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?

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.  Yes, we know this is very confusing and hard to explain.  If you would like to do a Zoom meeting, here’s our calendar to set it up.  

Make sure that your work employers Rx Prescription coverage is credible – that is at least as good as the Standard Part D Rx Prescription  coverage so that you don’t get a late enrollment penalty.

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.

Anthem Medicare Supplement

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?

If you didn’t enroll when you were first eligible, the size of the employer determines whether you have to pay a penalty if you enroll later.

 Fewer than 20 employees.

.

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.

Note

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.

There may also be Part A penalties  if you don’t qualify for Premium Free Part A along with having to wait (Special Enrollment Periods) !

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.

It’s illegal for an employer to offer any incentives to encourage you to take Medicare and drop the employer plan!  Coremarkins *  The Age Discrimination in Employment Act (ADEA) prohibits employers with 20 or more employees from cancelling group health coverage for current employees due to age, even when such employees become eligible for Medicare.  SHRM *

 

Additional Resources:

Centers for Medicare & Medicaid Services employer web page

Fact Sheet: Medicare decisions for someone nearing age 65

Fact Sheet: Deciding whether to enroll in Medicare Part A or Part B when you turn 65

Fact Sheet: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months

Enrollment Dates

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.

Note

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.

Part A late enrollment penalty

 

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.

Example

If you were eligible for Part A and have to pay a premium  for 2 years but didn’t sign up, you’ll have to pay the higher premium for 4 years. Usually, you don’t have to pay a penalty if you meet certain conditions that allow you to sign up for Part A during a special enrollment period.

 
 Medicare.gov I have employer Coverage
 

Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period (SEP). If you’re covered under a group health plan based on current employment, you have a SEP to sign up for Part A and/or Part B anytime as long as:

  • 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.

Note
 

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).

 

Note
 

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).

 

You may also qualify for a Special Enrollment Period for Part A and Part B if you’re a volunteer, serving in a foreign country.
 

Get an estimate of your Medicare eligibility date.

Learn how to sign up for Medicare if you have coverage through the Health Insurance Marketplace.Copied from Medicare.Gov

Links, References & Resources

See Medicare Publication 02179 for information on having dual coverage with Medicare.

official Medicare  link  to enroll in Medicare Part A Hospitalization and Part B Doctor Visits.

Kaiser Information & FAQ’s
Transition Employer Plans to Medicare

Since you have coverage through work, you can probably postpone enrolling in Part B – Doctor Visits and Part D Rx.

Learn More ===>

the horses mouth on if you should get Part B Doctor Visits, how to enroll, COBRA Traps, etc.

Medicare Eligibility & Premium Calculator Tool

Part B Late Enrollment Penalty

PBS News Hour FAQ’s Employer vs Medicare

Special, Annual & Initial Enrollment Periods 

Medicare Advantage & Rx Special Enrollment periods exceptions

Medicare Interactive - Rights to Special Enrollment

Plain English Medicare.Gov  Special Enrollment periods

PDP Part D Rx

Understanding Medicare Advantage & Rx Enrollment Periods Publication # 11219
MAPD & Rx Drug Plan Enrollment Periods

Official Details & Rules from
Medicare Managed Care Manual Chapter 2 Enrollment and Disenrollment

All Special Election Periods (SEP);

  • Special election periods constitute periods outside of the usual times when an individual may elect a plan or change his or her current plan election.

How the Medicare Advantage Application  typically asks the "Special" Enrollment Period questions:

  1. I am new to Medicare.
  2. It's Open Enrollment October 15th through December 7th
  3. I am enrolled in a Medicare Advantage plan and want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP).
  4. I recently moved outside of the service area for my current plan or I recently moved and this plan is a new option for me. I moved on (insert date) –––––––––––.
  5. I recently was released from incarceration. I was released on (insert date) –––––––––––.
  6. I recently returned to the United States after living permanently outside of the U.S. I returned to the U.S. on (insert date) –––––––––––.
  7. I recently obtained lawful presences status in the United States. I got this status on (insert date) –––––––––––.
  8. I recently had a change in my Medicaid (newly got Medicaid, had a change in level of Medicaid assistance, or lost Medicaid) on (insert date) –––––––––––.
  9. I recently had a change in my Extra Help paying for Medicare prescription drug coverage (newly got Extra Help, had a change in the level of Extra Help, or lost Extra Help) on (insert date) –––––––––––.
  10. I have both Medicare and Medicaid (or my state helps pay for my Medicare premiums) or I get Extra Help paying for my  Medicare prescription drug coverage, but I haven’t had a change.
  11. I am moving into, live in, or recently moved out of a Long-Term Care Facility (for example, a nursing home or long-term care facility). I moved/will move into/out of the facility on (insert date) –––––––––––.
  12. I recently left a PACE program on (insert date) –––––––––––.
  13. I recently involuntarily lost my creditable prescription drug coverage (coverage as good as Medicare’s). I lost my drug coverage on (insert date) –––––––––––.
  14. I am leaving employer or union coverage on (insert date) –––––––––––.
  15. I belong to a pharmacy assistance program provided by my state.
  16. My plan is ending its contract with Medicare, or Medicare is ending its contract with my plan.
  17. I was enrolled in a plan by Medicare (or my state) and I want to choose a different plan.  My enrollment in that plan started on (insert date) –––––––––––.
  18. I was enrolled in a Special Needs Plan (SNP) but I have lost the special needs qualifications required to be in the plan. I was disenrolled from the SNP on (insert date) –––––––––––.
  19. I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA). One of the other statements here applied to me, but I was unable to make my enrollment because of the natural disaster

16 comments on “Medicare need if covered by Employer Plan? Retiring?

