What Is The Medicare Part B Special Enrollment Period
The Medicare Part B SEP allows you to delay taking Part B if you have coverage through your own or a spouses current job. You usually have 8 months from when employment ends to enroll in Part B. Coverage that isnt through a current job such as COBRA benefits, retiree or individual-market coverage wont help you qualify for this SEP, but the SEP lasts for 8 months, so you may still qualify if your employment ended recently.
Get Someone On Your Side With Medicare
If youre able to answer the questions above, you will be equipped with the knowledge to answer whether it is mandatory to sign up for Medicare at age 65.
Medicare brings up many ifs, ands, and buts. Its easy to get lost in the chaos of it all. Thats why beginning the Medicare process is so frustrating to most.
Instead of doing a cannonball into the pool of Medicare, test the waters. Take it one step at a time and get the help of an experienced Medicare broker like Boomer Benefits. Our help is free.
I Am About To Turn 65 My Spouse Is 60 And Still Working We Are Both Covered Under Her Employers Health Plan Do I Have To Do Anything With Regard To Medicare This Year
A person with group health coverage through a current employer may be able to delay enrolling in Part A and Part B until that coverage ends, and wont face penalties for enrolling later, but only if the employer has 20 or more employees. If your wifes employer has at least 20 employees, you may want to enroll in Part A but delay enrollment in Part B until your group coverage through your spouses employer plan ends.
If you are already receiving Social Security benefits, you will be automatically enrolled in Part A and Part B when you turn 65. If you do not want to pay a premium for Part B benefits now because you have comparable coverage under your spouses employer plan, you will need to let Social Security know that you want to delay Medicare Part B enrollment. You can contact Social Security about this beginning three months before you turn 65. Otherwise, Medicare will assume you want to enroll in Part B and the monthly premium will be automatically deducted from your Social Security check.
If the employer has fewer than 20 employees, you should sign up for Part A and Part B when youre first eligible or you will face late enrollment penalties.
If you do delay Part B enrollment because you are covered under your wifes plan, remember to sign up for Part B once her coverage ends. That way, youll have continuous coverage and wont face a late enrollment penalty for Part B.
Recommended Reading: What Insulin Pumps Does Medicare Cover
Medicare As Secondary Insurance Costs Money
Now Part B is not premium-free. You will pay a monthly premium for Part B based on your income. Some people who are eligible for Medicare and employer group health coverage choose to delay enrolling in Medicare Part B and Part D while still covered on their group health coverage .
This saves them the premiums they would have paid for those parts. Your employer coverage already includes outpatient benefits so it may not be worth it to pay those Part B and D premiums.
When you DO delay Part B, your large group plan is considered creditable coverage. That means that you can enroll in Part B later without a late penalty when you decide to retire. Once you quit and leave the group plan, your insurance company will mail you a creditable coverage letter. Be sure you keep this. You will need it to show Medicare that you had other coverage so that you are not subject to late penalties for Parts B and D.
Read more about coordination of your Medicare benefits and large employer coverage here.
What Happens if You Retire and then Later Go Back to Work?
Also, many people ask us what happens if they retire, get Part B, and then later get a new job with employer insurance. You can cancel Part B at that time. Later when you retire again, youll have a second 6-month Open Enrollment window to get a Medigap plan with no health questions asked.
A Word About COBRA
When you are still actively working at a large employer, their Group Insurance pays primary and Medicare pays secondary.
What Is The Medicare Part D Late
If youve gone 63 consecutive days without creditable prescription drug coverage, either because you didnt enroll when you were first eligible or because you lost your creditable coverage and didnt get new coverage in time, then you may have to pay a late-enrollment penalty when you do enroll into Medicare Part D.
The Medicare Part D late-enrollment penalty is added to the premium of the Part D Prescription Drug Plan you enroll into. Your Medicare Prescription Drug Plan determines this penalty by first calculating the number of uncovered months you were eligible for Medicare Part D, but didnt enroll under Part D or have creditable coverage. Your Medicare Prescription Drug Plan will then ask you if you had creditable prescription drug coverage during this time. If you didnt have creditable prescription drug coverage for 63 or more days in a row after you were first eligible, the Medicare Prescription Drug Plan must report the number of uncovered months to Medicare.
For example, lets say you disenrolled from your Medicare Prescription Drug Plan effective February 28, 2021, and then decided to enroll into another Medicare Prescription Drug Plan during the Annual Election Period, with an effective date of January 1, 2022. This means you didnt have creditable prescription drug coverage from March 2021 through December 2021, which adds up to 10 uncovered months.
