Who is eligible for enrollment in Medicare?
Someone who is:
A U.S. citizen or legal resident for at least five consecutive years.
AND is one of the following:
Age 65 or older
Younger than 65 with a qualifying disability
Any age with a diagnosis of end-stage renal disease or ALS
When can I enroll in Medicare?
There are three periods of time that are available to enroll in Medicare. They are known as the Initial Enrollment Period, the General Enrollment Period and a Special Election Period.
Most people enroll during the initial enrollment period, or IEP for short. It is 7 months long and starts 3 months before your 65th birthday, includes your birthday month, and continues for 3 months after your birthday month. During your IEP you may enroll in Part A, Part B, or both. Or, you may choose to enroll in a Medicare Advantage plan or a prescription drug plan.
There is also a General Enrollment Period for those who missed their IEP. This period happens every year between January 1st to March 31st.
And finally, there is a Special Enrollment Period (SEP) for those who work past age 65. During your SEP, you may enroll in Part A, Part B, or both without penalty for up to 8 months after the month your health insurance coverage ends.
Keep in mind, penalties may apply if you enroll late. Make sure you know your enrollment period dates and what your options are. To learn more, check out our video on Late Enrollment Penalties.
Is Medicare enrollment automatic at age 65?
No, unless you are already receiving Social Security benefits. Many people have elected to defer Social Security benefits. In that case, to enroll in Medicare at age 65, you can enroll yourself at your local Social Security office.
When can I change my Medicare plan?
Generally, there are three time periods when you can change your Medicare plan.
The most common is known as Annual Enrollment Period which occurs from October 15th to December 7th each year. During this time, you can join, switch, or drop a Medicare Advantage Plan or prescription drug plan.
Next is the Special Enrollment Period when you can join, switch, or drop a Medicare advantage or prescription drug plan outside of the annual enrollment period. It typically lasts two months after the month of a qualifying event; such as, when you move or when you lose other creditable coverage, like an employer group health plan.
There is also the Medicare Advantage Dis-enrollment Period between January 1 and February 14th each year. During this period, you may drop a Medicare Advantage plan and return to Original Medicare, Parts A and B. And, you may also enroll in a prescription drug plan, Part D.
Finally, there is an enrollment period from January 1st to March 31st when you can switch your Medicare Advantage plan to another Medicare Advantage plan; or return to Original Medicare and enroll in a prescription drug plan.
To learn more about enrolling in Medicare, contact a Licensed Sales Agent at info@medicareissimple.com.
Retiring Past 65
Let's break down the most common questions surrounding retirement past age 65.
Do I need to be enroll in Part B if I keep my employer coverage?
In most cases, for as long as you or your spouse have employer health coverage, you can delay enrolling in Part B, which covers doctors’ visits and other outpatient services and requires a monthly premium. When your coverage ends, you'll be entitled to a special enrollment period to sign up for Medicare without incurring a late penalty.
But, there are some exceptions:
- If the employer has fewer than 20 employees, they may require you to sign up for Part B. If so, Medicare would become your primary coverage and the employer coverage would be secondary. In this case, you need to find out exactly how the employer plan will work with Medicare.
- If you are in an unmarried domestic partnership and receive health insurance under your partner’s employer plan, you don’t have the same right to delay Part B without penalty.
Will I need Part D prescription drug coverage?
If the prescription drug coverage offered by your employer plan is "creditable" — meaning it is of equal value to Part D coverage — you can delay enrollment until that coverage is no longer in effect. At that time, you'll be entitled to a special enrollment period to sign up with a Part D plan without penalty. If it's not, you would need to enroll in Part D during your initial enrollment period at age 65 to avoid late penalties.
Should I still sign up for Medicare Part A?
With one exception (see next item), there's no reason not to enroll in Part A, which mainly covers hospital stays, around the time you turn 65 because if you contributed enough Medicare payroll taxes while working there are no premiums for Part A. If you didn’t contribute enough, you may qualify for premium-free Part A on the work record of your spouse (current, divorced or deceased). Otherwise, you have the option of paying monthly premiums for Part A benefits.
Will I get the same health benefits at work as I get now?
You must be offered the same health insurance benefits as younger people working for the same employer. Your employer cannot require you to take Medicare when you turn 65.
Do I need to do anything about Part B at age 65 if I continue to be insured at work?
If you are receiving Social Security benefits, you will automatically be enrolled in Part A and Part B just before your 65th birthday. The letter sent to you with your Medicare card explains your right to opt out of Part B if you have employer insurance. To opt out, follow the instructions included in that letter within the specified deadline.
What if I have a health savings account at work?
You cannot continue to contribute to an HSA if you are enrolled in Medicare or, after age 65, you are receiving Social Security retirement or disability benefits. However, you may withdraw funds already in your account.
If your spouse provides a health savings account, you may use the HSA for your medical needs even though Medicare covers you.
What if my employer offers me COBRA benefits?
Part B and Part D have different rules for handling COBRA benefits.
For Part B, you may delay only so long as you or your spouse is actively employed. To avoid penalty, you must enroll in Part B during a special enrollment of eight months after coverage is lost.