  1. FAQ

    I’ve retired early, I’m not 65 yet

    What do I do for Health – Medical Insurance?

    There are plenty of Health Plans in the Individual Market.Get quotes here.  

    If your MAGI income is below 400% of Federal Poverty Level you may even qualify for subsidies – tax credits.

    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.

    *************

    Jacob F says:

    I retired from North Carolina State University july 2018.

    They told me that they would supplement my medicare to the same level of medical insurance I had before, but when I asked them how to enroll for that they were less than helpful.

    I have social security and they pay a monthly premium

    I don’t know whether I am enrolled or what to do to enroll or what exactly I am covered for or what to do.

    Reply
    1. Anonymous says:
      Are Medigap policies written during the 8-month Special Enrollment Period issued subject to the same terms as terms, with regard to pre-existing conditions, as those written during the Initial Enrollment Period?
      Reply
    2. Anonymous says:
      How do I show Medicare that I had qualifying employer coverage?
      Reply
          • When did you turn 65? Do you have a 1095 B or C form? That shows you had coverage, to avoid ACA/Obamacare mandate penalty.

             

            Here’s what the FEHB says:

            What Happens If I Don’t Take Part B as Soon as I’m Eligible?

            If you do not enroll in Medicare Part B during your initial enrollment period, you must wait for the general enrollment period (January 1- March 31 of each year) to enroll, and Part B coverage will begin the following July 1 of that year. If you wait 12 months or more, after first becoming eligible, your Part B premium will go up 10 percent for each 12 months that you could have had Part B but didn’t take it. You will pay the extra 10 percent for as long as you have Part B.

            If you didn’t take Part B at age 65 because you were covered under FEHB as an active employee (or you were covered under your spouse’s group health insurance plan and he/she was an active employee), you may sign up for Part B (generally without an increased premium) within 8 months from the time you or your spouse stop working or are no longer covered by the group plan. You also can sign up at any time while you are covered by the group plan. https://www.opm.gov/healthcare-insurance/healthcare/medicare/medicare-part-b-coverage/

            Reply
    3. Anonymous says:

      Thank you for responding to my question on Sept. 25th

       

      I still don’t see an answer to my question as to whether the parent must be currently working or if having group insurance as a retiree from the parent’s former employer provides the same protection to not incurring a penalty.

      This is a wonderful service you’re providing and I will be sure to refer my friends to you for their insurance needs.

      Reply
    4. Anonymous says:
      I’m disabled and covered under my Dad’s retirement plan. I just qualified for Medicare. Must I enroll in Part B or can that be postponed as I have employer coverage?
      Reply
    5. Anonymous says:
      Wow! Thanks!
      Reply
    6. Anonymous says:

      I turned 65 a few months ago, I’m still working and I’ve stayed on my employers group plan.

       

      1. If I cancel my current medical insurance, with my employer, then I guess I would need to sign up for Medicare part “B”, right?

      2. My income probably falls into the first tier so there would be a premium of $134 +/-

      3. Then I would need a Medicare Supplemental plan like my High Deductible F so another premium of $75 or so, right?

      4. Then another supplemental Prescription Plan Part D with a premium of around $40

      5. Also, my Granddaughter, whom I have legal custody of is on my group plan, so I would need to get individual coverage for her, right?

      6. I believe that was around $350 for a plan I liked.

      7. So I would end up with an estimated monthly expense of:

      Part B Medicare $134
      Plan Hi F Medi Gap $75
      Part D Rx $40

      Individual Plan for Grand daughter

      $350

      For a total of $599

      8. On Medicare Part “B” how would she pay that premium?

      A. Monthly bank withdrawal?

      Reply
  2. My wife turned 65 in April of 2019.

    She didn’t apply for Medicare at the time because she is covered under my work health plan.

    Company is Trader Joes and It’s a Blue Shield HMO.

    She now wants to enroll in Medicare and purchase a medigap plan.

    For the possible need of longer term physical therapy her doctor recommended a medigap program due to the limitations of an HMO on number of sessions allowed in a year.

    Can she enroll now and not wait for the enrollment period because she has been under an employer plan and can she do so without a a penalty for the same reason.

  3. I have a question about Medicare enrollment. I’ve been given conflicting info and need advice.

    I have insurance through my work so I am confused about enrollment in Part A.

    Can I enroll only in part A or do I have to enroll in Part B too?

    The Medicare website says I must enroll in both but I don’t need Part B. What do I do?

    Don’t want to miss out on Part A.

    • See the webpage above for your answers and citations. Please advise where exactly Medicare says you have to have both. While there are late enrollment penalties, see above for how they are waived if you have employer coverage.

      https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/should-i-get-parts-a-b

      I’m currently working, and I have coverage through my job.

      The size of the employer determines whether you may be able to delay Part A and Part B without having to pay a penalty if you enroll later.

      The 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.

      Note

      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.

      The employer has 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. 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 (but no earlier than the first month you’re 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.

      Note

      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.

      When the employment or employer/union coverage ends

      Once the 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.

      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.

Leave a Reply

Your email address will not be published.