If Your Spouse Is Younger Than 65
He or she has two options for getting covered when you transition to Medicare. They can:
- Receive benefits through their employer
- Purchase coverage through an individual insurance plan
Our advisors are here to assist your spouse in finding an individual health plan, which can bridge the gap until he or she meets the age requirement for Medicare.
Do You Have To Enroll In Medicare Every Year
When youâre already happily enrolled in a Medicare plan, enrollment periods throughout the year can be confusing. Do you have to enroll again? How often do you have to enroll?
Today, weâre going to answer all your questions on Medicare enrollment to help you know when and if you need to reenroll or renew your service.
Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
Note: When completing the forms CMS-40B and CMS-L564
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
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What Else Do I Need To Know
- Medicare can help cover your costs for health care, like hospital visits and doctors services.
- Most people dont pay a premium for Part A, but you do pay a monthly premium for Part B.
- If you cant afford the monthly premium, there are programs to help lower your costs. Get details about cost saving programs.
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.
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Medicare Part D Covers Prescription Drugs And Isnt Really Optional
Original Medicare includes only Parts A and B. That means if you take any prescription medications, or plan to and dont want to pay for them out of pocket youll need to add Medicare Part D to your coverage. This can be done as an add-on to Original Medicare or bundled with a Medicare Advantage plan. Medicare Part D premiums average about $33 per month, according to the CMS.
Signing up on time for Part D is especially important because theres a late-enrollment penalty if you miss your eligibility window. Medicare drug coverage can vary by medication, so start your research early to make sure your plan includes everything you need. Even if you dont take medication now, enrolling in Part D coverage can help prepare you for future prescription costs.
If You Have A Disability Esrd Or Als
Americans with a disability who have received Social Security disability benefits for 24 months are automatically enrolled in Medicare Part A and Part B. Automatic enrollment also applies to beneficiaries who have serious illnesses such as end-stage renal disease, ESRD, and amyotrophic lateral sclerosis, ALS. Youll receive your card when you qualify.
You dont need to do anything to sign up.
Similarly, if youve received disability benefits from the Railroad Retirement Board for 24 months, youll be enrolled automatically in Medicare Parts A and B.
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How To Sign Up For Medicare Advantage: When Can I Enroll
Medicare Advantage, also known as Medicare Part C, is another way to receive Original Medicare benefits and is offered through private insurance companies that have contracts with Medicare. At minimum, all Medicare Advantage plans must offer the same Medicare Part A and Part B benefits as Original Medicare. Some Medicare Advantage plans also include additional benefits, such as prescription drug coverage. You must have Original Medicare, Part A and B, to enroll in a Medicare Advantage plan through a private insurer.
You can enroll in a Medicare Advantage plan during two enrollment periods, the Initial Coverage Election Period and Annual Election Period.
Do I Need To Notify Anyone If Im Delaying Medicare
You don’t need to provide notice that you’d like to delay enrolling unless you’re receiving Social Security or Railroad Retirement Board benefits. If you are receiving either, you’ll be automatically enrolled in Medicare Parts A & B when you turn 65, and you’ll need to let Social Security know you wish to delay Part B. By law though, if you receive Social Security benefits you must also have Medicare Part A.
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When To Enroll In Medicare If I Am Receiving Retirement Benefits
If youre already collecting Railroad Retirement Board or Social Security retirement benefits when you turn 65, you will automatically be enrolled in Medicare Part A and Medicare Part B if you sign up for Medicare Part B at the time you sign up for retirement benefits.
If you live outside of the 50 United States or D.C. , you will automatically be enrolled in Medicare Part A, but will need to manually enroll in Medicare Part B.
B Late Enrollment Penalty
If you delay enrollment in Part B and don’t have coverage from a current employer , you’ll be subject to a late penalty when you eventually enroll in Part B. For each 12-month period that you were eligible for Part B but not enrolled, the penalty is an extra 10% added to the Part B premiums. And you’ll pay this penalty for as long as you have Part Bwhich generally means for the rest of your life.
In 2020, most Medicare Part B enrollees pay $144.60/month. So a person who is now enrolled but had delayed their enrollment in Medicare Part B by 40 months would be paying an extra 30% in addition to those premiums . That means they’d be paying roughly an extra $43/month for their Part B coverage, for a total of about $188/month.
Part B premiums generally change each year. Sometimes they stay the same from one year to the next, but the general trend has been upwards over time. So the part B penalty will generally also increase from one year to the next. If you’re paying 10% or 30% or 50% more than the standard rates, the dollar amount of that penalty will increase as the standard premiums increase over time.
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You Need Part B If Medicare Is Primary
What is Medicare Part B? It is your outpatient coverage.
Once you retire and have no access to other health coverage, Medicare becomes your primary insurance. Part A pays for your room and board in the hospital. Part B covers most of the rest.
The Medicare definition for Part B is outpatient coverage. However, Part B covers many things that happen both in and out of the hospital. Part B provides 80% coverage for doctor visits, labwork, physical therapy, medical equipment, diabetes supplies, surgeries, chemotherapy, radiation, dialysis and much more.
Is Medicare Part B optional? Yes, because some people who are still working may wish to delay it until they retire.
