Anne is eight years younger than her husband. When Anne turned 65, George was 57. Anne had been employed as a teacher for seven years and worked part-time after her children were grown.

She never paid into the Social Security system sufficient quarters to qualify for benefits on her own. However, she was able to obtain benefits based on her husband’s SS record when he reached retirement age.

Anne received health insurance coverage on George’s policy provided by his employer until George retired at age 60. Thereafter, George obtained private insurance for himself and Anne until he turned 65, at which time he enrolled in Medicare, Part A and Part B.

Was Anne Eligible for Medicare Part A at Age 65?

Anne was eligible for Medicare Part A, when she turned 65. Furthermore, she did not have to pay a premium for it since her husband had paid into the system for at least 10 years. However, since she was not receiving SS benefits at 65, she was not automatically enrolled in Medicare. She needed to apply to obtain that insurance during the open enrollment period of three months before she turned 65 and three months after she turned 65.

Was Anne Eligible for Medicaid Part B at Age 65?

Anne did enroll in Part A and was informed she was eligible for Part B by paying the premium required of all enrollees. Since Anne was covered by her husband’s insurance, she believed she did not need Part B and did not opt to sign up for it at that time. She waited to enroll in Part B for herself until George dropped their private insurance, at which time he was automatically enrolled in Part A and applied for Part B for himself.

Will Anne Be Penalized for Waiting to Purchase Part B?

By failing to sign up for Part B when she turned 65, Anne was not subject to a penalty for the three years that she was covered on George’s insurance through his employment. This coverage is considered equivalent to coverage under Part B and, therefore, does not incur a penalty.

The killer for Anne is that five years between George’s retirement at 60 and his turning 65, when Anne applied for Part B, she was covered under a private insurance policy,as opposed to insurance as a result of George’s employment. Anne’s premium for Part B was increased by 10% for every year that she was eligible to obtain Part B and did not. In her case, that meant she would pay an additional 50% higher premium for Part B for the rest of her life.

Assuming Anne signed up for Medicare Part B for the first time in 2016, her premium which would have been $121.80 per month as a first time participant, was increased to $609.00 per month.

Little Understood Medicare Rule Victimizes Part B Applicants

George and Anne became victims of a little understood Medicare rule that penalizes persons in their position. They assumed that, because they would not have been able to obtain the insurance policy they purchased after George’s retirement, this insurance would qualify to avoid the penalty. However, since it was not insurance while paid for by an employer to enroll in Part B, it did not count to avoid Anne’s penalty.

What Can Applicants do to Avoid the Trap of Confusing Rules?

 One thing that led to George and Anne’s dilemma was that they relied upon telephone conversations with Social Security Administration representatives and their own reading of information on the internet. They failed to get in writing what they were told.

Although nothing is fool proof, George and Anne’s situation might have been avoided if they had taken the written communications they received from SSA to their local SSA office and discussed the issues in person with a representative. The representative could have made certain they understood all the rules and walked them through the correct procedures to follow.

The rule described in this article is not the only one that can cause confusion and penalty. In any instance in which there are questions regarding eligibility for SS and/or Medicare, the recommendation to seek an in-person audience with a SS representative applies.

The local office for Somervell County residents is in Cleburne. Most of the representatives are extremely knowledgeable, helpful and courteous. If, in the unlikely event, one does not have that experience, return at a later date and ask for a different consultant. Visitors should arrive early in the morning to minimize wait time. Ask the representative for written confirmation of the explanations given.

Sandra W. Reed is an attorney with Katten & Benson, an Elder Law firm in Fort Worth. She lives and practices in beautiful Somervell County, near Chalk Mountain.