Medicare Eligibility Before Age 65
If youre under 65 years old, you might be eligible for Medicare:
- If you receive disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board for at least 24 months in a row
- If you have amyotrophic lateral sclerosis
- If you have end-stage renal disease . ESRD is permanent damage to the kidneys that requires regular dialysis or a kidney transplant
If youre eligible for Medicare because of any of these circumstances, you may receive health insurance through Medicare Part A and Medicare Part B , which make up Original Medicare. Your enrollment in Medicare may or may not be automatic, as explained below.
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.
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.
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How Do I Apply For Traditional Medicare
If youre not automatically enrolled in Medicare Part A and Part B, you need to sign up. You should enroll during your IEP, or a Special Enrollment Period if you qualify for one. As mentioned above, one example of a Special Enrollment Period might be if you delayed enrollment in Medicare Part A and/or Part B because you had employer coverage.
You typically sign up for Medicare through the Social Security Administration . You can go to the website at ssa.gov. Or, go in person to a Social Security office. You can reach the SSA at 1-800-772-1213 . Representatives are available Monday through Friday, from 7AM to 7PM, in all U.S. time zones.
Why Is It Important
Once you or your dependent are eligible for Medicare, your benefits under the UAW Retiree Medical Benefits Trust will be paid as if you have Medicare coverage, whether or not you are enrolled. Enrolling in Part A and Part B will allow you to avoid paying additional out-of-pocket medical expenses. The Trust will not pay amounts that Medicare would have paid. You will be responsible for paying these amounts.
If you enroll in Part A and/or B the month you turn 65 or during the last three months of your initial Enrollment Period, the start date for your Medicare coverage will be delayed.
Surviving Spouses age 65 or older must enroll in both Medicare Part A and Part B in order to be eligible for health care coverage provided by the Trust. In the event of the retirees death, the surviving spouse will not be eligible for coverage unless he or she is enrolled in Medicare Parts A and B, if eligible.
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Medicare Enrollment Required At Age 65
In order to qualify for a LACERS medical plan premium subsidy and be eligible for coverage in a LACERS-sponsored medical benefit plan, retired members, eligible surviving spouses/domestic partners and dependents must, upon turning age 65 or becoming eligible due to a disability:
We recommend that you apply online at ssa.gov or contact the Social Security Administration 90 days prior to your 65th birthday to enroll in Medicare. The 2022 basic Medicare Part B monthly premium cost is $170.10.
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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Do I Automatically Get Medicare When I Turn 65
Some people automatically get Medicare at age 65, but those numbers have declined as the Medicare and Social Security ages have continued to drift apart.
Most people who automatically get Medicare at age 65 do so because they have been receiving Social Security benefits for at least four months before turning 65. Traditionally, Medicare premiums are deducted from your Social Security check. For the longest time, you could retire with full Social Security benefits at 65 and start on Medicare at the same time.
You are still automatically enrolled in Medicare Part A and Part B at 65 if youre drawing Social Security, but not as many people draw Social Security that early these days because of changes to the eligibility age for full Social Security benefits.
In 2000, the Social Security Amendments of 1983 began pushing back the standard age for full Social Security benefits. The progressive changes are nearing their conclusion: Beginning in 2022, the standard age for full benefits will be 67 for anyone born after 1960.
Besides the Medicare eligibility age of 65, what remains unchanged is that you can opt to begin drawing partial Social Security benefits as early as age 62. So, if you opt for accepting partial Social Security benefits before age 65, you are automatically enrolled in Medicare.
A smaller group of people also automatically get Medicare at age 65: people who receive Railroad Board benefits for at least four months before 65.
How Social Security Benefits Can Affect Medicare Enrollment
If you are receiving Social Security benefits when you turn 65, youll be automatically enrolled in Medicare Parts A and B, even if youre working. Your Medicare card will arrive in the mail about 3 months before your 65th birthday.
Once youre enrolled in Medicare, a monthly Part B premium will be automatically deducted from your Social Security check. If you dont want Medicare Part B, you need to notify Medicare to opt out. There will be instructions for doing this on the back of your Medicare card.
If youre not receiving Social Security or Railroad Retirement Board benefits, you will need to enroll yourself in Medicare when you become eligible.
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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.
Enrolling In Original Medicare
When it comes to Original Medicare, enrollment could be a piece of cake. If youre already receiving Social Security or Railroad Retirement Board benefits and youre a U.S. resident, the government automatically enrolls you in both Medicare Part A and Medicare Part B at age 65. Three months prior to your 65th birthday, your Medicare card will arrive in the mail with instructions.
At this point, youll have the option to turn down Medicare Part B . But you probably wont want to do that unless you have coverage from your own or your spouses current employer, and the employer has at least 20 employees. Thats a valid reason for delaying your enrollment in Medicare Part B.
If you decide to not enroll in Part B, but plan to enroll at a later date, know that you could end up having to pay a higher premium 10% higher for each year you could have enrolled, but didnt. The penalty doesnt apply, however, if the reason you didnt initially enroll in Part B coverage was that you had employer-sponsored health insurance from your current employer, including TRICARE from current military employment.