You May Like: Who To Talk To About Medicare
How Does Medigap Serve Or Help Me
Medicare coverage lasts for the rest of your life. As you age, doctor visits and hospitalizations may increase. But, it is impossible to project your future healthcare needs.
Medigap policies work hand-in-hand with Original Medicare to limit your exposure to unexpected out-of-pocket medical costs. You decide how much you want to be covered and what premium you want to pay.
What Do Medicare Supplement Plans Cover
Medigap policies cover the following out-of-pocket costs:4
- Part A coinsurance and hospital costs up to an extra 365 days after Medicare benefits are used up.
- Part B coinsurance or copays.
- Blood .
- Foreign travel emergency .
- Above out-of-pocket limits.
The Part B excess charge is little understood but essential to know. Doctors who accept Medicare assignment agree to rates set by Medicare for covered services. Those who dont can charge up to 15% more than the Medicare-approved amount.
Unless you have a Medigap plan that covers excess charges, you will be responsible for those charges. The alternative? To only use participating doctors, although thats not always easy in an emergency or surgery involving many doctors.
Also, Original Medicare does not cover you outside the U.S. But some Medigap policies do.
Also Check: Do You Have To Resign Up For Medicare Every Year
Reasons To Delay Medicare Part B
You may want to delay Medicare Part B to postpone paying the monthly premium that comes with it. Pay attention to timing when youre ready to enroll, though. Part B charges a late enrollment penalty unless you qualify for a Special Enrollment Period. You may qualify if you have through an employer or union.
Speak with your plan benefits administrator before delaying Part B. They can help you find out if you would have creditable coverage and if you can delay or if you need to enroll in Medicare at 65.
There are few reasons you may consider delaying Medicare Part A or Part B for, so learn about your choices and make a plan for Medicare enrollment that works for you.
Is Medicare Mandatory At Age 65
According to the Social Security Administration, Medicare coverage is mandatory at age 65 only for employees of state and local governments who were hired or rehired after March 31, 1986. Exclusions do apply under Section 210 of the Social Security Act.
Medicare is a public health insurance plan in the United States for retired people over the age of 65 and non-retired people with permanent disabilities. HowStuffWorks explains that to be eligible for Medicare benefits, seniors must have worked at least 10 years in a job that withheld Social Security from their pay. Medicare offers basic hospital insurance and medical insurance but does not cover all medical expenses or the cost of specialized care. Patients also have the option of adding additional advantage plans and prescription drug plans to suit their needs.
Read Also: Can You Apply For Medicare After 65
When Does Medicare Not Automatically Start
Medicare will NOT automatically start when you turn 65 if youre not receiving Social Security Benefits or Railroad Retirement Benefits for at least 4 months prior to your 65th birthday. Youll need to apply for Medicare coverage.
Theres no such thing as a Medicare office enrollment in the program is handled by the Social Security Administration . If you have to enroll in Medicare Part A and/or B on your own, you can visit your local Social Security office.
You can also online by following the instructions at the Social Security Administration Medicare Benefits web page. In most cases, signing up online will take ten minutes.
Enrollment Windows Are Limited
If you’re thinking about delaying your enrollment in Medicare, keep in mind that there are enrollment windows that apply. After your initial enrollment window ends, you can only sign up for Medicare Part A and B during the general annual enrollment period from January 1March 31, with coverage effective July 1.
And you can sign up for Part D during the annual enrollment period from October 15December 7, with coverage effective January 1 of the coming year.
So if you delay your enrollment, you could be paying higher premiums when you eventually do enroll, and you’ll have to wait until an open enrollment period in order to have access to coverage. If you’re only enrolled in Part A, for example, and you get diagnosed with a serious illness in April, you’ll have to wait until the following January to have Part D coverage, and until the following Julymore than a year in the futureto have Part B coverage.
Keep all of this in mind when you’re deciding whether to enroll in the parts of Medicare that have premiums.
You May Like: Can You Get Medicare At 60
Can You Get Private Insurance Instead Of Medicare
If you have Medicare Part A or Part B, insurers generally arent allowed to sell you a traditional individual health insurance plan .
You can purchase individual health insurance if youve never enrolled in Medicare because you think the overall costs are too high. If youre in the unusual situation of paying for Part A premiums, you can also switch to individual health insurance.
If you develop a medical condition before turning 65 that would qualify you for Medicare, such as ESRD, you can decline to purchase Medicare.
If you decide to purchase private insurance once youre eligible for Medicare unless youre continuing the employer-sponsored insurance that qualifies you for a Special Enrollment Period then youll have to pay the costly late enrollment penalty once you do apply.
