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Tuesday, 19 June 2012

GAY AND GRAY: Applying for Medicare While Gay

JanAdams75x75Gay and Gray is a monthly column at Time Goes By written by Jan Adams (bio) in which she thinks out loud for us on issues of aging lesbians and gay men. Jan also writes on many topics at her own blog, Happening-Here, and you will find her past Gay and Gray columns here.]


This is the tale of how I enrolled in Medicare while lying to the government. They made me do it. Really. Here's the story:

One of the nicer byproducts of our becoming an internet society is that when you reach three months before your 65th birthday, you can fill out an online form to sign up for Medicare. No making an appointment at the Social Security office, no finding postage stamps. Just sit down at the computer and fill out a simple form.

The Social Security Administration even knows how to welcome my age group. The page leads with the headline. Boldly Go Online To Apply For Medicare and includes a video starring Patty Duke and George Takei in Star Trek uniforms.

So I tackled the form. And the process really is easy. Just five screens to fill out asking simple stuff like Name, Date of Birth, SS number, citizenship, enrolling in Medicare Part B only? (yes, I'm still working), etc.

Until I got to Group Health Plan Information. That's where it gets tricky.

Fortunately, I'd done my homework and knew the right answer. The right answer - the only answer I'm allowed to make - is "No."

Considering that I've been enrolled on my domestic partner's excellent group health plan for years, this is counterintuitive. I mean, who do they think has been paying for the dermatologist who removes my benign skin cancers and for my occasional pneumonia meds?

You see, under the Defense of Marriage Act (DOMA), the Social Security Administration is not allowed to recognize that I belong to a group health plan because they are not allowed to recognize that I am in a spousal relationship. And that matters: if I entered what a married heterosexual would in answer to this question, I'd end up paying extra for Medicare for the rest of my life.

Here's how Gay and Lesbian Legal Defenders, a New England rights advocacy organization, explains the sort of situation in which I find myself:

”When you turn 65 you must enroll in Medicare Part B or face a 10% lifetime penalty for every year you fail to enroll. So if you wait until age 70, you will be paying an additional 50% premium in addition to the regular Part B premium for the rest of your life. However, Medicare does allow two exceptions to this rule.

“First, if you are still working and are covered by either your employer’s or union’s group health plan, you can opt to enroll in Medicare Part B anytime while you are still working or during the 8 months after either your employer’s insurance or your employment ends WITHOUT incurring any penalty.

“There is a second exception that involves being on a spouse’s health plan, but because of the discrimination that same-sex married couples face because of the Defense of Marriage Act (DOMA), this benefit will not apply to same-sex married couples until either GLAD wins one of its lawsuits against DOMA (more information on GLAD’s cases here) or Congress repeals DOMA.”

So the only right answer to the "Covered under a Group Health Plan?" question on the Social Security form is "No."

I found this upsetting - so upsetting that I got on the phone and worked my way through a series of automated choices until I managed to reach a person. She actually was nice enough, willing to be helpful.

After explaining my situation and existing coverage, I asked: "Am I really supposed to lie on your form?" She said I must enter "No," even though the true answer is "Yes."

So I did just that. This made me nervous - we've all heard horror stories about insurance companies denying claims because of minor discrepancies on applications. Could I get in trouble for entering something that was manifestly untrue?

Besides, I believe in Medicare. I'm ready to lobby and struggle to keep it for all of us. I don't want to start my relationship with this vital program by telling an untruth. So I didn't completely restrain myself.

The last screen of Social Security's online form has a section for "remarks." Here's what I wrote:

”I have entered incorrect information under the previous screen because I HAVE BEEN covered under my partner's group health plan, but because my coverage is as a domestic partner, not a "married" spouse, the SS Administration apparently cannot recognize my existing coverage.

“This required me to enter information that is factually incorrect - after all, my partner's group health plan has been paying my health bills…But I was so instructed by your agent.”

Apparently this didn't have any effect on my paperwork. Does anyone even read “remarks" I wonder? Yesterday, a letter announcing that I am eligible turned up in the mail.

Look out Mitt! Look out Barack! You've got another elder chafing to hold your feet to the fire to preserve our Medicare.


