Am I Required To Enroll In Medicare At Age 65

Can You Get Private Insurance Instead Of Medicare

If you have Medicare Part A or Part B, insurers generally arent allowed to sell you a traditional individual health insurance plan .

You can purchase individual health insurance if youve never enrolled in Medicare because you think the overall costs are too high. If youre in the unusual situation of paying for Part A premiums, you can also switch to individual health insurance.

If you develop a medical condition before turning 65 that would qualify you for Medicare, such as ESRD, you can decline to purchase Medicare.

If you decide to purchase private insurance once youre eligible for Medicare unless youre continuing the employer-sponsored insurance that qualifies you for a Special Enrollment Period then youll have to pay the costly late enrollment penalty once you do apply.

If youre nearing the age of 65, then its important you start considering your Medicare coverage.

Tricare Champva & Va Benefits With Medicare

If you have TRICARE or CHAMPVA coverage, you will need to see if you qualify for premium-free Part A. If you are eligible, you will be required to enroll in both Part A and Part B to keep TRICARE or CHAMPVA coverage. If you are not eligible, enrollment is optional, but you could face late enrollment penalties. Its best to talk with your TRICARE and CHAMPVA benefits administrator to learn more.

VA benefits alone will not qualify you to delay Medicare without penalty, so if you have VA health coverage and are still working past 65, you will need to enroll in Medicare during your Initial Enrollment Period.

When Your Coverage Starts

The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always starts on the first of the month.

If you qualify for Premium-free Part A: Your Part A coverage starts the month you turn 65.

Part B : Coverage starts based on the month you sign up:

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If I Keep My Work Insurance Do I Need To Enroll In Medicare

If you have coverage through a current employer, you are not required to enroll in Medicare Part A and B. Below are some things to keep in mind about each part of Medicare.

Part A: For most people, Part A does not charge a premium. Typically, Part A pays after your work insurance. Part A probably wont pay much of the bill, but doesnt cost anything to have. For that reason, most individuals enroll in Part A at age 65.

Part B: Everyone pays a monthly premium for Part B. Part B typically pays after your work coverage and may not pick up much of the bill. Enrolling in Part B will also start your one-time guarantee to purchase a Medicare Supplement. Once this 6-month time frame starts, it cannot be stopped. For these two reasons, most people wait until their work coverage ends to enroll in Part B.

Part D: Everyone pays a monthly premium for Part D. As long as you have other “creditable coverage,” you do not have to enroll in a Part D plan. Creditable coverage means the insurance is as good as, or better than, a standard Part D plan. Check with your HR department to verify if your policy is creditable coverage. Typically, prescription insurance through work offers better coverage than what you can get through Medicare. For this reason, most people wait until their work coverage ends to enroll in Part D.

And Still Working: Should You Enroll In Medicare

Dear Carrie,

I’m planning to continue to work past age 65, and wondering if I should stick with my employer’s health insurance or move over to Medicare. How do I decide?

A Reader

Dear Reader,

This is becoming a common question as more and more people decide to work past age 65. In fact, according to the Bureau of Labor Statistics, in 2020, 26.6 percent of people aged 65-74 remained in the workforceand those numbers are projected to continue to grow. This can be seen as a positive since it means we’re redefining aging. At the same time, though, adequate health insurance remains essential.

So it’s an important questionand the answer largely depends on the size of your employer, as well as the cost and coverage of your current plan as compared to Medicare. You’ll need to familiarize yourself with the pertinent Medicare regulations and deadlines to ensure the most seamless transitionwhether that happens at age 65 or later.

Also realize that once you file for Social Security, you’re automatically enrolled in Medicare Parts A and B when you turn 65. However, you have the option to opt out of Part B, which you may want to do if you are covered by an employer plan.

If you haven’t filed for Social Security, you can choose to enroll in just Medicare Part A or both Parts A and B . Alternatively, you can postpone enrolling until you stop working. Let’s take a look at some Medicare basics as well as some of the factors that can help you decide.

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A Late Enrollment Penalty

You’d only be subject to a Part A late enrollment penalty if you’re not eligible for premium-free Part A coverage. Most Americans don’t have to worry about this, as they have at least ten years of work history, or are/were married to someone who does. But if you’d have to pay a premium to buy Part A coverage, there’s a penalty if you delay your enrollment.

