Page 39 - Delaware Medical Journal - November/December 2019
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MSDIS CORNER
What Role Should Medicare Play in My Life?
Aaron Mitchell Physicians have many types of
relationships with Medicare.
During your early years of practice, Medicare’s relevance is mostly in your balance sheet. Unless you’ve helped a parent or relative to enroll in Medicare, the process, the coverage, and the cost is likely to be knowledge you plan to acquire much later in life. We’re not trying to
in Medicare coverage, but we focus on making sure our physicians know what their rights and responsibilities are before they start receiving kits from AARP, Highmark, and others.
The solicitations start in full force for most people once they are within 12 months of turning 65 (the age most people qualify
These mailings come from Medicare supplement insurance companies, Medicare prescription drug companies,
as well as from the Social Security Administration and organizations like AARP. From personal experience, I would be careful giving information such as your email address on websites relating to Medicare quotes. I once helped an aunt to
look at Medicare supplement premiums and used my email address to receive her quote. Despite being in my early 30s, that email triggered applications for Medicare eight years.
The most important thing to note is that these mailings do not always explain all the options available to someone who may be approaching age 65. Some of
the solicitations even use intimidating language such as “late enrollment penalties” and “open enrollment windows.” Most of that language includes a short explanation of your seven-month “window” to enroll in Medicare when you turn 65. That seven-month period begins three months before the month you turn age 65 and claims to expire three months after you turn 65. What is not mentioned is that many people employed after age 65 have ongoing Special Enrollment Periods, negating any need to sign up for Medicare until they are approaching retirement. That ability depends on the size of the organization that provides your health insurance.
TEFRA/DEFRA is not some type of national defense system, a country music band, or a food truck on the Wilmington Riverfront. Instead, it is the rule that insurance plan or Medicare is the primary payor.
If your practice (or group) has fewer than 20 employees: Medicare is responsible for being the primary payor. In those situations, a physician or staff member turning 65 is likely to need Medicare Parts A and B, even if they remain actively at work and are covered under the group health plan. Most physicians who remain on their group plan will still delay signing up for Medicare drug coverage (Part D) and for a Medicare supplement or Medicare Advantage plan.
If your practice (or group) has 20 or more employees: The group health plan is the primary claims payor, not Medicare. In this situation, if you remain covered by your group health plan, you may be able to delay Medicare Parts A and B, as well as signing up for prescription drug coverage or Medicare supplements and Medicare Advantage plans.
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