Twenty years ago, George Zeppenfeldt-Cestero left his job as a hospital administrator in New York to open a one-person health care consulting firm.
Since he was losing his employee medical coverage, he shopped around and bought a private health insurance plan through Aetna.
It was expensive, with premiums starting at about $1,000 a month, but “it paid for all my doctors’ visits and my medications,” he said. “I was a satisfied consumer.”
But several years ago, Aetna informed him that it was discontinuing that plan, sending him scrambling for another insurer. That’s when, applying for coverage through the state marketplace under the Affordable Care Act, Mr. Zeppenfeldt-Cestero learned that he (and, he argues, Aetna) had made a serious error.
He should have signed up for Medicare Part B three years earlier when he turned 65.
By delaying, he had missed the best window — the so-called Initial Enrollment Period — to apply for Part B, which covers much of what we consider health care: doctor visits, tests, injectable drugs (including chemotherapy), ambulances, physical therapy and other non-hospital services. As a result, he has to pay permanently higher premiums, and he had to endure an unsettlingly long period — from December to July — before the coverage actually kicked in.
“It was very nerve-racking,” Mr. Zeppenfeldt-Cestero, now 71 and still working. “For six months, I was without any coverage whatsoever.”
Such Part B mistakes appear to happen with some frequency. Last year, nearly 700,000 Medicare beneficiaries were paying Part B penalties, according to the Centers for Medicare and Medicaid Services.
“It’s one of those issues that has started to snowball,” said Fred Riccardi of the nonprofit Medicare Rights Center, which annually fields 20,000 Medicare-related questions on its helpline (800-333-4114) and three million through its online tool Medicare Interactive.
To simplify a complex process, people are supposed to sign up for Part B when they turn 65, unless they are working and have coverage through an employer, or a working spouse’s employer.
Yet as people approach age 65, Mr. Riccardi pointed out, “there’s no notice that says, ‘It’s time to enroll in Medicare and if you don’t, you could have problems.’”
One factor underlying the confusion, experts say, is the decoupling of Medicare eligibility from the Social Security full retirement age. Both threshold ages used to be 65 but now, the full Social Security retirement age has passed 66 and will gradually rise to 67.
“It’s all become far more complicated than it used to be when people turned 65, got their Social Security, got their Medicare, and that was that,” said Patricia Neuman, director of the Kaiser Family Foundation Program on Medicare Policy.
Enrollment in Medicare Part A, which covers hospitalization and requires no premiums for most beneficiaries, occurs automatically at age 65 if you’re drawing Social Security retirement benefits. You have to take steps to enroll if you delay taking Social Security past age 65.
If you’re not yet receiving Social Security benefits, you also have to sign up for Part B, which this year costs $134 a month, more for individuals with incomes over $85,000 a year. The question is when to enroll.
Bear with me as I try to clear a path through the thicket, keeping in mind that I’m talking about Medicare based on age. Younger people with certain disabilities, also insurable through Medicare, contend with different rules.
You have seven months — the month in which you turn 65 and the three months both before and after it — to apply for Part B without penalty. You can apply online at https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b or at a Social Security office.