The penalty is a 10% increase in your monthly premium. In 2020, the Part A premium is $458/month for people with 0-29 quarters of work history, and $252/month for people with 30-39 quarters of work history. So those premium amounts would increase to $504/month and $277/month, respectively, if you’re subject to the late enrollment penalty.

But unlike the penalties for Part B and Part D, the penalty for late enrollment in Part A does not last forever. Instead, you’d pay it for twice as long as the amount of time you delayed your enrollment. So if you were eligible for Medicare for three years before enrolling, you’d have to pay the extra Part A premiums for six years. Keep in mind that the Part A premium changes each year , so the actual amount you’d be paying would vary for each of those six years.

What Are The Penalties For Enrolling In Medicare Late

The penalties for late Medicare enrollment show up as increased Medicare monthly premiums. If you qualify for premium-free Medicare Part A, there is no penalty for late enrollment, though you’ll have to wait until the General Enrollment Period of January to March to join.

If you need to pay for Part A and join after your initial enrollment period, you’ll pay 10% more for your monthly premium for twice as many years as you delayed enrollment. For example, if you enroll in Medicare four years late, you’ll pay the extra 10% every month for Part A for eight years.

Late enrollment in Medicare Part B can cost you more, and the penalty sticks around much longer. If you decide to enroll in Part B late, you can only do so during the General Enrollment Period and you’ll pay an extra 10% per month for every year you delayed enrolling. The penalty for late Part B enrollment is permanent — you’ll keep paying the extra premium every month for as long as you receive Medicare benefits.

For Part D, you can delay enrollment if you have existing prescription drug coverage, but penalties start accruing after 63 days without coverage. You’ll pay 1% more in monthly premiums for every month you delay enrolling in Part D.

After you join a Medicare plan, you’ll receive a notice explaining any possible penalties. If you disagree with any penalties, you can file an appeal within 60 days of the date on the notice.

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Options For Employees With Large Employer Coverage

The first, and possibly the most favored option is delaying Medicare enrollment. The reason you can do this is that your employee group plan acts as your creditable coverage. When you have , you are able to delay signing up for Medicare until you lose that creditable coverage.

There are no penalties because your employer coverage is primary, and Medicare is secondary. Many people enroll in Part A and delay Parts B and D until they retire.

However, you may not want to delay Medicare. Your answer to the fourth and final question will help you determine whether you want to enroll in Medicare and let it coordinate with your employer coverage or delay Medicare to save yourself from paying unnecessary Part B and D premiums while you are still working.

Do I Need To Notify Anyone If Im Delaying Medicare

You don’t need to provide notice that you’d like to delay enrolling unless you’re receiving Social Security or Railroad Retirement Board benefits. If you are receiving either, you’ll be automatically enrolled in Medicare Parts A & B when you turn 65, and you’ll need to let Social Security know you wish to delay Part B. By law though, if you receive Social Security benefits and are eligible for Medicare, you must also have Medicare Part A.

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Get Someone On Your Side With Medicare

If youre able to answer the questions above, you will be equipped with the knowledge to answer whether it is mandatory to sign up for Medicare at age 65.

Medicare brings up many ifs, ands, and buts. Its easy to get lost in the chaos of it all. Thats why beginning the Medicare process is so frustrating to most and why we speak Medicare for you.

Instead of doing a cannonball into the pool of Medicare, test the waters. Take it one step at a time and get the help of an experienced Medicare broker like Boomer Benefits. Our help is free.

The Parts Of Medicare

Social Security enrolls you in Original Medicare .

• Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
• Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.

Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.

• Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
• Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
• Medicare Part D helps cover the cost of prescription drugs.

Most people age 65 or older are eligible for free Medicare hospital insurance if they have worked and paid Medicare taxes long enough. You can sign up for Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .

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Delaying Enrollment Could Result In A Permanent Penalty

As described above, you can’t reject premium-free Medicare Part A without also giving up your Social Security benefits. But since your work history is allowing you access to Medicare Part A without any premiums, few people consider rejecting Part A coverage.

