Cancer Treatment Not Covered By Employer Health Insurance…

Help Toni!

I have developed a rare form of cancer that requires the use of proton therapy and my problem is that my employer’s health insurance does not cover proton therapy.  I must pay all the costs.

My oncologist’s office manager advised me that because I am over 65, I may want to apply for Medicare Parts A and B.  She says that Medicare will pay and provide the care I need.

I am not leaving or retiring from my job, but I need to begin my Medicare benefits as quickly as possible. Please advise me what I need to do.  David from Tulsa, OK

David:

During Medicare consultations at the Toni Says office, we are hearing of various health procedures being excluded from group health insurance plans and are covered under Original Medicare.

A healthcare professional once told me that many of the newest cancer and healthcare procedures are not readily approved by health insurance plans and that these procedures are generally approved with “Original or Traditional Medicare”.  He has to fight every day to get his patients the care they desperately need.

The process to enroll in Original Medicare Parts A and B past 65, employed and leaving company benefits is the same whether you or your spouse are:

• Having health issues like David has, since Medicare may pay for the specific procedure that employer health insurance plans are not covering, and one can apply for Medicare Parts A and B but does not retire.
• Have been laid off as so many have in recent months.
• Have decided to retire.

This procedure must be followed correctly, and the process is listed below:

1. The forms listed below must be signed by your HR or benefits manager for you and/or your spouse who is covered on company benefits since turning 65.
2. There are two forms that Social Security provides are available at the Social Security website (SSA.gov) and they are:

• Request for Employment Information (CMS L564): At the top of the form write Special Enrollment Period (Very Important) to inform the Social Security agent that is processing the form that you are signing up at the right time and may keep you from receiving a Medicare Part B penalty. This information is needed to process your and/or your spouse’s Medicare enrollment application and inform Social Security that you have had company benefits from an employer or employers.  If you have had 2 or more jobs since turning 65, then all companies have to sign a form.
• Application for Enrollment in Medicare Part B (CMS 40B): is filled out and returned to Social Security to say when Part B will begin.

3. Take both forms to your local Social Security office for your Medicare to begin and be sure to make copies of all paperwork given to the Social Security office just in case the paperwork is lost. ** Because of COVID-19 issues causing local Social Security offices to be closed with Social Security employees working from home, we have been advised to tell the public to call your local Social Security office direct for help filing your forms to apply for Medicare Part B. Most Social Security direct 800# can be located by Googling online that specific office 800# and the wait while holding is less than calling the main Social Security 800 number. **

You can see David, there are options for those who wish to enroll in Medicare that many are not aware exist.

Confused about Medicare Zoom webinars will be available each month to help America understand their Medicare options. Visit www.tonisays.com for more information.

Have a Medicare question? Call 832/519-8664 or email info@tonisays.com.