Social Security / Medicare How To opting out etc

[LuvOrlando]

Head is spinning after a very confusing conversation that just doesn't seem right so I'm going to run it up the flagpole but it's important so help & experience is very welcome.

I am younger than normal and just started SSDI unrelated to income.
I am insured through DH's current employer.
I am trying to reject redundant coverage, before it starts in a few months. I say trying because they did not process my physical form to opt out yet so it's in some kind of limbo.
I CAN opt out of all but type A for hospital, or so it seems.

If I ever want to go back to get Medicare without penalties I need to be able to prove I was always insured, which is fine I'd never go without insurance so it seems easy enough.
Thing is this is not easy, it is not enough to be able to prove insurance with explanations of benefits or cards or even Proof of Insurance letters from carriers, it seems proof of insurance needs to happen in a very specific way.
I THINK I was just told that Medicare will only recognize that I was covered if I can provide a CM-L564 for every single employer DH ever has from now until the time I want to be covered.
So I'm thinking what if he has 10 different employers between now and I am 65 and some of them get sold or go out of business and I can't get a form filled out?
How does this work? Do I need to have every single employer fill out one of these forms every year and keep it on hand for every single year I opt out?

 

[luvmarypoppins]

No advice but following because I will probably be dealing with this as well soon for the most part.

 

[easyas123]

Two things I'm thinking..one would be to ask your rep who got you signed up for Medicare for specific clarification. Second, I'm wondering if this isn't a compliance type thing? We provide insurance for our employees BUT they are required to go directly to the source for compliance type forms & tax forms, we don't, as the employer issue them. And as an employer we don't issue this form (I double checked with my Comptroller/HR gals - * this could be different in different Companies) It may be like a tax form or other type of form you go to your husbands current insurance company for.

 

[tvguy]

I think you need expert advice, not from the DIS because you don't want to make a mistake that could haunt you for the rest of your life.
One of the biggest benefits for SSDI is the ability to get Medicare before age 65 because the coverage is so much cheaper and better. So clearly you have some circumstance that is none of my business that makes you want to stay with traditional coverage.

 

[lanejudy]

If I ever want to go back to get Medicare without penalties I need to be able to prove I was always insured, which is fine I'd never go without insurance so it seems easy enough.
Thing is this is not easy, it is not enough to be able to prove insurance with explanations of benefits or cards or even Proof of Insurance letters from carriers, it seems proof of insurance needs to happen in a very specific way.
I THINK I was just told that Medicare will only recognize that I was covered if I can provide a CM-L564 for every single employer DH ever has from now until the time I want to be covered.
So I'm thinking what if he has 10 different employers between now and I am 65 and some of them get sold or go out of business and I can't get a form filled out?
How does this work? Do I need to have every single employer fill out one of these forms every year and keep it on hand for every single year I opt out?

Your DH should have this -- it might an email from his HR/benefits office -- or he can get it by contacting that office. My company provides a notification every year around the time of our open enrollment when we sign up for the next year's benefits. It's likely called a "Medicare Creditable Coverage Notice" or something similar. KEEP THOSE EACH YEAR. That is what you need to prove that you've had what Medicare considers sufficient insurance coverage.

You are correct that it's not as simple as showing a copy of your medical card or statements because the coverage must meet certain standards. But it is a fairly easy document to obtain from his employer each year. Just keep good records with a file of all these notices from each year and you'll be fine.

 

[lanejudy]

And just to add... if the health insurance and Rx coverage you currently have through your DH's employer -- or might have in the future -- is ever NOT considered "creditable" by Medicare, you would be required to sign up for the extra coverage (which will be considered secondary). That secondary coverage may in fact help any of your out-of-pocket expenses under your DH's plan.

My DH is currently covered by my family plan through my employer and also by Medicare. We've found over the years that the extra "expense" of the Medicare coverage was at minimum a break-even with regards to the amount it saves on his medical expenses (deductible, co-insurance, out-of-network, etc.) on my family plan.

