B with an effective date of the first of the next month.

Richard will need to take 2 Social Security forms, the CMS L-564 “Request for Employment Information” signed by the employer’s HR department along with the CMS 40-B “Application for Medicare Part B” to his local Social Security office.

During a Toni Says Medicare Consultation, we advise clients to meet with a Social Security rep in person (if possible due to COVID-19 social distancing) or fax it directly to the specific office or leave in the Social Security office’s mail drop box. Remember, always make copies of every document given to the Social Security office or received from the Social Security office.

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