Example : You Are Contributing To Your Group Health Insurance Plan
In almost all cases, you can save money by switching to Medicare with a Medigap plan if youâre the one contributing to your group health insurance plan.
Health insurance premiums are sky-high, with some plans costing upwards of $800 per month. Medicareâs monthly premium is nowhere close to that, and you can even add on a Medicare Supplement with no chance of reaching that kind of premium.
In sum, you can have much better coverage for a fraction of the cost if youâre paying for your group health insurance and are over 65.
If youâd like a Medicare specialist to help you one-on-one, schedule a free Medicare planner with one of our licensed agents.
If The Employer Has Fewer Than 20 Employees
The laws that prohibit large insurers from requiring Medicare-eligible employees to drop the employer plan and sign up for Medicare do not apply to companies and organizations that employ fewer than 20 people. In this situation, the employer decides.
If the employer does require you to enroll in Medicare, then Medicare automatically becomes primary and the employer plan provides secondary coverage. In other words, Medicare settles your medical bills first, and the group plan only pays for services that it covers but Medicare doesnt. Therefore, if you fail to sign up for Medicare when required, you will essentially be left with no coverage.
Its therefore extremely important to ask the employer whether you are required to sign up for Medicare when you turn 65 or receive Medicare on the basis of disability. If so, find out exactly how the employer plan will fit in with Medicare. If not, ask for that decision in writing.
Note that in this situation, signing up for Medicare Part B when you also have employer insurance will not jeopardize your chances of buying Medigap supplemental insurance after the employment ends. When Medicare is primary to the employer plan, you have the right to buy Medigap with full federal protections if you do so within 63 days of the employer coverage ending.
Primary And Secondary Payers
Your Medicare and private insurance benefits are coordinated, which means they work together. Typically, a primary payer will pay insurance claims first and a secondary payer will only kick in for costs not covered by the primary payer. The secondary payer may not pay all of the remaining uncovered costs, and you may be responsible for any additional balance.
In many instances, if you are age 65 and covered by either a retiree plan or a plan with fewer than 20 employees, then Medicare is your primary payer and private insurance is your secondary. If this is your situation, you should enroll in Part A and B, along with D if your private insurance plan doesnt have creditable prescription drug coverage.
If youre covered by a plan with 20 or more employees, Medicare is often the secondary payer. Medicare may pay costs that your employers plan doesnt.
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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.
Can I Decline Medicare Altogether
Medicare isnt exactly mandatory, but it can be complicated to decline. Late enrollment comes with penalties, and some parts of the program are optional to add, like Medicare parts C and D. Medicare parts A and B are the foundation of Medicare, though, and to decline these comes with consequences.
The Social Security Administration oversees the Medicare program, and recommends signing up for Medicare when you are initially eligible, even if you dont plan to retire or use your benefits right away. The exception is when you are still participating in an employer-based health plan, in which case you can sign up for Medicare late, usually without penalty.
While you can decline Medicare altogether, Part A at the very least is premium-free for most people, and wont cost you anything if you elect not to use it. Declining your Medicare Part A and Part B benefits completely is possible, but you are required to withdraw from all of your monthly benefits to do so. This means you can no longer receive Social Security or RRB benefits, and must repay anything you have already received when you withdraw from the program.
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How Rich Is Your Employer Group Health Coverage
Is it great, the best insurance youve ever had? Well good for you! You can rest easy knowing that you are covered well and dont need Medicare yet.
Is your insurance anything less than stellar? Then you might want to think about having Medicare in addition to your group health plan.
As we mentioned, when you work for an employer with 20 or more employees, your group health plan is your primary coverage. Medicare would be secondary.
If you were to have both Medicare and group coverage, your Medicare would supplement your group plan and may reduce some health spending. However, that might only be important to you if you have some health care spending going on and you just want more robust overall coverage. Its up to you.
When Would I Enroll If I Delay Or Only Take Part A
If you are able to delay enrolling in either all or part of Medicare, you will have a Special Enrollment Period of eight months that begins when the employer coverage is lost or when your spouse retires. During this time, youll be able to enroll in Medicare Parts A & B. You can also enroll in a Part D prescription drug plan. And, after you enroll in Part B, youll be able to enroll in a Medicare supplement insurance plan or a Medicare Advantage plan.
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Things You Should Know
How to find out whether or not you are eligible for Medicare Part A and Part B benefits if you are retired and under age 65 and your spouse or you are disabled
If you or your spouse is disabled and receiving Social Security disability benefits, contact Social Security about Medicare-eligibility. If eligible, contact the GIC at 617.727.2310 to request a Medicare Plan enrollment form.
If you have been a state employee and have never contributed to Social Security
You may still be eligible for Medicare benefits through your spouse. When you turn age 65, visit Social Securitys website or call Social Security to apply to see if you are eligible.
What happens to your spouse’s coverage if you enroll in a GIC Medicare Supplemental Plan
Your spouse will continue to be covered under in a GIC non-Medicare plan if he/she is under age 65 until he or she becomes eligible for Medicare. See the Benefit Decision Guide for under and over age 65 health insurance products. If your spouse is over age 65, he/she must enroll in the same Medicare supplemental plan that you have joined.
