This week, I answered questions from readers about Medicare coverage and the rules for repaying premium tax credits for marketplace coverage after a divorce.
Q. I have insurance through my federal employee retirement plan. Why should I pay an additional monthly premium for Medicare Part B?
A. Whether as a federal retiree you should sign up for Medicare Part B, which covers preventive care and services such as doctor visits and lab work to treat medical conditions, depends on your own preferences and priorities, said Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center, an advocacy group.
You have options. Unlike many private retiree health plans, your federal retiree plan will continue to be the primary insurer if you decide not to enroll in Medicare Part B, Schwarz said. In contrast, many private retiree plans may not provide any coverage at all if a retiree doesn’t sign up for Part B coverage, or they may only pick up the 20 percent coinsurance that’s generally charged to beneficiaries for Part B services, said Schwarz. If you decide to sign up for Medicare Part B, both private and federal retiree plans provide secondary “wraparound” coverage for services Part B doesn’t cover.
So if you’re pleased with the benefits your federal retiree plan provides and the amount of flexibility you have to make changes, you likely don’t have to sign up for Medicare Part B in order have coverage for those services. (In general, people should, however, sign up for Medicare Part A, which covers hospital benefits and typically costs beneficiaries nothing.)
The other consideration is the Part B penalty. If you don’t sign up for Medicare Part B when you’re first eligible — typically at age 65 — you’ll have to pay a late enrollment premium penalty of 10 percent for every year that you could have enrolled but didn’t. If you’re still working at age 65 and you have regular employee insurance coverage, you won’t face a penalty until your work or insurance ends.
If you’re sure that you’ll never want Part B coverage, then you can save the monthly Part B premium, typically $121.80 for people who sign up for the first time in 2016.
One thing to consider is whether your federal retiree plan provides the coverage you may need as you age, said Schwarz.
“We’ve heard from some people that the [federal retiree plans] don’t offer the same home care or skilled nursing facility benefits, that they might have higher cost sharing,” she said.
Q. I have a Medicare Advantage plan, and I decided to get a pneumococcal immunization last fall. My understanding was that it should have been free if I got it from a provider in my plan’s network. My primary care provider didn’t stock the vaccine and wouldn’t order it for me. After several calls to my insurer, an employee finally told me to get the shot at a non-network provider such as the health department and get reimbursed for the $194 cost. I did that, but now my insurer won’t reimburse me because I didn’t use the correct provider. What’s someone supposed to do in these circumstances?
A. You should appeal the insurer’s decision, said Jocelyne Watrous, who works for the Center for Medicare Advocacy.
Medicare covers two doses of the pneumoccocal vaccine, which protects against certain types of pneumonia. The shots are covered under Medicare Part B and generally given in a doctor’s office. There’s no charge for beneficiaries, according to a spokesperson for the Centers for Medicare & Medicaid Services.
Your Medicare Advantage managed care plan has to have an adequate network of providers for covered services. If you can’t find an in-network doctor to give you the shot, you should be able to go to an out-of-network provider for it, said Watrous.
“In the case where a patient absolutely cannot find an in-network provider to administer the service, then she can work with the insurer to address in-network versus out-of-network status,” said Clare Krusing, a spokesperson for America’s Health Insurance Plans, a trade group. “In this case, the patient can choose to move forward with an appeal.”
Q. If my ex-spouse and I have to repay health insurance premium tax credits to the Internal Revenue Service for a marketplace plan we had in 2014 when we were still married, can we set up separate payment plans?
A. Yes, if you’re divorced or legally separated and filing separate tax returns, you can have separate payment plans with the IRS, said Mark Luscombe, principal federal tax analyst at Wolters Kluwer Tax and Accounting, an information publisher and consultant.
Assuming you both were covered under the policy, you can decide how to divvy up how much each of you will pay. If you don’t reach an agreement, the IRS will split it 50/50, according to IRS rules.
Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.