Medicare And Employer Coverage: Do You Have To Apply For Medicare
Before you apply for Medicare, be aware that you might have several insurance options. For example, you may be able to:
- Drop your employer coverage and enroll in Original Medicare, Part A and Part B. If you take this route, you might want to think about signing up for prescription drug coverage under Medicare Part D, and/or buying a Medicare Supplement Insurance plan. Medicare Supplement insurance can help pay the out-of-pocket costs of Medicare Part A and Part B.
Alternatively, you may have the option to receive your Medicare benefits from a Medicare Advantage plan.
- Have both Medicare and your employer coverage? Medicare and employer coverage will need to coordinate benefits, which means that either Medicare or the employer plan pays first for covered care. The other insurance is âsecondaryâ and may also pay a portion of the costs. More on who pays first below.
- Stay with your employer coverage and apply for Medicare later. Keep in mind that being eligible for Medicare doesnât mean you have to take it. However, you might want to enroll in Medicare Part A as soon as youâre eligible, especially if you qualify for premium-free Part A. You generally qualify for Part A without paying a premium if youâve worked at least 10 years while paying Medicare taxes.
Later, when your employer coverage ends, you can apply for Medicare Part B. To avoid a late enrollment penalty for enrolling in Medicare, make sure you apply for Medicare during your Special Enrollment Period.
What Will Happen If I Don’t Pay My Part B Premium
Your Medicare Part B payments are due by the 25th of the month following the date of your initial bill. For example, if you get an initial bill on February 27, it will be due by March 25. If you dont pay by that date, youll get a second bill from Medicare asking for that premium payment. That second bill will be due by the 25th of the following month in this case, April 25.
If your second bill remains unpaid by its due date, youll receive a delinquency notice from Medicare. At that point, youll need to send in the total overdue amount by the 25th of the following month to avoid losing coverage. In our example, that would put you at May 25.
All told, youll have a three-month period to pay an initial Medicare Part B bill. If you dont, youll receive a termination notice informing you that you no longer have coverage.
Now if you manage to pay what you owe in premiums within 30 days of that termination notice, youll get to continue receiving coverage under Part B. If you dont do that, your coverage will be discontinued. At that point, youll need to sign up for Part B once again during the general Medicare enrollment period that runs from January 1 to March 31 every year.
What To Do Next When You Become Eligible For Medicare
If you currently have a health plan through Covered California:
If you dont currently have a health plan through Covered California:
If youre currently enrolled in Medicare Part A, or eligible for premium-free Medicare Part A, you cant enroll in new coverage through Covered California. This is because Medicare Part A is considered minimum essential coverage under the Affordable Care Act. But depending on your income and assets, you may be eligible for additional coverage through Medi-Cal. Once youre enrolled in Medicare, you can contact your local county office or complete the Covered California application to see if you also qualify for Medi-Cal.
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Coverage Away From Home Or During A Disaster
Q: Do I have medical coverage when Im traveling? A: Yes. In most cases, you’re covered for emergency or urgent care from any medical provider while traveling outside a Kaiser Permanente service area, including while traveling outside the U.S. Read more about Travel Coverage or visit kp.org/travel.
Q: What happens if I temporarily leave a Kaiser Permanente service area? A: While youre temporarily outside a Kaiser Permanente area, coverage is limited to medical emergencies and urgent care. For Kaiser Permanente Senior Advantage and Medicare Advantage members, renal dialysis services are also covered.Q: What happens if I permanently move out of a Kaiser Permanente service area? A: If you’re outside a Kaiser Permanente area for more than 3 to 12 months , or you permanently move outside the area, Medicare requires us to disenroll you from our plan. Call us and we can help you with coverage when you travel or move.
Q: How do I get care in the event of a disaster? A: If a state of disaster or emergency in your geographic area is declared, Kaiser Permanente will make every effort to keep our facilities open to care for you.
If theres a disaster, we’ll post information about access to our facilities on kp.org. Read more about Kaiser Permanentes Disaster Planning Policy.
You Engage In Medicare Fraud Or Disruptive Behavior
If you let someone else use your Medicare card in order to obtain services, or if you attempt to defraud Medicare in any other way, your coverage would likely be taken away from you.
Some Medicare Advantage plans could also potentially take away your coverage if you engage in disruptive behavior. The definition of disruptive behavior could vary depending on your plan provider, but it generally means engaging in any type of behavior that impairs the insurers ability to arrange for or provide care for you or other plan members.
