We’ve all been reading about the problems with Social Security phone calls and appointments. Clients who need help report they are on hold for an hour or longer and may be disconnected. Many who need in-person assistance can’t schedule an appointment or it’s often weeks in the future. If they go to the local office, they can wait for hours.
Given the current climate, those applying for Medicare need to do everything they can to ensure they do it right the first time. But that can be a monumental task. It’s like working on a jigsaw puzzle, only you have to fish out the right pieces from two or three boxes and there’s no picture to guide you.
A recent client situation highlights this analogy. It deals with the form those who delay Medicare at age 65 must complete when signing up later. The CMS-L564, Request for Employment Information, supports a Part B Special Enrollment Period, the opportunity to enroll in Medicare without penalty or delay.
The client is 71 and has had coverage as a dependent on his wife’s employer group health plan (EGHP) for many years. She plans to retire in June so he started the enrollment process in early March. He completed the CMS-L564 and submitted it to his local office. A short time later, he was notified that his application was suspended. He had no idea why so, after having no luck with phone calls or appointments, he decided to visit the office.
He waited almost two hours and finally met with an agent. It did not go well. The problem: He needed to prove that, since he turned 65, his wife was employed continuously and there were no gaps in the group plan coverage. The CMS-L564 he submitted originally supported only her current employment but his wife changed jobs recently. As instructed by the agent, he obtained documentation from her previous employer and is resubmitting the application.
Our client has been looking in the mirror, trying to figure out how he missed that and went astray. This time, he didn’t do anything wrong; rather, he was a victim of bad instructions.
Key Pieces Were Missing
The instructions for the CMS-L564 read, “In order to apply for Medicare in a Special Enrollment Period, you must have or had group health plan coverage within the last 8 months through your or your spouse’s current employment.” The client’s documentation covered the last eight months.
However, the Social Security instructions for enrolling in Part B only add the piece he missed. “If you’ve been covered by an active employer group health plan (either yours or your spouse’s) since turning 65, and it ended within the last 8 months, you can enroll in Part B without any penalty.” The documentation has to cover the period of time from age 65 to the present.
There’s more. For many retirees, the EGHP and employment can end at the same time, which begins the eight-month Part B SEP. Waiting to start the enrollment process until the SEP begins means there can be a gap in coverage, (especially when it can take two to four weeks or more for Social Security to process the application). But, you don’t have to wait. Another piece of valuable information appears in the Social Security booklet titled, “Medicare.” The SEP rules allow you to “Enroll in Medicare Part B any time while you or your spouse have a group health plan based on current employment” or during the following eight-month period.
Putting together the information from three different sources gets the complete guidance our client and others need. To qualify for a Part B Special Enrollment Period, you must be covered by an active employer group health plan (either yours or your spouse’s) since turning 65. You can enroll in Part B at any time while covered with a group plan based on active employment or during the eight months from the date employment or coverage ends (whichever comes first).
Because the instructions on the form were not complete, our client lost valuable time. His wife may have to delay retirement until his enrollment is processed.
Social Security has announced plans to “reduce the size of its bloated workforce … through an agency-wide organizational restructuring … with steps that prioritize customer service.” If and until customer service gets the priority it deserves, remember these tips.
- Don’t wait until the last minute to start the Medicare enrollment process.
- If delaying Medicare past age 65, consider enrolling in Part B so it is effective at the time the employer plan ends. There will be no gaps in coverage.
- If encountering any hiccups, address them immediately. Just as with our client, it may be necessary to stage a “sit-in” at a Social Security office.
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