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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:
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.
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.
What Do I Do If My Doctor Does Not Accept Medicare
You can choose to stay and cover the costs out-of-pocket, but this is not an affordable option for most Americans. Instead, you can ask your doctor for a referral to another healthcare provider that does accept Medicare, do your own research, or visit an urgent care facility. Most urgent care offices accept Medicare.
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.
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Do You Need Medicare If Youre Covered Under Fehb
If you are a federal employee age 65 or older, you are eligible to enroll in Medicare. Enrollment in the Federal Employee Health Benefits Program has great benefits, so often, federal employees dont see the need for Medicare. However, Medicare demands enrollment and even threatens those who dont enroll with penalties. If this is the case, you may be forced to choose whether to enroll in Medicare just to avoid the penalty.
What Parts Of Medicare Are Mandatory
Medicare is not mandatory for most people. However, its beneficial for eligible individuals to sign up as soon as possible in most cases to avoid penalties.
Enrolling in Part A is mandatory to keep your Social Security benefits. Part A inpatient coverage comes at no cost to most Americans. Its not mandatory to have Part A but if youve worked 40 or more quarters , youll get it premium-free. Those who qualify for free Part A should enroll once eligible.
But, if you want to contribute to a Health Savings Account after age 65, delaying Part A makes sense. Once Part A is active, you cant add to a Health Savings Account.
Part B and Part D are voluntary, and its not mandatory for you to enroll. Both involve monthly premiums. If you delay Part D, youll also face a Part D late-enrollment penalty.
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Some Retiree Health Plans Terminate At Age 65
If you’re not yet 65 but are retired and receiving retiree health benefits from your former employer, make sure you’re aware of the employer’s rules regarding Medicare. Some employers don’t continue to offer retiree health coverage for former employees once they turn 65, opting instead for retirees to transition to being covered solely by Medicare. Without coverage from your company, you’ll need Medicare to ensure that you are covered for potential health issues that arise as you age.
How To Cancel Medicare Easy Pay
If you need to change your Medicare Easy Pay bank account, address, or any other information, resubmit your Medicare Easy Pay form but select the change option.
If you no longer want to use Medicare Easy Pay for any reason, resubmit your Medicare Easy Pay form but select the stop option. Complete all the boxes in the form so that Medicare can locate your information to make changes.
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What Are The Benefits Of Getting Medicare While I Am Working
If youre unhappy with your current insurance, you might prefer the Medicare coverage. For example, your private health insurance may restrict you to a small network of doctors, while 99% of nonpediatric physicians accept Medicare. Switching to Medicare may also save you money on out-of-pocket costs versus your existing plan.
Even if you like your current insurance, you can enroll in Medicare as well. If you work for a large employer, Medicare would typically be your secondary policy.
Theres little downside to enrolling in Part A. It covers hospital stays and skilled nursing care once youve paid the deductible , and its premium-free to anyone who worked for at least 40 quarters in Medicare-covered employment.
Im Turning 65 Soon But I Like My Current Insurance Do I Have To Enroll In Medicare Will There Be Penalties If I Dont
It depends on how you are receiving your current insurance. If you are receiving employer-sponsored health insurance through either your or your spouses job when you turn 65, you may be able to keep your insurance until you retire. You will need to contact your employers benefits representative to find out whether they will continue your coverage when you turn 65. Since Medicare Part A is premium-free for most beneficiaries, you may want to enroll in Part A as soon as you are eligible , even if you will continue to receive employer-sponsored insurance at that time. If you are covered under an employer plan, you may want to delay signing up for Part B until you retire. However, it is a good idea to check with Social Security or Medicare to confirm you will not face a penalty for late enrollment. Similarly, unless you have drug coverage that is as good as what Medicare drug plans offer, you will need to sign up for a Medicare prescription drug plan when you enroll in Medicare or you may face a late enrollment penalty.
If you decide to drop your Marketplace coverage when you become eligible for Medicare, make sure your Medicare coverage has started before you cancel your Marketplace plan so that you avoid any gaps in coverage. You can start signing up for Medicare three months before your 65th birthday.
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Employer Or Military Retiree Coverage
If you or your spouse has an Employer Group Health Plan as retiree health coverage from an employer or the military , you may not need additional insurance. Review the EGHPs costs and benefits and contact your employer benefits representative or SHIIP to learn how your coverage works with Medicare.
Medicare Eligibility At Age 65
- You are at least 65 years old
- You are a U.S. citizen or a legal resident for at least five years
In order to receive premium-free Part A of Medicare, you must meet both of the above requirements and qualify for full Social Security or Railroad Retirement Board benefits, which requires working and paying Social Security taxes for at least 10 full years .
Learn more about Medicare eligibility at and before age 65 by referring to this helpful chart and reading more information below.
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What Factors Affect Your Medicare Enrollment Status If You Are Working
Medicare is the federal health insurance program that covers people age 65 and older as well as some younger people with disabilities or specific health conditions. If youre still working at 65 and covered by your employer plan, several factors will affect your Medicare enrollment status:
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The size of your employer: If your company has fewer than 20 employees, youll need to sign up for Medicare during your initial enrollment period.
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Whether you have spousal coverage: If you get insurance through your spouses employer, the same employer-size rule applies.