How To Change Your Medicaid Plan After You Enroll
In Michigan, enrolling for Medicaid is a two-step process.
If you get health care coverage through a job or Medicare, let your caseworker at the Michigan Department of Health and Human Services know. They will make the change to your file. You will have to continue to see your current doctor until your coverage changes.
What If I Want To Disenroll From My Current Medicare Part D Prescription Drug Plan But Dont Want To Enroll In Another Plan
If you disenroll from a Medicare Part D prescription drug plan and wait to join another Medicare prescription drug plan at a later time and do not have creditable coverage a Part D Late Enrollment Penalty may apply. To learn more about the Medicare Part D Late Enrollment Penalty, call Medicare at . TTY users call , 24 hours a day, 7 days a week.
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If You Lose Your Medicaid Eligibility:
If youre covered by both Medicare and Medicaid and then you lose eligibility for Medicaid, you can switch from Medicare Advantage to Original Medicare up to three months from the date you lose Medicaid eligibility, or the date youre notified, whichever is later.
- If youre told in advance that youll lose your Medicaid coverage for the following year, you can switch to Original Medicare between January 1March 31.
If Your Ma Plan Stops Providing Benefits In Your Area
If your MA plan stops providing benefits in your area at the end of the year, you have the right regardless of age or health condition to join another MA plan if one is available where you live, or to return to Original Medicare and join a Part D plan. Your Special Election Period is from December 8 of the current year through the end of February of the next year.
Note that this SEP gives you another chance to enroll in an MA or Part D plan in addition to the Annual Election Period, also known as Open Enrollment, from October 15 through December 7, when you can switch, enroll in or disenroll from MA and Part D plans. Any plan changes made before December 31 are effective January 1. Plan changes made after December 31 are effective the first day of the following month. If you switch to a new MA plan, make sure your doctor, the medical group that provides your care and your local hospital are all in the new MA plan network and plan to stay in it. If you find you need to switch doctors, make sure the doctor you choose is taking new patients.
Insurance companies must let you buy 1 of these 8 standardized Medigap plans A, B, C, F , K, L, M or N regardless of your health condition, unless you are younger than 65 and have end-stage renal disease .
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Can I Choose Marketplace Coverage Instead Of Medicare
Generally, no. You can choose Marketplace coverage instead of Medicare if you have to pay a Part A premium. Before making this decision, check if Marketplace coverage meets your needs and fits your budget. Also consider:
- If you dont sign up for Medicare when youre first eligible , you might have to wait to sign up. You might also have to pay monthly late enrollment penalties.
If You Enroll In Drug Coverage Thats Equivalent To Medicare Part D
If you enroll in TRICARE, VA coverage, or another plan that offers comprehensive prescription drug benefits and you have a Medicare Advantage plan that includes prescription drug coverage then you can leave your Medicare Advantage plan and return to Original Medicare.
- Youll want to check with your prescription drug plan to make sure that it provides you with credible drug coverage.
- You can do this at any time, but your ability to enroll in the alternative creditable drug coverage may be limited by that plans rules.
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Can You Cancel Your Medicare Supplement Plan
Over 14 million Original Medicare recipients in the United States also have a Medicare Supplement, or Medigap, policy. You can purchase one of several types of existing Medigap policies from participating private insurance companies across the country.
The purpose of Medicare Supplement plans is to help Medicare recipients fill in the gaps that are left after Original Medicare, Part A and Part B , pay for your health care services. Medigap plans cover some of your out of pocket expenses like copayments, coinsurances, and some deductibles not included in Original Medicare benefits.
There are currently several types of Medigap policies available to purchase in most states. All plans are different in what they cover, but they are standardized across the country.
Canceling, or disenrolling in a Medicare Supplement plan may be easy, but it may not be quite as easy to enroll in a new plan, or to re-enroll in the same plan at a later date. Keep this in mind before making your final decision.
When you terminate your policy, in most cases it continues through the month that you have already paid. Some insurance companies offer a refund of unused funds if applicable. Make sure you discuss all the details involved with the termination of your policy.
No matter the reason, if you wish to cancel your Medicare Supplement plan, you may. Be sure to discuss all the details about your providers requirements for disenrollment with a licensed agent.
What Is A Medicare Prescription Drug Plan
First, lets review some basics about Medicare drug plans.
