TONI SAYS: Leaving employer benefits past 65 is puzzling

By Toni King

Hello Toni:

My husband, Jay, retired six years ago when he turned 65. He enrolled in Medicare Part A only and decided to delay his Part B since I put him on my employer’s group health plan. Recently, I read an article about failure to enroll in Medicare Part B when turning 65 and the additional cost for each year that one delays enrollment.

I plan to keep my husband on my policy until my retirement in 3 years when I turn 65. I spoke with a representative at the Social Security office and asked if Jay would receive a penalty for delaying enrollment in Part B. The rep said he would not, but that Jay will need to provide evidence that he has been enrolled in my employer health insurance.

I am overwhelmed because I do not know what to for Jay’s Medicare when I retire at 65. — Shirley from Dallas

Hi Shirley:

I have good news for you because the Social Security representative gave you excellent advice about your husband’s Medicare. I have written about the famous form to verify employer benefits for those enrolling in Medicare past 65 called CMS L-564 “Request for Employment Information.”

Form CMS L-564 is filled out and signed by your Human Resources department and Jay will fill out CMS-40B form “Application for Enrollment in Medicare Part B.” Under #12 Remarks of CMS-40B state which month Jay wants his Medicare Part B to start. Across the top of each form write “Special Enrollment Period” to claim the Medicare enrollment period he wants to enroll in to keep from receiving a Part B penalty.

Avoiding a Medicare Part B penalty when past 65, as you discovered, Shirley, is stressful. A reader recently visited the Toni Says office for a Medicare consultation, because his wife is retiring. The husband,72, has been enrolled in Medicare Parts A and B since he turned 65 in 2018.

The wife, who qualified for the Medicare Supplement Open Enrollment (6-month enrollment period) because her Medicare Parts A and B began February 2024, can pick whichever Medicare Supplement plan she desires without having to answer one health question.

But the couple is experiencing the pain and agony of trying to enroll the husband in a Medicare Supplement as he has health issues. He is currently on both spousal company benefits and Medicare Parts A and B. However, because he has been enrolled in Medicare since 2018, he can only apply for a “guaranteed issue” Plan F not Plan G Medicare Supplement policy since he has heart and cancer issues that keeps him from qualifying medically. (Chapter 3 of Toni’s Medicare Survival Guide Advanced edition discusses the enrollment rules for Medicare Supplements.)

Readers, you must have a “current” company benefit’s termination letter to prove to the Medicare Supplement insurance company that you are in a “guaranteed issue” period in order to avoid having to answer health questions. If you do not have a current termination letter and you have health issues, then you will not qualify medically due to those issues and will have to choose either Original Medicare without a Medicare Supplement to pick up Medicare’s out of pocket or a Medicare Advantage Plan HMO or PPO.

I have written about this special 6-month window many times and have stressed the importance of enrolling in Part B at the correct time and the correct way. Remember if you leave employer benefits and decide to enroll in a Medicare Advantage plan to verify that your medical providers are in the network for the Medicare Advantage plan you are interested in.

For a Medicare Checkup, contact Toni Says Medicare team at 832/519-8664 or email [email protected] regarding your Medicare options. Toni’s new “Confused about Medicare” video series is available at