What you need to do at age 65 if your spouse or yourself was not eligible for Medicare Part A for free, but now, you and your spouse have subsequently become eligible for Medicare Part A for free
You or your spouse must notify the GIC in writing when you become eligible for Medicare Part A. The GIC will notify you of your coverage options. Failure to do this may result in loss of GIC coverage.
Medicare Eligibility For Medicare Advantage Before 65
After youre enrolled in Original Medicare, you may choose to remain with Original Medicare or consider enrollment in a Medicare Advantage plan offered by a private, Medicare-approved insurance company.
Medicare eligibility for Medicare Part C works a little differently. Youre eligible for Medicare Advantage plans if you have Part A and Part B and live in the service area of a Medicare Advantage plan. If you have End Stage Renal Disease , you usually cant enroll in a Medicare Advantage plan, but there may be some exceptions, such as a Medicare Advantage plan offered by the same insurance company as your employer-based health plan, or a Medicare Special Needs Plan .
When you enroll in a Medicare Advantage plan, youre still in the Medicare program and need to pay your monthly Medicare Part B premium and any premium the plan charges. The Medicare Advantage program offers an alternative way of receiving Original Medicare coverage but may offer additional benefits. For example, Original Medicare doesnt include prescription drug coverage or routine dental/vision care, but a Medicare Advantage plan may include these benefits and more. Benefits, availability and plan costs vary among plans.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
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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
Working At A Large Company
The general rule for workers at companies with at least 20 employees is that you can delay signing up for Medicare until you lose your group insurance .
Many people with large group health insurance delay Part B but sign up for Part A because it’s free.
“It doesn’t hurt you to have it,” Roberts said.
However, she said, if you happen to have a health savings account paired with a high-deductible health plan through your employer, be aware that you cannot make contributions once you enroll in Medicare, even if only Part A.
Also, if you stay with your current coverage and delay all or parts of Medicare, make sure the plan is considered qualifying coverage for both Parts B and D.
If you’re uncertain whether you need to sign up, it’s worth checking with your human resources department or your insurance carrier.
“I find it is always good to just confirm,” said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and general agent for Medicare plans.
Some 65-year-olds with younger spouses also might want to keep their group plan. Unlike your company’s option, spouses must qualify on their own for Medicare either by reaching age 65 or having a disability if younger than that regardless of your own eligibility.
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Enrolling In Medicare At 65
If you want to enroll when you are turning 65, you can enroll in Medicare Parts A & B, Part D prescription drug coverage or a Medicare Advantage plan. You can also look at adding a Medicare supplement insurance plan to Original Medicare to help with the out-of-pocket costs of Medicare. You will be able to enroll as early as three months before the month in which you turn 65. This is the start of your Initial Enrollment Period, which also includes the month of your 65th birthday and the next three months after.
How To Apply For Medicare Part A And Part B Before Age 65
Some people are automatically enrolled in Original Medicare. If youve been receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months in a row, you will be automatically enrolled in Original Medicare, Part A and Part B, when you reach the 25th month.
If you have ALS or Lou Gehrigs disease, youre automatically enrolled in Medicare the month you begin receiving your Social Security disability benefits.
Some people will need to sign up for Medicare themselves. If you have end-stage renal disease , and you would like to enroll in Medicare Part A and Part B, you will need to sign up by visiting your local Social Security Office or calling Social Security at 1-800-772-1213 . If you worked for a railroad, please contact the RRB to enroll by calling 1-877-772-5772 , Monday through Friday, 9 AM to 3:30 PM, to speak to an RRB representative.
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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 .
Is The $2880 Flex Card For Seniors Real
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Got questions about the $2,880 flex card for seniors? Youre not alone! Weve had countless people reach out to us, asking if this is a legitimate offer or a terrible scam.
In this article, were going to answer your most important questions, including:
- Are the flex card for seniors legitimate or a scam?
- Why do so many people try to scam seniors?
- How can you protect yourself from scammers and bad actors?
- How can you get a real flex card?
Lets get started.
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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.
What If Youre Still Working At 65
If youre still working at 65 and receiving health insurance through your employer, you may still need to sign up for Medicare. If your company offers health insurance and has fewer than 20 employees, your health insurer will refuse to pay for costs that Medicare would have covered. Signing up for Medicare will ensure that those costs are covered.
If your company has more than 20 employees, its still a good idea to enroll in free Part A coverage right away. Your coverage will be free since you already paid Medicare taxes. However, if you have a Health Savings Account, you wont be able to contribute to it once you enroll in Medicare, even if you only enroll in Part A.
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Is The Flex Card Real
Ultimately, the amount of money that you may be able to receive on a flex card varies depending on where you live and what plan you select. Many of the flex card offers I found were only available for enrollees in specific states.
Even if you are eligible, its important to evaluate any Medicare Advantage plan very carefully. Although the flex card is an enticing offer, you need to make sure that you arent sacrificing other precious health care benefits to get it. If you dont read the fine print carefully, you may end up paying the price in other areas of your plan.