At The Elder Storytelling Place today, Mary B Summerlin: Ordinary Day


Posted by Ronni Bennett at 05:30 AM | Permalink | Email this post

Comments

Ronni still calls me a "monthly columnist" but that frequency is currently a fiction. These days -- through November -- I'm employed working to pass an initiative to replace the death penalty in California with life in prison without parole. After the election, I hope to resume more active contributions on our subject here!

Thanks, Jan. It's good to know that lying to the government (aka "us") makes someone uncomfortable. But, hey, doesn't everyone lie on their tax returns? It's a national passtime, so take some comfort that you are not alone. Seriously, I sincerely hope that this unfair situation with Medicare and the circumstances that spawn it, will end soon.

Jan,

What an excellent post! I have never even considered this scenario, and would love to talk about this issue on my Medicare blog. May I share your story with my readers (in my own words, of course)?

Once again I am bowled over by the inhumanity of DOMA. Tnanks for writing about your undemocratic situation here and let's hope it ends soon.

As an insurance agent dealing with Medicare every day, I see some issues with your statements. (I am also getting my health insurance through my partner.)

When you are turning 65, it doesn't matter if you have been covered by a group health insurance plan - or if you haven't had health insurance for the last 20 years. You get your Medicare no matter what your health or your past insurance coverage. The question about group health coverage is just a survey question.

Additionally, you don't pay more or less for Medicare if you are married or not.

HOWEVER, if a person in a same-sex relationship is a stay-at-home mom or dad, that could be a problem. That's because a person must work at least ten years and pay Medicare taxes to qualify for Medicare - unless that person has been married. A wife or husband who never works outside the home will get Medicare through her or his spouse.

NOT TAKING MEDICARE PART B at 65: I am looking right now at the form a person fills out to apply for Part B when they have had employer group coverage beyond their 65th birthday. This form is filled out and signed by the employer stating that the person had group coverage and did not need Medicare Part B. This form allows a person to get his/her Part B without penalty or delay.

The form refers to "employee" and "claimant", but does not mention "spouse". And yet, a spouse can remain on her husband's employer plan beyond age 65 and uses this form to apply for Part B. So I think it doesn't really matter whether or not a person is "married" - they just need to prove they had employer group health coverage.

DOMA stinks (thanks a lot, Bill Clinton!, but I don't think it affects a person in terms of Medicare - unless a person was a stay at home mom or dad and did not work 40 quarters/10 years to earn Medicare on their own.

One more thing: In looking again at your post, I see that you are about to turn 65 and have been covered by your partner's employer health plan. You answered "no" to the question about being covered because you feared Medicare would reject you if you have employer coverage. This never happens. Anyone can decide to take Medicare when they turn 65 - even if they have an employer plan available to them.

I tell people to compare the cost of Medicare to their employer plan. So many working people have lousy employer health insurance with high deductibles and high premiums, even when shared with the employer.

Medicare is usually a better deal for people who work for small or medium-size companies. If a person works for a company with fewer than 20 employees, they must take Medicare. But if they work for a larger employer, they have a choice to keep the employer plan or enroll in Medicare.

Medicare is confusing, and government forms don't make it any easier to understand the process - but in your case, turning 65 and enrolling in Medicare, it doesn't matter if you have had employer coverage or not.

Thanks so much for this Jan.

Denise -- I didn't "fear" that Medicare would penalize me if I said I didn't need Part B because I was covered under my partner's (large) group coverage. I knew it.

Medicare advisers, the law firm referenced in the post, and at least one of my friends has had this experience. And the Medicare employee with whom I spoke agreed -- I would have been subject to penalty if I had told the truth. So I told the lie they insisted I must tell.

So much of what a person encounters when trying to understand and sign up for Medicare is hard to understand or downright absurd! It's no wonder so many people go with the basic Advantage plans (which offer no advantages). The path of least resistance is easiest for this vital but dreadful maze of coverages. I don't lie on my tax return and I don't want to lie elsewhere, so I appreciate Jan's predicament.

"Anyone can decide to take Medicare when they turn 65 - even if they have an employer plan available to them."

If my own experience is any indicator, upon turning age 65, an employer's insurance provider insists that Medicare be the primary insurance provider, no matter what anyone else wants.