The other parts of Medicare, however, do involve premiums that you have to pay in order to keep the coverage in force. That includes Medicare Part B and Part D , as well as supplemental Medigap plans. Medicare Part C, otherwise known as Medicare Advantage, wraps all of the coverage into one plan and includes premiums for Part B as well as the Medicare Advantage plan itself.

So it’s understandable that some Medicare-eligible people, who are healthy and not using much in the way of medical services, might not want to enroll in Part D and/or Part B. Similarly, people who are eligible for Part A but with premiums might want to avoid enrolling in order to save money on premiums. But before deciding to postpone enrollment in any part of Medicare, it’s important to understand the penalties and the enrollment limitations that will apply if you decide to enroll in the future.

There are penalties associated with delaying your Medicare enrollment unless the reason you’re delaying is that you are still working and you’re covered by the employer’s health plan. If that’s the case, you’ll be eligible for a special enrollment period to sign up for Medicare when you eventually retire.

Medicare Enrollment Can Be Tricky We Can Help

The Medicare system can be very complex, with a lot of twists and turns to navigate. Because its so complex, its normal to have a lot of questions about eligibility and enrollment. Two of the most common questions have to do with whether or not enrollment at 65 is a requirement.

• Is Medicare mandatory at 65?
• Is Medicare required for me when I reach a specific age?

In todays article, were going to explore the question of whether or not youre required to sign up for Medicare when you turn 65. Like the system itself, the answer has many different layers.

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What If I Get Health Coverage From Cobra Or Another Plan

You still need to sign up for Medicare during your initial enrollment period. You can delay signing up for Medicare only if you have insurance through your own or your spouses current employer.

If you or your spouse is not an active employee, you cant delay Medicare enrollment without penalty after leaving the job, even if you continue coverage on your employers plan through COBRA. The federal Consolidated Omnibus Budget Reconciliation Act of 1985 requires employers with 20 or more employees to let them continue health insurance coverage for up to 18 months, or up to 36 months for certain disabled individuals and family members, after they or their spouse leaves their job.

But Medicare becomes your primary coverage when you turn 65, and the COBRA coverage is secondary. This is another case where you could face big coverage gaps if you dont sign up for Medicare at the proper time.

Retiree health insurance benefits from a former employer function the same way, even if youre working in another job. You or your spouse must be actively working for the employer that now provides your health insurance if you want to delay Medicare enrollment and qualify for a special enrollment period later.

Keep in mind

Medicares Special Enrollment Period

If youre 65 or older and your medical insurance coverage is under a group health plan based on your or your spouse’s current employer, you may qualify for a . This process will let you sign up for Part A and/or Part B during the 8-month period that begins with the month after your group health plan coverage endswhichever comes first.

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What Happens When I Retire

It’s important to understand what your options are once you retire. The first step is to find out if you can keep the coverage you have now when you retire, and whether or not it can be combined with Original Medicare coverage. If you have group retiree health coverage, you’ll need to contact the plan’s benefits administrator to learn about how the coverage works with Medicare and what you need to do.

Medicaid Or Medicare Savings Programs

Medicare beneficiaries with limited income or very high medical costs may be eligible to receive assistance from the Medicaid program. There are also Medicare Savings Programs for other limited-income beneficiaries that may help pay for Medicare premiums, deductibles, and coinsurance. There are specified income and resources limits for both programs. Contact your local county Department of Social Services or SHIIP to apply for one of these programs.

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Do I Need To Sign Up For Medicare When I Turn 65

Medicare Part C An Alternative To Original Medicare

When you enroll in Medicare, you have the option to choose a Medicare Advantage plan as an alternative to Original Medicare, which includes Medicare A and B. Medicare Advantage is a type of Medicare health plan offered by a private company that provides all Part A and B benefits.

On the plus side, a Medicare Advantage plan also usually provides Part D benefits as well as sometimes providing extras like vision and dental at a lower total cost. On the minus side, you generally have to choose doctors within a particular medical network and get a referral to see a specialist. Another caveat: in some cases, joining a Medicare Advantage plan could cause you to lose your employer plan. Be sure to check with your benefits administrator.

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