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The quality of your drug coverage: If your health insurance doesnt include , as defined by Medicare, youll need to purchase a stand-alone drug plan that meets those standards. Going without this level of prescription drug coverage for more than a few months will cause Medicare to charge you a late enrollment penalty on top of your Part D premium after you sign up.
Is Medicare Part B Mandatory At Age 65
Medicare Part B is not mandatory to have at age 65, but if you donât have any other health coverage, you will want to sign up for it. Medicare Part B has a monthly premium, which is $134, and that usually comes out of your Social Security check, so you donât even notice it.
If youâre still working and have health insurance through your employer, you may not need to sign up for Medicare Part B.
And a growing number of individuals over 65 are choosing to continue working. In fact, almost 19% of people 65 and older are still working. Thatâs about 9 million people. To put that into perspective, only about 4 million people over 65 were still working in 2000.
The most common jobs of older workers, according to the Bureau of Labor Statistics, include management, office and administrative support, and sales.
If this might be you, thereâs a good chance that youâre still getting some kind of health insurance through your employer. If thatâs the case, you probably donât need to pay for Medicare Part Bâs coverage, because youâre already covered.
This isnât always the case, though. For example, if your employer does not pay for your health insurance premium, you might be shelling out hundreds of dollars per month for it. In that case, it can save you a lot of money to switch to Medicare.
Our team of licensed agents can help you determine which route would save you the most money, so if youâre not sure, be assured that we can help.
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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.
Do I Need A Supplemental Insurance Plan
One little-known fact is that Medicare only covers about half of beneficiaries’ healthcare charges. The rest must be paid out of pocket or by other health insurance. Fidelity estimates these costs to be $260,000 for the average 65-year-old couple retiring in 2016, so this isn’t a small amount of money.
Because of this, many Medicare beneficiaries who don’t have another insurance plan choose to buy supplemental insurance, which is also known as a Medigap plan. The benefits and costs of these plans can vary significantly, so here’s a thorough guide to these if you’re interested.
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Did You Answer Yes To Question 2
If you are still working, then we immediately move to the next question, which is how many employees does the company that you work for have? Your answer will determine whether or not you will need to sign up for Medicare at age 65.
Was your answer, less than 20 employees?
Then you will need to as soon as youre eligible. If you fail to enroll in Medicare when you become eligible while working for a company that has less than 20 employees, you will incur late enrollment penalties. Medicare is primary when you work for a small company, so you need both Parts A and B.
Was your answer, 20 or more employees? Great, then you have options.
Should I Take Medicare Part B
You should take Medicare Part A when you are eligible. However, some people may not want to apply for Medicare Part B when they become eligible.
You can delay enrollment in Medicare Part B without penalty if you fit one of the following categories.
Employer group health plans may cover items normally not covered by Medicare Part B. If so, and you meet one of the categories above or below, then you may not need to enroll in Medicare Part B and pay the monthly premium.
If you are:
- a spouse of an active worker
- a disabled, active worker
- a disabled spouse of an active worker
and choose coverage under the employer group health plan, you can refuse Medicare Part B during the automatic or initial enrollment period. You wait to sign up for Medicare Part B during the special enrollment period, an eight month period that begins the month the group health coverage ends or the month employment ends, whichever comes first.
You will not be enrolling late, so you will not have any penalty.
If you choose coverage under the employer group health plan and are still working, Medicare will be the “secondary payer,” which means the employer plan pays first.
If the employer group health plan does not pay all the patient’s expenses, Medicare may pay the entire balance, a portion, or nothing. An employer group health plan must be primary or nothing.
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The Following Will Give You A Better Idea Of Medicare Penalties:
There is no penalty if you are still covered by active employment coverage. FEHB is considered active employment coverage while still employed by the federal government. When you retire, FEHB is considered annuitant coverage.
Important Notes:
- Those who are age 65, still working, and covered by FEHB wont be penalized for declining Medicare.
- Those who are retired, but still covered under FEHB through a working spouse are considered covered by active employment coverage and therefore, arent penalized.
Medicare Part A does not have a late penalty. Part A is free for most Americans. Even if you enroll late, there is no penalty. However, there is a drawback. Part A precludes enrollees from contributing to a Health Savings Account. HSA offers more robust benefits that a Flexible Spending Account, such as:
- Higher contribution limits: $3,450 for those enrolled in a Self-Only Health Plan and $6,900 for those enrolled in Self Plus One or Family Plans
- $1,000 additional catch-up contributions for those over 55
- No use it or lose it
- No account limits
- Account can be invested
- Money in this account can be used for a broader range of qualified expenses, such as Long-Term Care Insurance premiums, Medicare Part B premiums, and non-prescription drugs and services
- You can access HSA money into retirement
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.
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Is Medicare Mandatory When Youre First Eligible
If youre still working when you turn 65, or you become eligible through disability, you may be covered under your employers group plan. Or maybe your spouse has an employment-based or union-based group health plan that covers you. You usually dont have to enroll in Medicare right away if you have a group health plan.
Traditional Medicare refers to Medicare Part A, which is hospital insurance, and Part B, which is medical insurance. Part A can be premium-free if youve worked and paid taxes long enough. If you qualify for premium-free Medicare Part A, theres little reason not to take it.
In fact, if you dont pay a premium for Part A, you cannot refuse or opt out of this coverage unless you also give up your Social Security or Railroad Retirement Board benefits. Youd also have to pay back your previous benefits to the government.
