How Medicare Works With Your Other Insurance
When you have more than one insurance provider, there are certain rules that determine who pays what it owes first and who pays based on the remaining balance. For seniors who don’t have other insurance, Medicare is obviously the primary payer. However, when you have other insurance, it’s a little more complicated.
Depending on the type of insurance you have , Medicare can either be the primary or the secondary payer. If Medicare would be a secondary payer to your current insurance, you can delay signing up for Medicare Part B. If your current insurance would become a secondary payer to Medicare, you should sign up during your initial enrollment period, which is the seven-month period that begins three months prior to the month you’ll turn 65.
It’s also worth noting that although I’m specifically mentioning Medicare Part B, which is medical insurance, this applies to Part A as well. However, Medicare Part A is free to the vast majority of Americans, so it’s probably worth signing up for Part A whether you’re required to or not. On the other hand, Medicare Part B has a monthly premium you’ll have to pay , which is why it can make sense to delay signing up if it’s not going to be your primary insurance.
Do You Have To Sign Up For Medicare At Age 65
- Are you required to sign up for Medicare when you turn 65? The answer is more than just a simple yes or no. Be sure to find out when you should sign up so that you dont face a late enrollment penalty or a lapse in coverage.
When you turn 65, you may have the opportunity to enroll in Medicare. But is it mandatory to sign up?
Technically, it is not mandatory to sign up for Medicare at 65 or at any age, for that matter. But its important to consider the situations in which you might decide not to enroll in Medicare at 65 so that you can make sure not to have any lapse in health insurance coverage or face a Medicate late enrollment penalty.
What Are The Implications Of Not Signing Up For Part D When You Are First Eligible
First and foremost, Medicare has a late enrollment penalty for not signing up for Part D when you are first eligible. For many people, this initial eligibility is when you turn 65 and start Medicare. In this situation, you have an initial election period to choose a Part D plan that lasts for seven months the month you turn 65 plus three months on each side of the turning 65 month. After that initial election period, if you have not signed up for a plan, the late enrollment penalty begins .
For others, if you are covered by a group plan past age 65 , your initial eligibility for Part D begins when that coverage terminates. In this situation, you have two months after the group coverage ends to sign up for a Part D plan. After that two month period ends, the Medicare Part D late enrollment penalty would begin.
Besides the late enrollment penalty, there are other implications of not signing up for a Part D plan when you are first eligible. The most significant of these is that you can only enroll in a Part D plan during a valid enrollment period. The valid enrollment periods are:
- Your Initial Election Period when you are first starting Medicare
- A Special Election Period when you are losing group coverage as described above
- The Annual Election Period this period runs October 15 to December 7 each calendar year
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Do You Have To Sign Up For Medicare If You Are Still Working
The most common reason for people not signing up for Medicare when they turn 65 is because they are still working. Because theyre still working, theyre likely covered under their employers health insurance plan and are also unlikely to be collecting Social Security retirement benefits.
Being covered under your employer-provided health insurance plan has no bearing on your Medicare eligibility. Medicare works in conjunction with several other types of health insurance including health insurance provided by employers or unions and wont prevent you from enrolling.
However, if you are not collecting Social Security retirement benefits at least four months before you turn 65, you will not be automatically enrolled in Medicare when you turn 65. In this case, you will have to manually sign up for Medicare when youre ready to enroll.
Many people choose to delay their Social Security retirement benefits until a later age when they can collect the full amount. If you choose to delay your retirement benefits, you must still sign up for Medicare manually once youre eligible in order to avoid any late enrollment penalties .
Some people who are still working sign up for Medicare anyway, because Medicare can work as extra insurance along with an employer group health insurance plan. Some people may decide that Medicare is more affordable than their employers insurance, so they may continue working but disenroll from their group plan and enroll in Medicare instead.
Do I Have To Sign Up For Medicare
Thinking about how to sign up for Medicare at age 65? You might not have to worry about Medicare enrollment its automatic for many people.
But even if youre enrolled in Original Medicare automatically, that might not take care of all your needs. Original Medicare doesnt cover routine dental care or prescription drugs, for example. Well get to additional coverage options later.
