Help Toni!

I have developed a rare form of cancer that requires the use of proton therapy at MD Anderson and my problem is that our employer health insurance plan does not cover proton therapy. I will have to pay all of the costs from my 401K. Since I am over 65, I can apply for Medicare and it will pay.

I have seen articles that you write about people leaving their jobs and having to apply for Medicare. 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 Galveston, TX


You are the second person who has contacted me recently about proton therapy being excluded from their group health insurance plan and was advised to go to Medicare.

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

The process to enroll in Medicare Part A and/or B past 65 is the same whether you or your spouse are leaving your company benefits because of #1) health issues or your cancer treatment is not covered by company insurance,, or #2) you have been laid off as so many have in recent months or #3) you have decided to retire.

The procedure has to be followed correctly and the step-by-step process is listed below:

Your HR or Benefits Manager must sign the forms listed below for you and/or your spouse who are covered on company benefits since turning 65.

There are two forms that Social Security provides from the Social Security website and they are:

Request for Employment Information: At the top of the form written in red letters is Special Enrollment Period 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 you 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: is filled out by Social Security to say when Part B will begin.

Once your company signs the employment form, take both forms to your local Social Security office for your Medicare to begin.

We advise all who come to the Toni Says office for their Medicare Planning consultation to take the forms to the Social Security office and visit with a Social Security agent in person.

Always make copies of paperwork given to the Social Security office just in case the paperwork is lost.

**When leaving you and/or your spouse’s benefits or employment, there is an 8-month timeframe to keep from receiving a Part B penalty. Wait longer than 8 months and you WILL have a Medicare Part B penalty.

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

Toni King is the author of the new Medicare Survival Guide®, a simple guide that puts Medicare in “people terms” now on sale on this website. Email questions to Ask Toni. If you are still confused about your Medicare or Social Security options, call the Toni Says office at 832/519-TONI (8664).


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