If you havent yet enrolled in Social Security but are eligible and want to begin receiving benefits, you can enroll online, or at a local Social Security office. Be sure you understand how your benefits depend on the age at which you start receiving them, and theres no right or wrong answer in terms of when you should activate your benefits.
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How Much Does Medicare Cost At Age 65
The standard premium for Part B modestly increases year over year. Part A costs also can increase, including the annual deductible and other coinsurance. Known as hospital insurance, Part A doesnt require a monthly premium as long as you have paid Medicare taxes through employment for at least 10 years.
Part B, known as medical insurance, typically pays 80% of the covered cost while you pay the deductible and then 20%.
Medicare Eligibility By Disability
Most Medicare recipients under the age of 65 reach eligibility during their 25th month receiving Social Security disability benefits. If you qualify for Medicare because of a disability, your Initial Enrollment Period will begin during the 22nd month you receive these benefitsthree months before youre eligible for coverage.
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Do I Qualify For The Medicare Part B Special Enrollment Period
You qualify for the Part B SEP if:
- you are eligible for Medicare because of your age or because you collect disability benefits.
- you had Medicare Part B or current employment-based health coverage in the month you qualified for Medicare and
- less than eight months have elapsed since you didnt have either current job-based group health coverage or Medicare Part B.
Some people may need to use the Part B SEP if theyre still working. Youll want to sign up for Part B if your employer has less than 20 employees. This is because your employer plan pays only after Medicare does. If you dont enroll in Part B, your employer plan will pay less for your care or nothing at all when it finds out youre Medicare-eligible. If your employer has more than 20 employees, you dont have to take Part B as long as youre still working, but a small number of people do enroll to lower their out-of-pocket costs.
You have to take Part B once your or your spouses employment ends. Medicare becomes your primary insurer once you stop working, even if youre still covered by the employer-based plan or COBRA. If you dont enroll in Part B, your insurer will claw back the amount it paid for your care when it finds out. At that point, you would need to enroll in Part B, but might no longer qualify for the SEP if you delayed enrolling for more than 8 months.
Why You May Consider Signing Up For Medicare At 65
If youre approaching age 65 and are not going to keep working, you have employer coverage from an employer with fewer than 20 employees, or your spouses employer requires you to get Medicare to stay on their health plan, then you need to enroll during whats known as your Medicare Initial Enrollment Period . If you dont, youll likely face financial premium penalties for enrolling late.
Your IEP is a 7-month window that generally includes the month of your 65th birthday, the 3 months before and the 3 months after For example, if your 65th birthday is on June 20, then your IEP starts on March 1 and ends on September 30.
This is the time to learn about your Medicare coverage options and get what you do or dont need coverage for. Most who have to get Medicare at age 65 will get Part A , Part B and some form of prescription drug coverage through either a stand-alone Part D plan or a Medicare Advantage plan.
Depending on your situation such as if you still have or want to keep employer coverage you may not need every part of Medicare available. But keep in mind here a simple rule: If you are not eligible for a Medicare Special Enrollment Period you need to get Parts A, B and D when youre first eligible to avoid financial penalties. Also, if youre still working, its a good idea to check with your employer plan benefits administrator to see how Medicare might work with that coverage before making any final decisions.
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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.
Avoiding Late Enrollment Penalties
If youre 65 or older and covered under an employer group health plan, either from your own or your spouses current employment, SSA will allow you to enroll in Medicare Part B without a late-enrollment penalty if you’re eligible to enroll during a Special Enrollment period.
When retiring after age 65, you are encouraged to immediately enroll in Medicare Part B with SSA during your Special Enrollment Period.
- While the Special Enrollment Period is eight months, the window to enroll in a CalPERS Medicare health plan is only 30-60 days post-retirement, so immediate action is strongly encouraged.
- If CalPERS does not receive your Medicare Part A and B information within 60 days, your health benefits will be canceled.
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Reasons To Delay Medicare
If youre thinking about deferring Medicare, discuss the pros and cons with your current insurer, union representative, or employer. Its important to know how or if your current plan will work with Medicare, so you can choose the most comprehensive overage possible.
Some of the common reasons you may want to consider deferring Medicare include:
- You have a plan through an employer that you want to keep.
Medicare Other Insurance And How We Can Help
Did you know you can enroll in Medicare even if you have other kinds of insurance such as Medicaid, VA benefits, and employer-sponsored health insurance? That said, some of these types of insurance work better with Medicare than others. In some cases, they may affect your ability to enroll in Medicare.
To find out how to choose the right Medicare coverage and understand how it will interact with health insurance you may already have, call the number below. A licensed Medicare expert can answer your Medicare eligibility questionsand help you enroll.
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General Tips For Working Members Age 65 And Older
Four months before your 65th birth month you will receive a letter from CalPERS titled Important Information Concerning Health Coverage at Age 65. This notice contains information regarding the CalPERS Medicare enrollment requirements. We encourage you to carefully review and save this letter for future reference.
We recommend you also review and save all mail received from the Social Security Administration , as it will contain valuable information regarding your Medicare enrollment. You may remain enrolled in a CalPERS Basic health benefits plan until retirement. When you retire, you’ll no longer be eligible to remain in a CalPERS Basic health plan if you are eligible for Medicare Part A at no cost.