However, it is a critical component of your overall health package when Medicare is primary.
Some common scenarios where Medicare is primary are:
- When you are 65 or older and have employer coverage at a company with less than 20 employees
- When you are under 65 on Medicare due disability and work for an employer with less than 100 employees
- If you have retiree coverage from a former employer
- With COBRA insurance, you must enroll in Part B by the 8th month of COBRA
- When you are turning 65 with Tricare for Life or CHAMPVA
- When you are 65 or older and enrolled in Medicaid
Employer coverage, retiree coverage, COBRA, TFL and Medicaid all function as your secondary insurance only if do your part and first enroll in Part B. Failure to enroll in Part B means you will also owe a penalty if you decide to enroll later on.
Some People Are Enrolled Automatically And Some Arent
If youre under the age of 65 and already receive Social Security benefits, you will be automatically enrolled in whats called Original Medicare. This includes Medicare Part A and Part B . Note that Medicare Part B carries a premium: Most people pay $170.10 per month in 2022, according to the Centers for Medicare & Medicaid Services, or CMS.
If youre not receiving Social Security benefits, you can during your initial enrollment window and choose which insurance combination is best for you.
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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.
I Turn 65 In A Few Months When Should I Sign Up For Medicare
En español | If you already receive Social Security benefits, Social Security will automatically sign you up for Medicare Part A and Part B though you can decline Part B enrollment if you want to. Otherwise, you need to apply for Medicare. The best time to do that depends entirely on your own situation. Broadly, there are two options:
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Do I Have To Enroll Or Renew My Medicare Supplement Every Year
Much like Medicare Part B, as long as you remain up-to-date on your payments, you can keep your Medicare Supplement indefinitely.
There are some circumstances where you may be asked to change your coverage, like if the company your plan is through goes out of business. But you will receive notice if such an occasion occurs.
If you want to know more about Medicare Supplement renewals, check out this previous post that looks at Medigap renewals in more detail.
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.
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Your Medicare Special Enrollment Period
If your employer has at least 20 employees and youre still working and covered under that plan when you turn 65, you can delay your enrollment in Medicare . In that case, youll get an eight-month special enrollment period to sign up for Medicare if and when you leave your job or your employer stops offering coverage. It will start the month after you separate from your employer, or the month after your group health coverage ends whichever happens sooner.
Sign up during those eight months, and you wont have to worry about premium surcharges for being late. And the eight-month special enrollment period is also available if youre delaying Part B enrollment because youre covered under your spouses employer-sponsored plan, assuming their employer has at least 20 employees.
But note that in either case, it has to be a current employer. If youre covered under COBRA or a retiree plan, you wont avoid the Part B late enrollment penalty when you eventually enroll, and you wont have access to a special enrollment period to sign up for Part B youll have to wait for the general enrollment period instead.
Medicaid Or Medicare Savings Programs
Medicare beneficiaries with limited income or very high medical costs may be eligible to receive assistance from the Medicaid program. There are also Medicare Savings Programs for other limited-income beneficiaries that may help pay for Medicare premiums, deductibles, and coinsurance. There are specified income and resources limits for both programs. Contact your local county Department of Social Services or SHIIP to apply for one of these programs.
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Does Medicare Have Its Own Version Of An Hsa
Medicare offers its own version of an HSA called Medicare Medical Savings Account plans. MSA plans are sold through private insurance companies.
The plans must be used with a high-deductible Medicare Advantage plan, which replaces Medicare Part A and Part B and are also sold through private insurers. These plans only kick in to cover your medical bills after you reach a high yearly deductible.
Money you contribute to an MSA can cover dental, vision, hearing and long-term care not covered by Medicare. They do not cover Medicare Part D prescription drug plans.
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.
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Who Needs To Sign Up For A Medicare Part D Plan
As you can see in the example above, the Part D penalty can be significant. With Part D premiums starting at around $15 in most states, most people find it beneficial to have at least minimal Part D coverage when they start with Medicare, even if their medication needs are non-existent.
If you are someone who does use prescription drugs, it certainly is beneficial to sign up for a Medicare Part D plan. The most advisable way to do this is to compare the plans based on how well they cover your specific medications. You can run a comparison on Medicare.gov to do this instructions for doing it are listed here.
If you have questions about your transition to Medicare Part D or anything else related to the transition you can reach us at 877.506.3378 or online.
If I’m In The Fehb Should I Enroll In Part A
Most people dont have to pay a premium for Part A. When combined with FEHB coverage, having Part A would limit your out-of-pocket costs for the expenses it covers . Having Part A means you cant contribute to a Health Savings Account , so youd want to delay enrolling in Part A if your FEHB coverage is HSA-qualified and you want to continue making contributions to your HSA.
You can only delay Part A until you begin collecting Social Security at which point your Part A coverage will start automatically. The Office of Personnel Management , which administers the FEHB, recommends taking Part A if you dont have to pay a premium.
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Medicare General Enrollment Period
If you did not enroll during the IEP when you were first eligible, you can enroll during the General Enrollment Period. The general enrollment period for Original Medicare is from January 1 through March 31 of each year. Keep in mind that you may have to pay a late enrollment penalty for Medicare Part A and/or Part B if you did not sign up when you were first eligible.