 

[LuvOrlando]

I am opting out because I am already covered with DH family plan and plus honestly, Medicare now scares me with the clawback provisions which are alarming to say the least. With regular insurance things are just covered, the end. As I read stuff it sounds like if you use Medicare they run a bar tab and once you die they literally take every last dime back from the family, using liens to take the house and all. Even if I don't work I suppose it could be taken from DH because on paper what is his is half mine. Whole thing has me spooked.

Thank you lanejudy!
DH works for a small size business that hasn't had a HR department so we don't have any of these documents other than insurance cards plus I can ask for regular proof of insurance, which we used for the kids and their colleges so I thought that was ok. The lady at Social Security today was fairly insistent that regular forms would not be enough and if I do not have what is expected at 65 the penalties would be unavoidable so I was going to print out this form and have someone at DH's job fill it out for me once a year.

I was shocked and thought I misunderstood something because there must be a million businesses in the US (restaurants/childcare/lawn) that don't have HR so you'd need to get a owner or boss to fill it out. One more new thing I now know. This is a very challenging process and there has been no good reference so far. I had an attorney help with the SSDI, you'd think they would have given me pointers but no, it's so muddy.

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.pdf

 

[easyas123]

I think you need expert advice, not from the DIS because you don't want to make a mistake that could haunt you for the rest of your life.

100% this

 

[_19disnA]

You husband should discuss this with whomever handles payroll/benefits/etc. where he works. It might not be called HR or Personnel, but SOMEONE has to handle basic things like payroll, taxes, benefits, new hires, etc. even if they do this part-time along with other tasks.

 

[tvguy]

I am opting out because I am already covered with DH family plan and plus honestly, Medicare now scares me with the clawback provisions which are alarming to say the least. With regular insurance things are just covered, the end. As I read stuff it sounds like if you use Medicare they run a bar tab and once you die they literally take every last dime back from the family, using liens to take the house and all.

Never heard of that. I've been on Medicare for 6 months now. With regular insurance there are approvals needed, deductibles to be met. With Medicare, if the Doctor orders it, no approval needed. Medicare and my supplement pay it and it's the end. Never heard of Medicare "clawing back: a penny.

 

[barkley]

Head is spinning after a very confusing conversation that just doesn't seem right so I'm going to run it up the flagpole but it's important so help & experience is very welcome.

I am younger than normal and just started SSDI unrelated to income.
I am insured through DH's current employer.
I am trying to reject redundant coverage, before it starts in a few months. I say trying because they did not process my physical form to opt out yet so it's in some kind of limbo.
I CAN opt out of all but type A for hospital, or so it seems.

If I ever want to go back to get Medicare without penalties I need to be able to prove I was always insured, which is fine I'd never go without insurance so it seems easy enough.
Thing is this is not easy, it is not enough to be able to prove insurance with explanations of benefits or cards or even Proof of Insurance letters from carriers, it seems proof of insurance needs to happen in a very specific way.
I THINK I was just told that Medicare will only recognize that I was covered if I can provide a CM-L564 for every single employer DH ever has from now until the time I want to be covered.
So I'm thinking what if he has 10 different employers between now and I am 65 and some of them get sold or go out of business and I can't get a form filled out?
How does this work? Do I need to have every single employer fill out one of these forms every year and keep it on hand for every single year I opt out?

both dh and i have been through this in the last couple of years. we used my retiree insurance for many years until it became terrible/overpriced so when we opted to go on a medicare plan we had to come up with the paperwork to avoid penalties. fortunately i'm a pack rat so for decades i saved each year's notice from my former employer that detailed what insurance i had/who it covered. i provided those and they were accepted with no issue. i believe the form you've mentioned is only used if you are going to enroll not if you wish to opt out.

honestly-i would avoid calling social security, call CMS directly in your state. i'm retired from dshs and while we had clients that were on medicare our only association with program knowledge regarding it (like social security) was that it was something some of our clients received. someone from social security may have a fleeting knowledge but medicare is such a complex program and there are some issues that are so individualized/state of residency specific- CMS has the most accurate and up to date information on (i've also found they are much easier to get through to on the phone)-

how to proceed now
what paperwork to start collecting and retaining for the future.

