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Why Some People End Up with Medicare Part B Penalties

by: Margie Johnson Ware, Aging and Health Specialist

The call came from Alice, an old college friend who knew I worked as a Medicare adviser. “Can you help my husband,” she began. “I left it up to him to get his Medicare organized. Now I’m not so sure that was a good idea …”

Alice and James are typical of many couples. Both have demanding professional and social lives and very little time for Medicare research. Alice is under 65 and still working. James is over 65, retired, and covered by retiree insurance. But he hadn’t enrolled in Medicare Part B during the seven months of his Initial Enrollment Period, thinking he wouldn’t need it. While Medicare Part A is free for most people, Part B typically carries a premium, and James had wanted to avoid paying it if he didn’t need to.

Now he has some pretty serious health issues, but no real way to pay for them. Like James, many individuals on retiree health insurance mistakenly believe that their retiree plan is all they need, or they miss their Initial Enrollment Period because they think that they can enroll in Part B any time they want. Others are worried about their finances and don’t think they can afford Part B. If this applies to you, you can learn more about getting cost assistance with Part B using the Getting Help with Costs guide.

There are five main types of Medicare plans, some of which are optional and some of which are mandatory. Although there are some exceptions, many beneficiaries need to enroll in both Part A (covers hospital services, typically free) and Part B (covers doctor visits, typically costs money). The other three plan types are optional (Medicare Advantage/Part C, Part D, and Medigap). If you neglect to enroll in Part A and B on time, you may have to pay late penalties.

Beneficiaries who can wait to get Part B with no penalty:

Individuals who are still covered by their employer insurance based on employment (not retired), or their spouse’s employer insurance (the employer needs to have 20 or more employees to qualify for this exemption). These individuals will still need to enroll in Part B eventually, during a Special Enrollment Period, when they retire and lose their employer coverage. Learn more about delaying enrollment in Part B through our 65 and Still Working guide.

Disabled individuals covered by their spouse’s employer coverage when the employer has 100 or more employees. These individuals need to enroll in Part B if they lose employer coverage and must do so during the Special Enrollment Period.

Beneficiaries who don’t have to get Part B, but will pay a penalty for joining late:

Veterans who have decided to only use the Veteran’s Affairs (VA) health system and Federal employees who opt to use their Federal Retiree Health Insurance instead of Medicare.

Beneficiaries who DO need to enroll in Part B (but mistakenly avoided it):

  • Those with retiree coverage

  • People with small employer group coverage (company is 20 employees or smaller)

  • People with Tricare who are turning 65

Unless you meet certain requirements, you will need to enroll in both Part A and Part B during your seven-month Initial Enrollment Period.

Considerations for enrolling in Medicare Part B

Enroll as soon as possible as there will be late penalties if the Initial Enrollment Period has passed. A five-year delay subjects may result in a penalty of more than $50 per month, the delay in enrolling should be as short as possible. The Medicare General Enrollment Period for adding Part B is January 1 to March 31 each year with coverage starting July 1. Learn more about the General Enrollment Period.

You may be eligible to have your Part B premium paid for by your state, which can help with the costs from enrolling late. If your individual monthly income is $1,456 or less ($1,960 for a married couple), you may qualify for the Part B premium paid by a Medicare Savings Program. Although the state will look at your bank balances and investments, the value of your house and car are not included. Contact your local State Health Insurance Counselor (SHIP) for additional advice.

Related Content

Original Medicare (Part A & Part B) Explained
Original Medicare, or Medicare Part A & Part B is sometimes called “Traditional Medicare” or “fee for service” Medicare.
Original Medicare (Parts A & B) Costs
For most people, there is no premium for Medicare Part A, but there are out-of-pocket cost for Medicare Part B including premiums, deductibles, and coinsurance
Medicare Savings Programs (MSPs)
Medicare Savings Programs (MSPs) help cover Medicare premiums. To qualify participants need to meet certain income and resource levels and have Medicare Part A.