Okay, I get the picture now.

You had to take Medicare when you turned 65 because your partner's employer coverage would not be recognized after you turned 65 - because the feds don't recognize your marriage.

Sorry, my reading comprehension isn't what it used to be.

Why wouldn't you take Part A?

There is no penalty unless you don't take Medicare Part B when eligible and you aren't covered under applicable employee group coverage, so as the agent said, answering one way or the other should not have affected you UNLESS you were only taking Part A and refusing Part B.

To the person who said employers require Medicare enrollment when eligible, depending on the size of the employer that may not be right. I'd check with Social Security - but like the agent above said, many times Medicare and a supplement are much better and cheaper coverage than some of the employer group plans out there.

My health insurance company mandated I apply for Medicare when i turned 65 because it then becomes a supplement to Medicare.

The answer to the following question might be in the post, or comments, but I didn't see it.

I have had health insurance with BC/BS for 40+ years. When I retired at age 60 I continued to pay the premiums. When I turned 65 this year I signed up for Medicare Part A (because I had to) and I also signed up for Part B. But I've never been sure that I need Part B, and it's expensive. Since I still pay my BC/BS premiums, isn't Part A (my primary insurance) all I need? I'd like to drop Part B.

I can see one issue with the employer group insurance - it has nothing to do with a late enrollment penalty - if you answer yes and it's based on active employment and the employer has more than 20 employees, then Medicare pays second when a person has both the employer insurance and Medicare. That might be where the legal issue comes in - a employer policy that is not an employer policy. So answering yes could mean Medicare wouldn't pay unless the group policy paid first.

There are SHIP (State health insurance assistance program) counselors in every state, and they can help with these Medicare issues. (Such as an explanation of Part A - which covers hospital and skilled nursing home - and Part B - which is doctor and therapy and lab charges and secondary coverage by retiree policy or a Medicare Supplement.)

I was forced to take Medicare "A" and "B", too, when I became 65 and my previous primary ins. through my husband's work (though I was still working but didn't take my employer's ins. plans) became my supplementary insurance plan. Think this is probably what many of us experience.

The whole gay, married vs not wed, conflicting erratic laws in this nation must be absolutely maddening to try to navigate. What a conundrum, Jan! Can understand your concern about trying to do the right thing and all the legal complications.

I think of the time and energy we all devote to dealing with getting health care in thus nation and how wonderful it would be to not have to cope with all that business.

If a person is self-employed he/she has an individual insurance policy. If a person retired before 65 they would get an individual health insurance policy (unless they are lucky enough to have access to their former employer's insurance). These people must use Medicare as their primary insurance when the turn 65.

If a person works for a company with fewer than 20 employees, they must use Medicare as their primary insurance when they turn 65.

Using employer insurance as a supplement to Medicare might be more expensive than getting a true Medicare supplement and Part D plan. Compare the costs and coverage to be sure you're not paying too much by keeping your employer coverage as a supplement to Medicare.

In Jan's case, it sounds like her partner works for a big company with good health insurance. The cost for this coverage might be less than paying for Medicare plus a supplement plus a Part D plan. But Jan is not allowed to stay on her partner's employer health plan because she is not considered married by the federal government. (Well, she can stay on it, but would be penalized for not enrolling in Medicare at age 65.)

So Jan doesn't have the option provided to people whose marriage is recognized by the federal government. She is required to move over the Medicare when she turns 65, even if it will be more expensive than staying on her partner's employer plan.

"Q" above in error is Joared.

There is lots of helpful info in the discussion above, but I'm still confused! I called Social Security to enroll in part A only because I'm retiring and it seemed the best option to go on my partner's plan. When I told the person on the phone that, more questions and long pauses ensued. Eventually, after checking, she told me I could not opt out of part B without penalties because my partner and I are NOT the same sex, just not married. She said if we WERE the same sex, the domestic partnership would be recognized, but since we are not, I can't say I'm covered by his insurance, even if I am. If I don't want my insurance costs to rise 10% each year becaue I'm not using B, I have to enroll.
Yes, I'm well aware we could marry if we want to, but why should the feds feel they must coerce us? Not going to work, but now I need to revisit how I can make my economy work with my chronic health issues adequately covered.

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