If youre nearing the age of 65, then its important you start considering your Medicare coverage.
Medicare Part B Monthly Premiums During 2020
The important point for federal employees continuing to work in federal service past age 65 with FEHB insurance coverage is that they need not enroll in Part B until after they retire from federal service.
The reason for this delay in enrolling in Part B is threefold:
First, while continuing to work in federal service the employees FEHB insurance coverage will always be considered primary coverage and the employee has access to a HCFSA to help whatever is not paid or reimbursed through the FEHB health plan.
Second, while working the employees MAGI will most probably be larger compared to the MAGI in retirement and the employee would likely pay much more for Part B.
Third, the employee can enroll in Medicare Part B once he or she retires from federal service and not be subject to a late enrollment penalty provided the retired employee within 8 months following the employees retirement from federal service.
What Steps Should Employees Working Past Age 65 Take with Medicare Once They Retire from Federal Service?
Given that most federal employees working past age 65 are already enrolled in Medicare Part A, it is recommended these employees once retired enroll in Medicare Part B. To avoid a late enrollment penalty, they need to enroll in Medicare Part B within 8 months following their retirement date from federal service. In particular, they must do the following:
The following example illustrates:
Don’t Miss: Is Root Canal Covered By Medicare
Is It Mandatory To Go On Medicare At Age 65
For some, not enrolling in Medicare can be a poor decision. But, some people wont receive a penalty for delaying enrollment. Lets take a look at a few different scenarios.
Factors that come into play:
Are you retired?
- If retired, you more than likely need to enroll at 65 years of age.
Are you still employed?
- If the company has fewer than 20 employees, you should enroll as soon as possible. If more than 20 employees, you may have options.
Are you happy with your employer group health coverage?
- If youre happy with your coverage, you can keep using it as your primary insurance and use Medicare as secondary insurance.
Your Initial Enrollment Period begins three months before your sixty-fifth birthday and ends three months after you turn 65. Thus, you have seven months to enroll.
If you choose to enroll after your Initial Enrollment Period ends, you could face a penalty. Or worse, delaying Part B could result in having to wait for the General Enrollment Period, which adds to the cost of your late penalty.
Enrollment Is Not Mandatory At Age 65
Medicare is a federal health insurance program for people who are 65 or older , certain younger people with qualifying disabilities and people with end-stage renal disease or ALS. Being eligible to enroll in Medicare coverage doesnt mean that you must enroll. Note that delaying or missing enrollment in Medicare when you are first deemed eligible may result in lifetime penalties, delays in benefits or limited coverage. If youre eligible to enroll in Medicare, the decision to move forward with your enrollment application depends on a number of factors. For those who are currently employed, the primary factor is the size of your employer. There are other factors that influence enrollment decision making and delaying enrollment learn more about those on our Enrollment page.
Youre Our First Priorityevery Time
We believe everyone should be able to make financial decisions with confidence. And while our site doesnt feature every company or financial product available on the market, were proud that the guidance we offer, the information we provide and the tools we create are objective, independent, straightforward and free.
So how do we make money? Our partners compensate us. This may influence which products we review and write about , but it in no way affects our recommendations or advice, which are grounded in thousands of hours of research. Our partners cannot pay us to guarantee favorable reviews of their products or services.Here is a list of our partners.
Lets Look Three Reasons Some Americans Decide To Enroll In Medicare At Age 65
That shouldnt deter anyone from enrolling in Medicare at age 65.
Because most Americans are eligible for retirement insurance benefits several years before theyre eligible for Medicare, many people have little choice but to enroll in private health insurance plans until they become Medicare-eligible. If youre enrolled in a private health plan, you dont need to cancel that plan if you enroll in Medicare, though you may choose to do so. If you decide to continue with your private insurance while enrolled in Medicare, Medicare will generally be your secondary payer, helping cover some of the costs your private insurance wont cover.
If you have private insurance, you may choose to opt out of coverage while remaining enrolled in . This will allow you to save on the cost of your Part B premium, currently set at $104.90 per month for most Americans.
If you have COBRA coverage and decide to enroll in Medicare, your COBRA coverage normally will end upon your enrollment in Medicare. You may, however, be able to keep COBRA coverage for services not covered by Medicare . Even if you lose COBRA coverage due to your enrolling in Medicare, your spouse and dependent children should be eligible to maintain their COBRA coverage for up to three years.
Remember, COBRA is temporary and shouldnt be seen as a long-term alternative to Medicare.
Recommended Reading: How Much Will Medicare Pay For Nursing Home Care
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.