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TONI SAYS: I was laid off… What are my health insurance options? | Lifestyles

EDITOR’S NOTE: This weekend edition marks the launch of a new advice column, “Toni Says,” by Toni King, health insurance and health insurance expert. King worked as a field sales leader for 28 years. His column, presented in a question-and-answer format, puts in “human terms” the ever-changing government rules and regulations for Medicare.

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Hello Tony:

My husband, David, was laid off because of what’s happening to the economy and rising gas prices. He is 68 years old and has never been enrolled in Medicare. I will be 65 in September and we are both covered by his employer’s health insurance plan which is ending.

We were told that he will receive a penalty because he is over 65 and has never registered for part B. I really hope not! I will have to enroll in COBRA until I turn 65 in September. Please explain what our Medicare enrollment options are since we are of different ages and have different enrollment situations. Thanks

— Paul

Great question, Paula:

There are 2 different rules about enrolling in Medicare parts A and B in your household and I’ll keep how to enroll in Medicare for you and David SIMPLE!

1) David must apply for SEP (Special Enrollment Period) by uploading form CMS-L564 (Employment Information Request) from or email [email protected] and we’ll email you a form.

Have David’s Human Resources department sign the form and attach it to the CMS-40B (Medicare Application Part B). File both forms with your local Social Security office when applying for Medicare Part B. Notify the Social Security representative that David is losing his benefits and needs his Part B to start the day after they end .

2) Paula, your way of enrolling in Medicare is simple and quite different from David’s because you will be 65 in September. Go to at least 90 days before turning 65 and apply online for a September 1 effective date.

This is an ALERT to the public as local Social Security offices, which were closed due to the pandemic, have recently reopened. The public should call their local Social Security office directly for assistance in completing Medicare Part B application forms. Most Social Security direct phone numbers can be located by searching online for the 800 number of that specific office. Typically, the wait while on hold is less than calling the main Social Security 800 number.

Below is a checklist for those enrolling in Medicare:

1) Original Medicare Part A: Covers hospital stays, skilled nursing/rehabilitation, blood transfusions, home care, and palliative care.

2) Original Medicare Part B: Covers primary care or specialists whether in the office or in surgery, outpatient surgery, durable medical equipment, x-rays, CT scans, MRIs, chemotherapy, etc.

3) Original Medicare/Medicare Advantage: Discuss with your healthcare institutions and healthcare professionals which Medicare plans they accept, such as Original/Traditional Medicare with Medicare Supplement or Medicare Part C (Medicare Plan Advantage such as HMO, PPO or PFFS). Search the Medicare Advantage Plan Hospital/Provider Directory online to make sure your doctors and hospitals are part of the network for that specific plan. Call to verify that they are currently on the network.

4) Medicare Prescription Drug Plans: Research drug plans each year to see if your prescription drug plan or Medicare Advantage standalone with prescription form covers all of your prescription or generic drugs.

5) Long Term Care (LTC): Consider an LTC option such as standalone LTC policies, hybrid annuities or life insurance with LTC riders, veterans assistance and companion benefits or apply for financial assistance from your specific state’s Medicaid for LTC.

6) Always make copies of every document given to the Social Security office or received from the Social Security office.

For answers to questions about Medicare, email: [email protected] or call 832-519-8664.