Hi Larry,
My husband and I are American citizens living abroad. My husband is receiving his social security payments, - I have not chose yet to do so. We will be both 65 years old this October 2020. Should we sign up for Medicare now? Currently we have German health insurance coverage. If and when we return to the U.S,. - we do not want to be penalized for having not signed up for medicare when we turned 65. Is there a special form to fill out so that we do not have to sign up for medicare right now since we do not need it? Please explain if possible. We will sign up if necessary, of course, and how much time left do we have to sign up if we do so (without being penalized)?
Are the premiums for medicare part a and part b high? Would it make sense to have the medicare advantage packet that covers more (my husband has cancer and off of chemotherapy now) please help if you can
thank you so much

Hi,

Medicare typically only pays for medical services provide in the U.S., so you'd likely only need to enroll if you're planning on returning to the U.S. Part A of Medicare is premium free for people who are insured for U.S. Social Security benefits. Therefore, it sounds like you and your husband can enroll in Part A at age 65 without paying any premium. Even if you don't enroll at age 65, though, you could enroll in Part A any time after reaching age 65 and your coverage would take effect up to 6 months prior to the month you enroll. So, Part A coverage shouldn't be a problem for you.

However, there's no regulation that would allow you to sign up for Part B of Medicare later than normal without being subject to premium penalties simply because you're living outside the country. If you and your husband are U.S. citizens, then your initial enrollment period (IEP) for Medicare would be the 7 month period with your month of age 65 attainment being the 4th of those months. For example, if you reach age 65 in October 2020, then your IEP would run from July 1 2020 through January 31 2021. If you don't sign up for Part B of Medicare during your IEP, then unless you qualify for a special enrollment period (SEP, you could only apply for Part B during a general enrollment period (GEP).

GEPs occur each year from January 1 through March 31. If you sign up for Part B coverage during a GEP your Part B coverage starts on July 1st of the the calendar year in which your GEP enrollment occurs, and you're subject to a 10% premium penalty for each 12 month period from the end of your IEP through the end of the GEP in which your Part B enrollment occurs. In other words, signing up in a GEP may result in a gap in your coverage and a higher Part B premium rate. The current Part B standard premium rate is $144.60, but premium amounts can be higher for individuals with taxable incomes above $85,000, and couples with taxable incomes above $170,000 (https://www.medicare.gov/your-medicare-costs/part-b-costs).

For example, say that a person signed up for Part B coverage in the 2020 GEP. If that person was eligible for the standard premium rate but they were age 70 and subject to a 50% premium penalty, their monthly Part B premium would be $216.90 (i.e. $144.60 x 1.5).

People who are covered by an employer group health plan (EGHP) that's primary to Medicare can delay signing up for Part B coverage until their EGHP ends as an active employee without being subject to premium penalties. So, if you and your husband are covered under a qualified employer plan (https://secure.ssa.gov/apps10/poms.nsf/lnx/0600805266) then you may be able to delay enrolling in Part B without suffering a penalty if you later choose to enroll. Otherwise, though, you'd likely need to either enroll during your IEP or else pay a higher premium if you enroll later.

Medicare advantage plans are plans run by private insurance companies approved by Medicare. My expertise doesn't include Medicare advantage plans or any other Medicare supplement plans, so I'm unable to give you any advice with regard to those plans.

Best, Jerry