When should I enroll in Medicare?

This is the number one question we get all the time from people under 65. This is going to depend on several factors, for example;

• • Are you still going to be working to qualify for health insurance?
  • Are you taking social security earlier than 65?
  • Does your employer have over 20 employees?
  • Are you going to join COBRA coverage when you leave your employer coverage?
  • Do you or your employer currently fund an Health Savings Account (HSA)?

Let’s tackle these one at a time, let’s first discuss your Initial Enrollment Period (IEP):

Initial Enrollment Period (IEP)

• • 7-month window that begins 3 months before your 65th birthday month, includes the month of your 65th birthday, and ends 3 months after your 65th birthday month.
  • Enroll through your local Social Security office (if receiving Social Security before age 65, enrollment in Parts A & B is automatic)
  • Parts A & B can begin as soon as the first day of the month you turn 65.
  • Can enroll in Original Medicare (Parts A & B) and prescription drug plan (Part D), or you can enroll in a Medicare Advantage plan (includes both medical and drug).

During this time we would recommend talking with your employer or benefit administrator about your current coverage and how it affects you turning 65. Sometimes your benefits through your employer might be better than joining Medicare, however, it would be wise to compare all options available by talking with us.

To highlight the point above, if you are receiving Social Security before you turn 65 then they will automatically sign you up for Medicare. You may even receive a physical Medicare card in the mail before your birth month. If you plan on keeping your employer coverage there are instructions on how to send your Medicare card back to Social Security and letting them know that you are going to continue coverage through your employer.

Parts A and B can begin as soon as the first day of the month you turn 65, however, it may not start before your birth month unless under certain conditions. These conditions would be if you have been receiving Social Security Disability Income (SSDI) for a full 24 months or if you have End Stage Renal Disease (ESRD) or if you have been diagnosed with Lou Gehrig’s disease (ALS).

What can I do during my Initial Enrollment Period (IEP)

• • Sign up for Medicare Advantage with or without drug coverage (MA) or (MAPD)
  • Stay on Original Medicare and add a Prescription Drug Plan (Part D)
  • Stay on Original Medicare and add a Medicare Supplement Plan (Medigap) and Prescription Drug Plan (Part D)

Are you going to continue working past 65?

My employer has fewer than 20 employees:

You should sign up for Part A and Part B when you’re first eligible. In this case, Medicare pays before your other coverage. Learn more about how to get Parts A and B. If you don’t enroll when you’re first eligible, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.

My employer has more than 20 employees:

Ask your benefits manager whether you have group health plan coverage (as defined by the IRS). If you have group health coverage based on current employment, you may be able to delay Part A and Part B and won’t have to pay a lifetime late enrollment penalty if you enroll later. If you want to delay both Part A and Part B coverage, you don’t need to do anything when you turn 65.

If you’re eligible for premium-free Part A, you can enroll in Part A at any time after you’re first eligible for Medicare. Your Part A coverage will go back (retroactively) 6 months from when you sign up for Medicare or Social Security/RRB benefits (but no earlier than the first month you’re eligible for Medicare). To avoid a tax penalty, you should stop contributing to your Health Savings Account (HSA) at least 6 months before you apply for Medicare.

If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, you may have to pay a penalty.

What happens when my employment or employer/union coverage ends?

Once your employment (or your employer/union coverage) ends, 3 things happen:

You may be able to get COBRA coverage, which continues your health insurance through the employer’s plan (in most cases for only 18 months) and probably at a higher cost to you. However, if you’re eligible for Medicare, you don’t qualify for COBRA coverage without having to pay a premium.

You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA. To sign up for Part B while you’re employed or during the 8 months after employment ends, complete an Application for Enrollment in Part B (CMS-40B) and a Request for Employment Information (CMS-L564). If you choose COBRA, don’t wait until your COBRA ends to enroll in Part B. If you don’t enroll in Part B during the 8 months after the employment ends:

• • You may have to pay a penalty for as long as you have Part B.
  • You won’t be able to enroll until January 1–March 31, and you’ll have to wait until July 1 of that year before your coverage begins. This may cause a gap in health care coverage.

If you already have COBRA coverage when you enroll in Medicare, your COBRA will probably end. If you become eligible for COBRA coverage after you’re already enrolled in Medicare, you must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have End-Stage Renal Disease (ESRD)). Learn more about how Medicare works with other insurance.

If you leave coverage from your employer or union (including COBRA coverage), you can join a Medicare Advantage Plan or Medicare drug plan. Your chance to join lasts for 2 full months after the month your coverage ends.

I’m 65 (or older) and didn’t sign up for Medicare Part A and/or Part B when I was first eligible.

If you didn’t sign up for Part A and/or Part B when you were first eligible and you aren’t eligible for a Special Enrollment Period:

• • You can sign up during the General Enrollment Period between January 1 – March 31 each year.
  • You must pay premiums for Part A and/or Part B. Your coverage will start July 1.
  • You may have to pay a higher premium for late enrollment in Part A and/or a higher premium for late enrollment in Part B.

To sign up for Part B, complete an Application for Enrollment in Part B (CMS-40B).

If you aren’t automatically enrolled in premium-free Part A (for example, because you’re still working and not yet getting Social Security or Railroad Retirement Board (RRB) benefits), you can sign up (if you’re eligible) any time after your Initial Enrollment Period (the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

• • Your coverage start date will depend on when you sign up.
  • If you have to buy Part A and/or Part B, you can only sign up during a valid enrollment period.

If you wait until the month you turn 65 (or the 3 months after you turn 65) to enroll, your Part B coverage will be delayed. This could cause a gap in your coverage.

If you need to know more about your options please contact us by clicking here or call us at the number below.