Medicare is a federally administered health insurance program for those 65 years and older, certain younger people with disabilities, and people with end-stage renal disease. A Medicare prescription drug plan adds prescription drug benefits to your health coverage.
You can either get prescription drug coverage through a Medicare Advantage plan or a stand-alone Medicare plan. Learn more about these two different plans here. And if youre ready to enroll, you can read more here.
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Can You Stop And Restart Medicare
If you’re going back to work and can get employer health coverage that is considered acceptable as primary coverage, you are allowed to drop Medicare and re-enroll again without penalties. If you drop Medicare and don’t have creditable employer coverage, you’ll face penalties when getting Medicare back.
Canceling Part B Because You Cant Afford The Premiums
If you dont have a job with creditable health care coverage but still dont want to pay Part B premiums, use caution. Without health insurance thats as good or better than Medicare, you could start racking up late-enrollment penalties the longer you go without coverage. If you decide to re-enroll in Part B later, these penalties could make your premiums even less affordable.
If you can’t afford your Part B premiums, consider other options before canceling your coverage. You can apply for Medicaid coverage if you’re in a low-income household or have few assets. Medicare also offers several savings programs, which help qualified individuals pay their Medicare expenses.
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Subsidy Eligibility Is Also Based On Income
Its unusual for an employer-sponsored plan to be considered unaffordable or to fail to provide minimum value. And large group plans that fail to meet these standards are subject to the ACAs employer mandate penalty. But as noted above, the family glitch means that some plans that are considered affordable are not actually affordable for family members.
But even if youre eligible for a subsidy based on the coverage provided by your employer, you still have to qualify based on your household income .
Theres normally an income limit equal to 400% of the federal poverty level, but the American Rescue Planeliminated that income cap for 2021 and 2022. Households that are otherwise eligible for a premium subsidy can get one regardless of income, if the benchmark plan would cost more than 8.5% of the households income. The Build Back Better Act would extend this provision through 2025.
How Do You Cancel A Medicare Advantage Plan Or A Part D Drug Plan
You typically have to wait for the Medicare Annual Enrollment Period to cancel a Medicare Advantage or Medicare Part D prescription drug plan. The fall Open Enrollment Period takes place from October 15 to December 7 every year. During this time, you may disenroll from your Part C or Part D plan and return to Original Medicare or enroll in a different Part C or Part D plan.
From Jan. 1 to March 31 each year you can use the Medicare Advantage Open Enrollment Period to drop your current Medicare Advantage plan and enroll in another Medicare Advantage plan. You cant switch from a Medicare Advantage plan back to Original Medicare plan during this period, however.
You may also cancel your Medicare Advantage enrollment during your Initial Enrollment Period, which is the 7-month period that you first become eligible for Medicare. If you signed up for a Medicare Advantage plan during this period but decide to cancel the plan before this period ends, you can do so without any penalty.
Lastly, you may be able to cancel a Medicare Advantage or Part D plan if you qualify for a Special Enrollment Period. You may qualify for a Special Enrollment Period for various reasons, such as moving to a new location that isnt in your current plans service area.
You can compare Medicare Advantage plans and Part D Medicare drug plans online for free to find a new plan that better fits your needs.
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Information About Your Rights And Privacy
With a Kaiser Permanente Medicare health plan, you have a range of guaranteed rights and protections, including:
- Timely access to covered services and drugs
- Fair and respectful treatment at all times
- The right to file a complaint
- Security and privacy for your health information
- Clearly explained treatment options and participation in making decisions about your treatment options
- The right to get plan information and treatment explanations in a language or format that works for you
Find more details in your plans documents, such as the Evidence of Coverage, or in the Medicare & You handbook available at medicare.gov. You also can call Medicare at 1-800-MEDICARE , 24 hours a day, 7 days a week.
Q: How do I ask for coverage for a medical service or payment of a bill? A: To request a coverage decision about medical services youd like but havent received, or about payment of a bill, contact Member Services.
A response for a standard request for care or services can take up to 14 calendar days. A response for a request for payment can take up to 30 days. If your health requires a quick response, you should ask us to make a “fast coverage decision.” You, your doctor, or your representative can make the request for medical care. We’ll respond to a fast coverage decision within 72 hours. If we say no to your request for coverage for medical care or payment, you can ask for an appeal.
For additional details, see Chapter 9 in your Evidence of Coverage.