Turning 65 is typically the trigger to enroll in Medicare. But members of a few groups, including veterans and workers with employer plans, have other options.

In this week’s “Ask Phil” column, Phil Moeller, the author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs and the co-author of the updated edition of The New York Times bestseller How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security, addresses those special cases, plus explains Medicare Supplement plan price variations.

Got a question of your own about Medicare or Social Security? Send it to  askphil@considerable.com.

Do veterans need to sign up for Medicare?

Question: As a veteran with medical benefits, do I have to sign up for any kind of Medicare?

Phil Moeller: If you are satisfied with your health care, you do not need to enroll in Medicare when you turn 65, or at any other age. However, this means that you generally will be limited to getting your care at Veterans Administration (VA) facilities and from the doctors who practice there.

The widely-publicized problems with the VA health system—most notably lengthy wait times to see a doctor—has forced the agency to offer care at non-VA facilities. But I have not seen any good information to date on how successful this change has been is meeting veterans’ needs. 

A warning: If you decide at age 65 to forego Medicare and later change your mind, you may have to pay late-enrollment penalties, and they are steep if there has been a large time gap between your eligibility and enrollment dates. 

For example, the penalty for not signing up for Medicare Part B is 10% for every 12-month period during which you were eligible for Part B but not signed up.

Why do I see such a wide price range for Medicare Supplement policies?

Question: Why do Medicare Supplement premiums for the same plans vary so much between companies? Some, like Plan G and Plan F,  have as much as a $100 difference.

Phil Moeller: Medigap plans are regulated at the state level, and insurance companies have substantial leeway to charge different prices. While there may be slight differences in, for example, the G plans sold by different insurers in the same state, the policies are largely identical.

If consumers shopped carefully for their Medigap plans, these price variations would large decline. But many consumers don’t look closely at Medigap prices, and some insurance brokers who sell Medigap plans are attracted to higher-priced plans because the policies pay them higher commissions.

Do I need Medicare if I’m on my husband’s workplace plan?

Question: We currently have insurance through my husband’s employer. What happens when I am eligible for Medicare?

Phil Moeller: If your husband’s plan covers more than 20 employees, it must continue offering you health coverage so long as he is an active employee.

Workers and spouses in small-employer plans generally must get Medicare at age 65, at which time it becomes their primary health insurance and the employer plan becomes their secondary, or supplemental, insurer.

While you may not have to get Medicare, I urge you to consider it anyway. Employer health coverage is not what it used to be.

Some high-deductible plans require you to spend thousands out-of-pocket before the plan’s coverage kicks in. Medicare can help pay those deductibles and may be a better deal, either in place of employer coverage or in addition to it.

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