So how do you know if youre going to be automatically enrolled in Medicare?
- Generally, if youre already getting Social Security retirement benefits when you become eligible for Medicare, youre automatically signed up for Part A and Part B.
- If youre not getting Social Security benefits yet when you turn 65 for example, if you decided to delay your benefits youll need to sign up.
Watch for your red, white, and blue Medicare card to arrive in the mail around three months before your birthday. Your coverage begins the first day of the month of your 65th birthday for most people. If you turn 65 on the first of the month, your coverage begins the month before your birthday.
When do I sign up for Medicare?
You can sign up for Medicare at any time during the seven-month period that begins three months before your 65th birthday, includes your birthday month, and extends three months past the month you turn 65.
Learn about Medicare enrollment if you qualify for Medicare before age 65 due to disability.
When will your coverage begin if you sign up during your IEP?
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When Do You Apply For Original Medicare
You might not even have to apply for Original Medicare, which includes Part A and Part B . Many people are enrolled automatically. That applies to you if youre already getting Social Security benefits when you turn 65.
But even if youre automatically enrolled in traditional Medicare, you do have to take action if you want other Medicare coverage. For example, say you want to buy a Medicare Supplement insurance plan. The government doesnt enroll you. You need to do that if thats what you want. Well get into this more later on.
Enrollment In Medicare Advantage And Part D
Unlike Original Medicare, there is no option for automatic enrollment with these plans. For Part D, you can enroll during the Annual Enrollment Period from October 15th through December 7th if you miss your IEP.
For enrollment in a Medicare Advantage plan , you can also use the same Annual Enrollment Period.
Recommended Reading: How To Qualify For Medicare And Medicaid
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:
If you sign up:
1 month after you turn 65
2 months after you sign up
2 or 3 months after you turn 65
3 months after you sign up
Who Can Delay Signing Up For Medicare
So, whose insurance remains the primary payer? In a nutshell, if you have coverage through your or your spouse’s current employment, and the employer has 20 or more employees, your insurance plan remains the primary payer.
If you aren’t sure if your employer meets the “group health coverage” criteria, ask your employer’s benefits manager.
If you do qualify, you can delay signing up for Medicare for as long as you are still working. Once the employment or your employer-based health coverage ends, you’ll have eight months to sign up for Medicare Part B without paying a penalty, which is a permanently higher premium.
It’s also important to note that regardless of whether you’re still working or not, if you’ve already signed up for Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. If you don’t want to keep Part B, you’ll need to cancel it .
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Your Medicare Special Enrollment Period
If your employer has at least 20 employees and youre still working and covered under that plan when you turn 65, you can delay your enrollment in Medicare . In that case, youll get an eight-month special enrollment period to sign up for Medicare if and when you leave your job or your employer stops offering coverage. It will start the month after you separate from your employer, or the month after your group health coverage ends whichever happens sooner.
Sign up during those eight months, and you wont have to worry about premium surcharges for being late. And the eight-month special enrollment period is also available if youre delaying Part B enrollment because youre covered under your spouses employer-sponsored plan, assuming their employer has at least 20 employees.
But note that in either case, it has to be a current employer. If youre covered under COBRA or a retiree plan, you wont avoid the Part B late enrollment penalty when you eventually enroll, and you wont have access to a special enrollment period to sign up for Part B youll have to wait for the general enrollment period instead.
How Do I Get Full Medicare Benefits
If youve worked at least 10 years while paying Medicare taxes, there is no monthly premium for your Medicare Part A benefits. But if you havent worked, or worked less than 10 years, you may qualify for premium-free Part A when your spouse turns 62, if she or he has worked at least 10 years while paying Medicare taxes. However, to be eligible for Medicare, you need to be 65 years old. You also need to be an American citizen or legal permanent resident of at least five continuous years.
So, to summarize with an example:
- Bob is 65 years old. Hes on Medicare, but he pays a monthly premium for his Medicare Part A benefits. He only worked for seven years and no longer works.
- His wife, Mary, has worked for over 30 years.
