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Some Need an Appointment to Apply for Medicare

Today’s video addresses the distinct application process for those who haven’t “earned” premium-free Medicare Part A on their own work records. I cannot say for sure, of course, but think it’s probably fair to say that most Americans think simply being an American entitles you to premium-free Medicare Part A at age 65 but that is not true. That would be far too straightforward for our country’s challenging approach to healthcare.

In the U.S., we single out the people who have largely been at-home spouses, for not-so-special treatment in their application for Medicare. These individuals earn premium-free Part A through the spouse’s, divorced spouse’s, or deceased spouse’s work records. Rather than being able to apply online, through ssa.gov, like those applying on their own work record, they must have an in-person or telephone appointment with Social Security. They often must produce original marriage certificates and divorce decrees and mail the documents to Social Security or bring these documents into Social Security.

We recommend calling your local Social Security office at the very beginning of one’s Initial Enrollment Period (IEP) if going onto Medicare at 65. In fact, we recommend calling the month before the IEP begins to see if an appointment can be scheduled during the IEP. This may very well depend on your local office but we recently became aware of a client being able to make an appointment prior to when the IEP began which resulted in an appointment at the beginning of the IEP. This is helpful because you need enough time to have your randomly generated Medicare number early on in order to complete other applications.

If at age 65 you are married to someone with large, active group coverage, you don’t have to transition to Medicare until your spouse retires. But if you haven’t earned premium-free Part A through your own work record, then you will need an in-person or phone appointment with Social Security so plan ahead. Also, as we have advised before, you wouldn’t want to enroll in Medicare Part A if you wanted to continue contributions to a health savings account.

A worker earns premium-free Part A by paying into Social Security for roughly 40 quarters or 10 years. Someone who hasn’t worked and paid payroll taxes faces much more complexity in determining their eligibility. If you’re not sure of your status, you should be able to find that information on your MySocialSecurity online account so create one if you have not. Worst case, call your local Social Security office and ask. The excerpt below is from Medicare Interactive, a service provided by the Medicare Rights Center, a nonprofit organization.

When you turn 65, you may be eligible for premium-free Part A based on your spouse’s work history if:

  • You are currently married and your spouse is eligible for Social Security benefits (either retirement or disability). You must have been married for at least one year before applying.
  • You are divorced and your former spouse is eligible for Social Security benefits (either retirement or disability). You must have been married for at least 10 years, and you must now be single.
  • You are widowed and married for at least nine months before your spouse died. You must be single.
Be aware that there are some exceptions to the eligibility rules listed above. To confirm your eligibility for premium-free Part A, call the Social Security Administration at 800-772-1213. If you are a railroad worker, contact your local Railroad Retirement Board field office.One can also use the tool on medicare.gov to determine eligibility. Go to:
www.medicare.gov/eligibilitypremiumcalcBecause the vast majority of Americans do qualify for premium-free Part A, I personally don’t see value in making eligibility requirements for those who earn it through a spouse or former spouse so complicated and the enrollment process so much more involved. In fact, it seems plausible that allowing everyone to use an online process and upload documents, if necessary, might save the government money, right? And, of course, don’t we want people to be covered? Our country suffers from an ongoing dilemma of wanting to improve access to coverage but at the same time making access difficult.We acknowledge that there is much more complexity in someone who hasn’t paid payroll taxes on their own in filing for Social Security payments. Divorce is common so many individuals have more than one 10-year marriage. But, applying for Medicare Part A could be simpler.Finally, this matter is largely a women’s issue. People who earn Social Security and Medicare through a spouse are almost always women whether married, divorced or widowed. The system was structured to cover them too – as it should be – so the purpose in creating a far more onerous process for them to enroll eludes me. And, remember, Social Security accepts a signed form CMS-L564 from a former employer as “proof” that an individual actually maintained active group coverage after turning 65. I can think of only one time in all these years in business that Social Security challenged a completed CMS-L564 thinking that an individual wasn’t entitled to a Special Enrollment. And in that instance Social Security was wrong. To this day we don’t know why Social Security didn’t believe our client was running a small business. In sum, since the Special Enrollment process is largely an honor system, why require so much proof of one’s marital status when so many offices are backlogged?I could continue my ranting and raving with all the instances naturalized citizens have had to bring original birth certificates into Social Security which are in languages no one in the office can read but I’ll stop here.

Again, the rules are the rules so please don’t run afoul of them! For now, make sure you have original documents in case you are asked for them, have your former or deceased spouse’s Social Security number, and, remember, start early to request a telephone or in-person appointment because some Social Security offices are not current with their workloads.

Please watch the video and spread the word. Thanks.