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.
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Should You Sign Up For Medicare If Youre 65 And Still Working
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If youre 65 or older, still working and are covered by employer health insurance, it can make sense to sign up for Medicare now. Enrollment might reduce your out-of-pocket costs.
Millions find themselves in this situation. The proportion of Americans ages 65 to 74 who are working is projected to reach 30.2% in 2026, according to the Bureau of Labor Statistics.
But Medicare is complicated, and there are a lot of caveats and some surprise expenses to be avoided. So for working people 65 or older, heres help with figuring out when to enroll in Medicare and how to avoid costly late-enrollment penalties and gaps in coverage.
A note for married couples where one spouse is covered by the others employer insurance: The information provided here also applies to you when you turn 65.
Full Retirement Age By Year
Full retirement age is the age you begin to receive full Social Security benefits. If you start to draw your Social Security benefits before reaching your full retirement age, the payment you receive will be less.
An easy way to think about full benefits and retirement age is this,
- Social Security will reduce your payments if you choose to receive your benefit before full retirement age. The percentage of reduced amount is highest at age 62 and decreases until you reach full retirement age.
- If you choose to receive Social Security payments when you reach full retirement, you will get the total amount.
- Suppose you choose not to receive Social Security payments when you reach full retirement and delay your benefit. In that case, you can increase the amount of your payment by earning delayed retirement credits.
If youre not sure when you reach full retirement age, our table provides the years and months you need to know for full retirement.
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Delaying Medicare Parts A & B
If you qualify to delay both Medicare Parts A & B, you can do so without penalty as long as you enroll within eight months of either losing your employer coverage or ceasing to work, whichever comes first. You will enroll during a Special Enrollment Period and will need to also provide written proof of creditable drug coverage to avoid Part D penalties.
Do I Need To Sign Up For Medicare When I Turn 65
It depends on how you get your health insurance now and the number of employees that are in the company where you work.
Generally, if you have job-based health insurance through your current job, you dont have to sign up for Medicare while you are still working. You can wait to sign up until you stop working or you lose your health insurance .
- If youre self-employed or have health insurance thats not available to everyone at the company: Ask your insurance provider if your coverage is employer group health plan coverage If its not, sign up for Medicare when you turn 65 to avoid a monthly Part B late enrollment penalty.
- If the employer has less than 20 employees: You might need to sign up for Medicare when you turn 65 so you dont have gaps in your job-based health insurance. Check with the employer.
If you have COBRA coverage: Sign up for Medicare when you turn 65 to avoid gaps in coverage and a monthly Part B late enrollment penalty. If you have COBRA before signing up for Medicare, your COBRA will probably end once you sign up.
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Working Past 65 Here’s When And Why You Should Enroll In Medicare
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If youre not planning to retire anytime soon but youre about to turn 65, you might be wondering if you should sign up for Medicare. Everyones circumstances are different, but in general, the decision to enroll will depend on the size of your employer and the value youre getting from your workplace health insurance.
Should I Sign Up For Medical Insurance
With our online application, you can sign up for Medicare Part A and Part B . Because you must pay a premium for Part B coverage, you can turn it down.
If youre eligible at age 65, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday.
If you choose not to enroll in Medicare Part B and then decide to do so later, your coverage could be delayed and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didnt sign up for it, unless you qualify for a “” .
If you dont enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a general enrollment period from January 1 through March 31. Your coverage begins on July 1 of the year you enroll. Read our publication for more information.
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Delaying Enrollment Could Result In A Permanent Penalty
As described above, you cant 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 its 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, its 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 youre delaying is that you are still working and youre covered by the employers health plan. If thats the case, youll be eligible for a special enrollment period to sign up for Medicare when you eventually retire.
What Happens If You Don’t Sign Up For Medicare
If you do not sign up for Medicare Part A or Part B when you first become eligible, you may be subject to a late enrollment penalty if you choose to sign up later on.
- The Part A late enrollment penalty is only applicable to beneficiaries who do not qualify for premium-free Part A . The Part A late enrollment penalty is up to 10 percent of the monthly premium , and you must pay the penalty for twice the number of years that you could have had Part A but did not. For example, if you were eligible for Part A for two years before you finally signed up, you would have to pay the extra 10 percent penalty for four years.
- The Part B late enrollment penalty is up to 10 percent of the standard Part B premium for each 12-month period that you could have had Part B but did not. You have to pay this penalty for as long as you are enrolled in Part B.
Late enrollment penalties do not apply to everyone who delays coverage, however.
For example, if you delay enrollment because you have employer-provided health insurance coverage, you may be able to enroll in Medicare Part A and/or Part B at a later date without facing a late enrollment penalty.
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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.
Medicare Mythbuster: ‘i Must Enroll In Medicare At Age 65’
Sample Medicare Card
Many people thinking about Medicare enrollment experience stress. Adding to that stress is a variety of Medicare myths and misunderstandings. Perhaps one of the biggest myths is I must enroll in Medicare at age 65, no matter what.