 

[barkley]

I am opting out because I am already covered with DH family plan and plus honestly, Medicare now scares me with the clawback provisions which are alarming to say the least

so far as i'm aware the only 'clawback' medicare has is for part d and that's a clawback from individual states, not private individuals. mediCAID which is an entirely different insurance program for low income ineligible to medicare individuals does (in some states) have estate recoupment provisions (though generally to qualify you don't have much of an estate for them to recoup from in the first place).

the only time medicare will ask for monies back is in the event they determine that someone is responsible for injuries-in the case of a car accident i was in medicare paid for everything but then recovered every penny from the other driver's insurance.

 

[lanejudy]

DH works for a small size business that hasn't had a HR department so we don't have any of these documents

Whoever handles/manages his payroll and benefits. There must be someone. And with a small employer, it may be even more important to make sure the current coverage is considered "creditable." (Most large employers have such plans, some smaller employers may not.)

With regular insurance there are approvals needed, deductibles to be met. With Medicare, if the Doctor orders it, no approval needed.

Not accurate. Deductibles and pre-authorization may be required for Medicare, similar to commercial insurance. It all depends on the plan.

i believe the form you've mentioned is only used if you are going to enroll not if you wish to opt out.

Correct, that form is required if a person enrolls in Medicare after they are first eligible. Once eligible for Medicare a person must maintain "creditable coverage" in order to opt-out -- proof may not be requested to be shown at the time of opting out, but is required from that point forward if they ever do sign-up for Medicare in the future. OP is going on SSDI which automatically qualifies for Medicare regardless of age. OP is allowed to opt-out but will need that proof for every year under separate coverage if they ever sign-up for Medicare.

Just for example say OP is 50 years old now. In 15 years OP will reach age 65 and the DH retires and they need to sign-up for Medicare. OP will need to prove "creditable coverage" for the 15 years they opted out of Medicare. ​

OP is very wise to make sure they understand what documentation will be required in the future because it's much easier to collect that each year forward rather than backtracking to get it.

 

[LuvOrlando]

You husband should discuss this with whomever handles payroll/benefits/etc. where he works. It might not be called HR or Personnel, but SOMEONE has to handle basic things like payroll, taxes, benefits, new hires, etc. even if they do this part-time along with other tasks.

There is a base in another country that did payroll and taxes, I am not a betting person but would be willing to wager that there has been zero coordination with anything as US specific as Social Security provision.

There is now a HR dept that started only last month and I asked DH to inquire on this so either they have some sort of form on hand or I am going to be sending the CMS-L564 to HR as a Happy New Year request every year. From what I understand, the penalties are a fairly large chunk which must be brutal.

 

[LuvOrlando]

both dh and i have been through this in the last couple of years. we used my retiree insurance for many years until it became terrible/overpriced so when we opted to go on a medicare plan we had to come up with the paperwork to avoid penalties. fortunately i'm a pack rat so for decades i saved each year's notice from my former employer that detailed what insurance i had/who it covered. i provided those and they were accepted with no issue. i believe the form you've mentioned is only used if you are going to enroll not if you wish to opt out.

honestly-i would avoid calling social security, call CMS directly in your state. i'm retired from dshs and while we had clients that were on medicare our only association with program knowledge regarding it (like social security) was that it was something some of our clients received. someone from social security may have a fleeting knowledge but medicare is such a complex program and there are some issues that are so individualized/state of residency specific- CMS has the most accurate and up to date information on (i've also found they are much easier to get through to on the phone)-

how to proceed now
what paperwork to start collecting and retaining for the future.

I was puzzled by the fact this form was cited too since nothing about it reads like it is intended to verify coverage at any time, except for when you are applying. However, I guess this is the only thing they have so that's what I'm going to do. Not gonna lie, a bunch of funny and not so funny skits about bureaucracy and paperwork are flashing in my head as a grave warning so I'll do whatever I am told to do until forever, what's one more screenshot I email to myself in the grand scheme of things.

