Close this search box.

Wisconsin Man Must Live With His Medicare Part B Choice

Print Article

MARCH 16, 1998 VOLUME 5, NUMBER 37

When a Social Security recipient (or someone eligible to receive Social Security) turns 65, he is automatically enrolled in Medicare’s Part A insurance coverage. That insurance covers hospital care (among other things). At the same time, the new Medicare recipient may also sign up for Medicare Part B, which covers outpatient doctor’s visits. Less than 5% of seniors decline Part B coverage, usually to avoid having to pay the monthly $43.80 premium for the option. To most, though, Part B insurance is well worth the cost.

A few Medicare participants have a different problem. A 65-year-old who elects not to retire can continue to receive both salary and benefits from his employer, delay receiving Social Security, and yet begin to receive Medicare coverage. If the employer provides medical insurance, the Part B coverage for the senior worker may be unnecessary. Such a worker could decline Part B coverage until he actually retires, and save the cost of the premiums.

If a Medicare recipient elects not to participate in Part B, he can still sign up for the coverage later. To discourage recipients from holding out until they actually need the coverage, federal rules call for an increased premium for most late participants in Part B. For those workers who did not need Part B coverage because of their employers’ medical coverage, however, the increased premiums are waived.

Complicating this entire picture is the problem of supplemental insurance coverage, commonly referred to as “Medigap.” Many Medicare participants purchase private insurance to cover the deductibles and copayments imposed by Medicare, particularly in Part B benefits. Once again, however, Medicare recipients who are still employed and covered by their employers’ health insurance programs may not need such coverage. Because these principles are complex, it frequently happens that new Medicare beneficiaries misunderstand the rules and make mistakes which later prove to be costly.

Consider, for example, John J. McGowan. Mr. McGowan lived and worked in Wisconsin. When he became eligible for Medicare in 1991, he was still working and covered by his employer’s insurance plan. He elected not to participate in Medicare Part B–a reasonable choice at the time. When he actually retired four months later, he could have immediately signed up for Part B, but he instead purchased a private Medigap policy and believed that he did not need to participate in Part B.

A year after Mr. McGowan retired, he suffered a heart attack and underwent coronary bypass surgery. For the first time, he learned that much of his care would not be covered either by Medicare or by his supplemental insurance policy. Mr. McGowan had to pay about $15,000 out of his own pocket.

Federal law permits people like Mr. McGowan to sue to retroactively enroll in Medicare Part B if they can show that the initial failure to sign up was unintentional and that it was the result of an error on the part of a federal official. Mr. McGowan brought such a lawsuit, and argued that it is always a mistake for Medicare officials to fail to advise potential recipients to sign up for Part B coverage.

The Federal Court of Appeals disagreed. In their opinion, the judges agreed that “all this ‘Part A’ and ‘Part B’ and ‘Medigap’ lingo is perplexing for a person whose medical insurance has always been provided by an employer, and who has never before had to wrestle with such choices. Still, intake workers at Social Security offices can’t deliver what would amount to short law school courses on the operation of the Medicare system and its relation to private insurance markets. The next man in line would grow a beard before being served….” Mr. McGowan was stuck with the consequences of his mistaken choice. McGowan v. Shalala, Seventh Circuit Court of Appeals, 2/5/98.

Stay up to date

Subscribe to our Newsletter to get our takes on some of the situations families, seniors, and individuals with disabilities find themselves in. These posts help guide you in the decision making process and point out helpful tips and nuances to take advantage of. Enter your email below to have our entries sent directly to your inbox!

Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

Elizabeth N.R. Friman


Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

Famous people's wills

Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.