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Retiree Health Insurance for Non-U.S. Citizens: Special Considerations

Many retirees rely on Medicare to help pay for their health care costs. Traditionally, the program is available only to U.S. citizens and legal permanent residents who have paid into the system through payroll taxes throughout their working years. However, there are some special circumstances under which non-U.S. citizens who hold legal permanent resident status may be eligible to enroll in Medicare.

In these cases, the individual must present proof of his or her lawful permanent resident status to Medicare in addition to meeting the normal age or disability requirements. Individuals wishing to enroll in Part A must file an application with the Social Security Administration within 6 months of the month in which they turn age 65.

For example, an individual who worked in the coal mining industry and developed pneumoconiosis black lung disease while working as a miner is a permanent resident of the United States. He or she can use his or her permanent residency to qualify for Medicare Read the post even though he or she has not paid any Social Security payroll taxes. In this case, the worker should apply for Medicare during the special enrollment period that takes place 60 days prior to the date on which his or her spouse’s employment is expected to end, or during the annual open enrollment period.

It should be noted that an employee whose employer offers group health insurance coverage and declines to sign up for Medicare during the QLE or the open enrollment period will not be able to purchase private coverage through the Marketplace with premium subsidies. This is because he or she would have been eligible to sign up for premium Part A if he or she had enrolled during his or her lawful permanent resident qualifying event, but was unable to do so for any number of reasons beyond the person’s control.

If the worker later does become eligible for Medicare, he or she can keep his or her private health insurance and stay enrolled in Part B if he or she pays the premiums timely. To do so, he or she should fill out form CMS-40B.

In addition, the option to continue private health insurance must be documented by the employing office on either an SF 2809 or on a memo attached to the Official Personnel Folder copy of that form. The reason must be stated in the Remarks section of the SF 2809 or on the memo. This allows the carrier to reconcile its records with those of the employing office, thus preventing a mistake that might result in disenrollment. A good way to document this is for the employing office to place a stamp or seal on the form that indicates this has been done. This will prevent the employee from having to contact the carrier and explain the issue again. A failure to do so could result in the loss of Medicare benefits. This is a serious matter that requires immediate action.

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