Lets look at a few facts of Medicare enrollment.
Fact #1: Those who are already receiving Social Security benefits before age 65 will be enrolled in Medicare automatically when they turn 65. They do not have to do anything they will get their Medicare card in the mail.
Depending on the type of coverage one has, suspending Part B, medical insurance, in this situation, might be advantageous.
Fact #2: Those who plan to enroll in Social Security at age 65 must also enroll in Medicare.
In both cases , enrollment in Medicare, at a minimum Part A, hospital insurance, is required because it is a condition of receiving benefits. If you dont want Medicare, then you cant get Social Security.
Fact #3: Those who do not plan to enroll in Social Security at age 65 and who have an employer group health plan, be it as the employee or a dependent, can delay enrolling if the coverage meets two criteria:
A company with 20 or more employees sponsors the group health plan, and
The owner of the policy is still working.
When its time to retire, these individuals can qualify for a special enrollment period. They can enroll in Medicare, without delay or penalty.
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Having Creditable Drug Coverage
Before you officially delay Medicare, make sure you have creditable drug coverage. This means your employer drug coverage is at least as good as the standard Medicare Part D plan coverage. If your employer’s drug coverage isn’t creditable, you will need to enroll in a Part D plan during your Initial Enrollment Period to avoid the Part D late enrollment penalty . Consequently, you’ll also need to get either Part A or Part B in order to get a Part D plan.
Signing Up For Medicare Part D At 65 If Youre Still Working
To make sure you have prescription medication coverage, you need either from work, Medicare Part D, or a Medicare Advantage plan with drug coverage. Your employer can tell you if your workplace coverage is creditable, meaning its as good as or better than Part D.
Once you , you could lose your workplace prescription coverage, and you may not be able to get it back.
If you dont have either and you dont enroll in Part D on time, youll pay higher Part D premiums.
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Will The Medicare Age Be Raised To 67
In recent years, the proposal to raise the Medicare eligibility age to 67 began to gain traction. However, many are actually in favor of lowering the Medicare age below 65 rather than pushing it back to 67.
As of now, there has not been any indication that either of these proposals will become law. The standard Medicare enrollment age is currently 65 and there are no plans of changing that in the near future.
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Retiree Coverage Continuing Past Age 65 You’ll Still Need To Enroll In Medicare A And B
Some companies will not cut a retiree off completely at the age of 65, but instead continue to offer supplemental retiree benefits, which can be used in conjunction with Medicare . The supplemental retiree health benefits may include prescription drug coverage , doctor visits, and other outpatient health care. Medicare will be your primary coverage if you’re covered under a retiree health plan, with the plan offered by your former employer serving as secondary coverage.
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What If You Worked 10 Years Or Less
Most people will qualify for coverage by paying Medicare and Social Security taxes for 10 years through any combination of employers. Youll need to have spent 10 years doing taxable work to enroll in Medicare Part A for free. If youve worked for less than 10 years in the US, youll need to pay monthly premiums for Medicare Part A.
However, if your spouse who is 62 or older has enough quarterly credits or receives Social Security benefits, then youll still qualify. You may also be able to qualify based on your spouses work record if youre widowed or divorced.
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.
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Do I Need To Get Medicare Drug Coverage
You can get Medicare drug coverage once you sign up for either Part A or Part B. You can join a Medicare drug plan or Medicare Advantage Plan with drug coverage anytime while you have job-based health insurance, and up to 2 months after you lose that insurance.
Even if you have a Special Enrollment Period to join a plan after you first get Medicare, you might have to pay the Part D late enrollment penalty. To avoid the Part D late enrollment penalty, dont go 63 days or more in a row without Medicare drug coverage or other .
If you have other drug coverage: Ask your drug plan if its creditable drug coverage.
Each year, your plan must tell you if your non-Medicare drug coverage is creditable coverage. Keep this information you may need it when youre ready to join a Medicare drug plan.
During A Special Enrollment Period
This SEP is available only if you have health insurance from an employer for which you or your spouse actively works. It allows you to delay enrolling in Part B until the employment or the coverage ends whichever occurs first.
The SEP actually lasts throughout the time you have coverage from current employment and for up to eight months after it ends. If you enroll at any point during this time frame, your Medicare coverage will begin on the first day of the following month, and you will not be liable for late penalties regardless of how old you are when you finally sign up.
Be aware that an IEP always trumps an SEP if the two should happen to overlap. For example, if your IEP ends on Aug. 31, and you retire on the same date, you will not be entitled to an SEP. Therefore, if you delayed enrollment until after Aug. 31, you would not be able to sign up until the following general enrollment period and your coverage would not begin until July 1 so you would be left for almost a year without coverage. Even if you signed up during the final months of your IEP, your coverage would still be delayed by two or three months. But, to continue this example, if you retired on Sept. 1, under the rules of the SEP, you could enroll in August and receive Medicare starting Sept. 1 with no loss of coverage.
Two other Medicare enrollment scenarios have different rules.
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