What Medicare Coverage does one need
to get if they are still working?
Is there a SEP Special Enrollment Period for Part B, MAPD Medicare Advantage and Medi-Gap when you lose Group Coverage?
Part D Rx?
Since you have coverage through work, you can probably postpone enrolling in Part B – Doctor Visits and Part D Rx.
Learn More ===>
- Medicare.gov – should I get part B?
- Publication 11036 Enrolling in Parts A & B and
- Medicare & You #10050
- Can you postpone Part A enrollment if you are covered under a Employer Group Plan?
- Early Retirement – What Health Insurance?
- Transitioning from Employer Group Coverage to Medicare
the horses mouth on if you should get Part B Doctor Visits, how to enroll, COBRA Traps, etc.
When you retire, lose your employer coverage you may then enroll in Part B Doctor visits, you will also have a special enrollment period to get Part D Rx and enroll in a Medi Gap Plan and Medicare Advantage.
So, basically, as long as you have great coverage at work, just sign up for Part A Hospital and then get Part B, supplements and Part D Rx when you retire. There might be issues if your wife wants to sign up late for Part B, as there are technical rules about it being employee coverage not COBRA, which could affect you too if you go on COBRA.
See Medicare & You Page 26 – Part B Special Enrollment Period.
Video Introduction to Medi Gap
Anthem Medicare Supplement - Get Quotes, Information and ONLINE Enrollment - No extra charge for our help
If I have Employer Group Health Coverage
do I need to enroll in Parts A Hospital & B Doctor Visits?
You should sign up for Part A and Part B when you’re first eligible. Medicare will be primary and pays before your other coverage.
If you don’t enroll in Part B 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.
20 or more employees.
Ask your benefits manager whether you have group health plan coverage (as defined by the IRS). People with group health coverage based on current employment may be able to delay Part A and Part B and won’t have to pay a lifetime late enrollment penalty if they enroll later.
How you delay your coverage depends on your situation:
- If you’ll be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you’ll automatically get Part A and Part B. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday. If you don’t want Part B, follow the instructions that came with the card. If you keep the card, you keep Part B and will pay Part B premiums.
- If you won’t be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you don’t need to do anything when you turn 65.
Here’s the form to fill out L 564 E to get a special enrollment period, when you retire.
Kaiser Information & FAQ’s
Transition Employer Plans to Medicare
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 (but no earlier than the first month you are eligible 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.
Premium-free Part A coverage:
- Begins 6 months back from the date you apply for Medicare (or Social Security/RRB benefits). To avoid a tax penalty, you should stop contributing to your Health Savings Account (HSA) at least 6 months before you apply for Medicare.
- Begins no earlier than the first month you were eligible for Medicare.
If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up.
- You or your spouse (or family member if you’re disabled) is working.
- You’re covered by a group health plan through the employer or union based on that work.
You also have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
- The month after the employment ends
- The month after group health plan insurance based on current employment ends
Usually, you don’t pay a late enrollment penalty if you sign up during a SEP.
COBRA and retiree health plans aren’t considered coverage based on current employment. You’re not eligible for a Special Enrollment Period when that coverage ends. This Special Enrollment Period also doesn’t apply to people who are eligible for Medicare based on having End-Stage Renal Disease (ESRD).
If you have a Health Savings Account (HSA) with a High Deductible Health Plan (HDHP) based on your or your spouse’s current employment, you may be eligible for an SEP. To avoid a tax penalty, you should stop contributing to your HSA at least 6 months before you apply for Medicare. You can withdraw money from your HSA after you enroll in Medicare to help pay for medical expenses (like deductibles, premiums, coinsurance or copayments).
I’ve retired early, I’m not 65 yet
What do I do for Health – Medical Insurance?
Get a complementary quote, benefits, rates & subsidy calculation for California here.
If you are 62+ and getting Social Security some of your Social Security is taxable and counts towards MAGI income for subsidies.
If you are disabled, you get Medicare after two years of SSDI.
If you can really live on a budget or are unfortunately forced to, there is Medi-Cal if you are under 138% of Federal Poverty Level. We don’t get paid to help you with that, so just contact Medi-Cal directly.
Check out the Retirement Section of our website.
Should I get Parts A & B?
Most people should enroll in Medicare Part A (Hospital Insurance) when they're first eligible, but certain people may choose to delay Medicare Part B (Medical Insurance). In most cases,
it depends on the type of health coverage you may have.
- You must pay your Part B premium every month for as long as you have Part B (even if you don’t use it).
- I'm currently working, and I have coverage through my job.
- I have coverage through my spouse who is currently working.
- I have retiree coverage (from my former employer or my spouse’s former employer) or COBRA coverage.
- I have TRICARE, and I'm a retired service member.
- I have TRICARE, and I'm an active-duty service member.
- I have CHAMPVA.
- I have End-Stage Renal Disease (ESRD).
- I have Marketplace Covered CA or other private insurance.
- I don't have any of these.
Medicare and You 2020 #10050
Everything you want to know - Read Along