For Part D, so long as your COBRA or retiree drug coverage is creditable, you do not need to enroll in Part D until these benefits end, at which point a special enrollment period begins.
To learn more about Medicare enrollment, contact a Licensed Sales Agent at info@medicareissimple.com.
How and when do I sign up for Original Medicare if I am disabled?
Medicare is not just for people aged 65 and older. It also covers the millions of Americans living with a disability.
You automatically get Part A and Part B after you have been on disability benefits from Social Security for 24 months. You'll get your red, white, and blue Medicare card in the mail 3 months before your 25th month of disability.
You will have to pay your Part A premium (if you owe one), deductible and co-pay; and, your Part B premium, deductible and co-pay.
Can I sign up for Part C and D?
Yes. When you decide how to get your Medicare coverage, you may choose Medicare Advantage (Part C) or Prescription Drug Coverage (Part D).
Do I have to sign up for Medicare if have coverage from an employer or spouse?
The Part B penalty clock starts on the first of the month after your Initial Enrollment Period ends. If you have coverage from a group health plan by a spouse or family member your deadline begins after employment ceases. If for some reason you incur a penalty for not having signed up for Part B, the clock resets when you turn 65 and you will no longer have to pay the penalty. See our video on Late Enrollment Penalties for more information.
I’m disabled and under 65. Can I keep my Medicare coverage if I go back to work?
Yes. You can keep your Medicare coverage for as long as you’re medically disabled. Contact us to determine your eligibility.
If you can't afford the Part A premium, you may be able to get help from your state. You may be eligible for the Medicare Savings Program called Qualified Disabled and Working Individuals Program (QDWI).
Contact a Licensed Sales Agent at info@medicareisimple.com for more information on enrolling in Medicare.
What if I missed my Initial Enrollment Period?
A General Enrollment Period (GEP) for those who missed their Initial Enrollment Period (IEP) happens every year between January 1st to March 31st.
There is a Special Enrollment Period (SEP) for those who work past age 65. During your SEP, you may enroll in Part A, Part B, or both without penalty for up to 8 months after the month your health insurance coverage ends.
Keep in mind, penalties may apply if you enroll late. Make sure you know your enrollment period dates and what your options are. To learn more, check out our video on Late Enrollment Penalties.
To learn more about Medicare enrollment, contact a Licensed Sales Agent at info@medicareissimple.com.
Late Enrollment Penalties
To protect our retired citizens from the rising costs of health care as they age, the government created Medicare. They added premiums, deductibles, and co-pays to help pay for those costs. Eligible recipients who fail to provide evidence of creditable group health coverage, or coverage equal to that received by Original Medicare, will pay a penalty if they fail to sign up for Part B.
Here are some common questions regarding late enrollment penalties.
How does the Part B late penalty work?
If you don't sign up for Part B or have creditable coverage from a group health plan when you're first eligible, you'll have to pay a late enrollment penalty.
The penalty clock starts ticking at the beginning of the month after your seven-month initial enrollment period (IEP) expires and shuts off on the final day of the annual general enrollment period (GEP from January - March) in which you sign up for Part B (or March 31).
Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B but didn't sign up for it. You'll have to pay this penalty for as long as you have Part B.
Once you've missed your first deadline for joining Part B, you will have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Coverage will start on July 1 of that year.
What if I sign up inside 12-months from when my initial enrollment period ended?
So long as you have obtained coverage before the 12-month period from March 31st has ended you will not owe a penalty. Here are two examples:
If your initial enrollment period ends on the last day of May 2022 and you obtain coverage on January 1st, 2023, you will have been without coverage for 10 months (June 1, 2022 – March 31, 2023 = 10 months), you will not be penalized.
If your initial enrollment period ends on the last day of February 2022 and you obtain coverage on January 1st, 2023, you will have been without coverage for 13 months (March 1, 2022 – March 31, 2023 = 13 months). You will have a 10% monthly penalty added to your Part B premium for the rest of the time you are on Medicare Part B.
Is there a penalty if I keep group health coverage from my employer?
Not necessarily, as long the coverage is equal in benefit to Original Medicare.
There is a special enrollment period to sign up for Part B without penalty once you lose this coverage.
What if I have private insurance?
Medicare does not consider individual health coverage as creditable coverage. If you do not obtain Part B coverage 12-months from your IEP a penalty will apply.
Do these rules apply if I am eligible for Medicare due to disability?
Yes. The Part B penalty clock starts on the first of the month after your Initial Enrollment Period ends. If you have coverage from a group health plan by a spouse or family member your deadline begins after employment ceases. If for some reason you incur a penalty for not having signed up for Part B, the clock resets when you turn 65 and you will no longer have to pay the penalty.
What if am living abroad when I turn 65?
The penalty clock starts ticking at the end of your IEP if you live outside the United States after you turn 65, and you or your spouse are not working. If you are working and have group health coverage, then same rules apply for when you lose this coverage. If covered by the national public health system of the country where you live, you will have an SEP upon your return to the US.
To learn more about late enrollment penalties, contact a Licensed Sales Agent at info@medicareissimple.com.
Address
6200 Stone Hill Farms
Flower Mound, TX 75028
Hours of Operation
Mon-Fri 8:30 am - 5pm CST; Evenings and Weekends by appointment