I didn't start the chat with Social Security. I had called Medicare first because I saw on my social Security page that I am enrolled in A, B & C so I was completely puzzled. I don't want any and sent in the opt out form for B back in October and will now resend it and possibly do a walk in sometime in Feb to make sure things are processed, the walk in was recommended. Not sure where the opt out whet but didn't end up in the right hands I guess and apparently there is no way to get a reprint of the opt out form that was on the back of a bit of paper in the notification packet, next time I make copies before sending anything. At any rate, Medicare said they unable to intervene for an opt out as they can only do what Social Security dictates and the local office said the paperwork doesn't come to them So when I called the local Social Security office about opting out the subject of proof came up.

I really thought they would/could just pull the insurance verification info over from taxes since Affordable Care Act requires that we all carry and prove insurance anyway in that format, and it's already there and, presumably, vetted. When we did FAFSA for my kids all the information transferred over from taxes, there was a little check that would tie it all in that simplified the process and avoided reporting errors like unintentional typos. I also know that Social Security already uses tax information to verify household income or lack of income when they screen for the additional benefits that come from certain low income levels, which do not apply to my household. Why taxes wouldn't just share with Social Security too was a bit of a surprise but maybe they are working on it.

This whole process is a lot to take in, it must be terrible in the event of a sudden injury or illness, for me this is a long boil so the element of shock isn't in the mix, thankfully.

 

[LuvOrlando]

100% this

I think you need expert advice, not from the DIS because you don't want to make a mistake that could haunt you for the rest of your life.

Who is the expert though? The offices will answer direct questions but I don't know what questions to ask so I am bumbling through, I would have totally missed this important point if I didn't just randomly look up my account and notice an error and then have the time and patience to wait on hold a bunch to ask. As far as I can tell this entire process is 100% learn as you go and older people share in social groups but since I am so much younger than typical there is noone I know who has done it except maybe the pool of people on here who can make suggestions.

I used a SSDI attorney because the process was horrendous and the attorney gave absolutely no guidance.

I'm just sharing what I discover because I want to know what other people seem to know.

 

[easyas123]

I used a SSDI attorney because the process was horrendous and the attorney gave absolutely no guidance.

Sorry if I misread your initial post...came off to me as if you were asking/wondering, so I offered what little I could from my view on it as an employer- as if a employee had asked me for this info. Honestly, if your attorney gave no guidance perhaps you should seek out a different attorney?

 

[LuvOrlando]

so far as i'm aware the only 'clawback' medicare has is for part d and that's a clawback from individual states, not private individuals. mediCAID which is an entirely different insurance program for low income ineligible to medicare individuals does (in some states) have estate recoupment provisions (though generally to qualify you don't have much of an estate for them to recoup from in the first place).

the only time medicare will ask for monies back is in the event they determine that someone is responsible for injuries-in the case of a car accident i was in medicare paid for everything but then recovered every penny from the other driver's insurance.

Ohhhh, OK, the lady on the phone said something about a recovering money from a lawsuit that made no sense to me at the time so maybe this is what she meant. Still, I read about liens on homes and that freaked me out, it would be good to know what this is about

Uggh, I need to get some straight information. If anyone knows of reliable sources for explanation I would be very appreciative, maybe a state by state guide since I will be moving from one state to another, possibly more than once - who knows what my future will be.

 

[lanejudy]

OP -- be aware of the statement bolded below, taken directly from the form link you provided above:

WHAT IS THE PURPOSE OF THIS FORM?​

In order to apply for Medicare in a Special Enrollment Period, you must have or had group health plan coverage within the last 8 months through your or your spouse’s current employment. People with disabilities must have large group health plan coverage based on your, your spouse’s or a family member’s current employment.​

This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application.​

The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment.​

You've stated your husband has a small business employer. The group health plan may or may not be considered "creditable coverage" for Medicare purposes. In a nutshell, the employer's coverage must be equivalent or better than Medicare. (the link refers to Part D but there is penalty for Part B as well)

 

[LuvOrlando]

Sorry if I misread your initial post...came off to me as if you were asking/wondering, so I offered what little I could from my view on it as an employer- as if a employee had asked me for this info. Honestly, if your attorney gave no guidance perhaps you should seek out a different attorney?

No worries. The attorney seems to only help navigate to get you in, like an old school travel agent that makes the reservations and just wishes you good luck LOL