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Signing Up For Medicare
Follow the steps below if you need to actively enroll in Medicare.
If you decide to enroll in Medicare during your Initial Enrollment Period, you can sign up for Parts A and/or B by:
- Visiting your local Social Security office
- Mailing a signed and dated letter to Social Security that includes your name, Social Security number, and the date you would like to be enrolled in Medicare
- Or, by applying online at www.ssa.gov
If you are eligible for Railroad Retirement benefits, enroll in Medicare by calling the Railroad Retirement Board or contacting your local RRB field office.
Keep proof of when you tried to enroll in Medicare, to protect yourself from incurring a Part B premium penalty if your application is lost.
- Take down the names of any representatives you speak to, along with the time and date of the conversation.
- If you enroll through the mail, use certified mail and request a return receipt.
- If you enroll at your local Social Security office, ask for a written receipt.
- If you apply online, print out and save your confirmation page.
Should You Wait Until 65 To Sign Up For Medicare
If you wait to sign up right before your 65th birthday , you may go for months without coverage.
Initial Enrollment Period
Your Initial Enrollment Period will last for 7 months. This Initial Enrollment Period begins 3 months before the month of your 65th birthday and ends 3 months after your birthday month. If you fail to enroll before your birthday month, your coverage will be delayed by a month or more.
General Enrollment Period
Youll have the option to sign up during the General Enrollment Period which falls between January 1 and March 31 every year if you didnt sign up during the Initial Enrollment Period. But youll potentially be charged a late enrollment penalty. Your premiums for Part B will be permanently increased by 10% for each year that you neglected to sign up for Part B and your monthly premiums for Part A will temporarily increase by 10%. As a rule, most people dont pay premiums for Part A, but then again, most people dont delay signing up for Part A. Your coverage will start on July 1, three months after the General Enrollment Period ends.
You may be able to avoid the late enrollment penalty and having to wait for the General Enrollment Period if you qualify for a Special Enrollment Period.
Special Enrollment Period
Its important to check with your insurer or HR department to make sure that your coverage is sufficient to postpone Medicare enrollment.
Enrolling In Medicare Advantage Or Part D At Age 65
If you did not sign up for any private Medicare insurance plans during your Initial Enrollment Period when you first qualified for Medicare because of your disability, you may have another opportunity to do so during the Annual Enrollment Period , which takes place from each year.
Learn more about the Medicare Advantage and Medicare Part D plan options that are available where you live by comparing plans online for free today. You can also get started comparing plans by calling to speak with a licensed insurance agent.
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About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare has neither reviewed nor endorsed this information.
Medicare Faqs And Information To Consider
If you are already receiving Social Security benefits, Railroad Retirement benefits, or Federal Retiree benefits, your enrollment in Medicare is automatic. Your Medicare card should arrive in the mail shortly before your 65th birthday. Check the card when you receive it to verify that you are entitled to both Medicare Parts A and B.
Initial Enrollment Period:
If you are not eligible for Automatic Enrollment, contact the Social Security Administration at 800-772-1213 or enroll online at www.socialsecurity.gov, or visit the nearest Social Security office to enroll in Medicare Part A and Medicare Part B. You have a seven month window in which to enroll in Medicare without incurring a penalty. If youre not automatically enrolled in premium-free Part A, you can sign up for it once your Initial Enrollment Period starts. Your Part A coverage will start six months back from the date you apply for Medicare, but no earlier than the first month you were eligible for Medicare. However, you can only sign up for Part B during the times listed below.
General Enrollment Period:
- General Enrollment Period for Medicare Parts A & B
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.
When To Apply For Medicare: Whats The Initial Enrollment Period
For most people, the Medicare Initial Enrollment Period is a seven-month period. It starts three months before the month you turn 65, includes your birthday month, and goes three more months after that. So if your 65th birthday is in November, your IEP runs from August through February.
Your IEP is different if youre not yet 65, but you qualify for Medicare by disability. For example, you might be automatically enrolled during your 25th month in a row of receiving Social Security disability benefits.
Learn how enrollment works if youre under 65 but eligible for Medicare through disability.