Medicare Basics
What is Medicare?
Medicare is a federal health insurance program that gives you access to specific coverage and benefits. Medicare is different from health insurance you may have had before. It offers you a variety of coverage options — and it has key enrollment dates and guidelines you need to follow. We’re here to help you make sense of it all.
How is Medicare Different From Other Health Insurance?
You may be surprised at the differences between Medicare and other types of health insurance. If you’ve had health coverage through your employer, your plan likely included medical and prescription drug coverage, along with other benefits. It also may have covered both you and your spouse.
Medicare only covers one person at a time. This means you and your spouse must enroll separately. In addition, Medicare gives you options that can make it possible to receive your benefits in a variety of different ways.
You can:
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Choose hospital and medical coverage delivered through the federal government.
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Add prescription drug coverage delivered through a private company.
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Purchase a supplemental insurance policy from a private insurer that can help cover some of the costs.
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Choose coverage from a private insurer that combines hospital, medical and often prescription drug coverage into one plan.
In short, with Medicare you can choose coverage that fits your needs, budget and lifestyle. We can help you take full advantage of that freedom.
Who is Eligible for Medicare?
Medicare is a federal health insurance program that gives you access to specific coverage and benefits. Medicare is different from health insurance you may have had before. It offers you a variety of coverage options — and it has key enrollment dates and guidelines you need to follow. We’re here to help you make sense of it all.
When and How Do I Enroll in Medicare?
If you’re like most people, you’ll enroll in Medicare around the time you turn 65. Your Initial Enrollment Period begins three months before your 65th birthday, includes the month you turn 65 and ends three months after that birthday.
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Keep in mind that if you don’t get Medicare during this Initial Enrollment Period, you may have to pay Medicare Part B or Part D late enrollment penalties. Plus, you could be missing out on coverage and benefits that can help protect your health and finances. That’s why it’s generally a good idea to enroll as soon you can. How you enroll generally depends on if you’re getting benefits from Social Security, the Railroad Retirement Board or the Office of Personnel Management.
If You Are Receiving Benefits From Social Security or the Railroad Retirement Board
You will automatically get Medicare Part A and Part B starting the first day of the month you turn 65 If you are receiving benefits from either Social Security or the Railroad Retirement Board at least four months prior to your 65th birthday,
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If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.
If you are not receiving benefits from Social Security or the Railroad Retirement Board
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You’ll need to sign up with Social Security to get Medicare Part A and Part B.
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You can apply online at socialsecurity.gov, at your local Social Security office or by calling Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).
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If you worked for a railroad, call the RRB at 1-877-772-5772.
If You Are Under Age 65 and Have a Qualifying Disability
You will automatically get Part A and Part B:
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After you get disability benefits from Social Security for 24 months.
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After you get certain disability benefits from the RRB for 24 months.
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The month your disability benefits begin if you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s Disease).
If you have ESRD (End-Stage Renal Disease),
you can choose to enroll in Part A and Part B:
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You’ll need both Part A and Part B to qualify for the full benefits that cover certain dialysis and kidney transplant services.
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You can apply online at socialsecurity.gov, at your local Social Security office or by calling Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).
What If I Continue to Work Past the Age of 65?
Are you planning on working past age 65? When it comes to Medicare eligibility, there are a few key things to consider. If you are still employed and receive health coverage through a large employer (20 employees or more), you may have the option to delay enrolling in Medicare without facing penalties. However, it's important to note that once you do decide to enroll in Medicare, you will need to do so within a specific timeframe to avoid any late enrollment penalties. On the other hand, if you work for a small employer (less than 20 employees), you may need to enroll in both Medicare Part A and Part B once you turn 65, as Medicare would become your primary insurance. Understanding your options and the rules surrounding Medicare enrollment can help you navigate this process smoothly.
Delaying Medicare Part A and Part 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 (or your spouse's) 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.
Delaying Medicare Part A
Medicare Part A is usually premium-free for most people, so you could opt to enroll in only Part A while still working. However, if you have a health savings account (HSA), be aware that once you enroll in any part of Medicare you cannot continue to make contributions to your HSA.
You may want to delay Part A if you have an HSA and want to continue contributing to it. If you decide to get Medicare coverage and stop contributing your HSA, you can continue to use the funds for qualified medical expenses — including some Medicare costs.
Enrolling in Only Medicare Part B
Medicare Part B charges a premium. Some people who work past 65 and have employer coverage delay enrolling in Part B just to postpone paying the premium and then sign up later during a Special Enrollment Period. If you don’t qualify for a Special Enrollment Period, even if you’re still going to work past 65, you need to get Part B during your Initial Enrollment Period to avoid financial penalties.
Before You Delay Medicare Enrollment, Ensure You Have Creditable Insurance.
Before you officially delay Medicare, make sure you have creditable drug coverage. This means your employer health and drug coverage is at least as good as the standard Medicare Part B and D plans coverages. 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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Are you planning to work past age 65 and delay Part B?
Are you planning on working past age 65? When it comes to Medicare eligibility, there are a few key things to consider. If you are still employed and receive health coverage through a large employer (20 employees or more), you may have the option to delay enrolling in Medicare without facing penalties. However, it's important to note that once you do decide to enroll in Medicare, you will need to do so within a specific timeframe to avoid any late enrollment penalties. On the other hand, if you work for a small employer (less than 20 employees), you may need to enroll in both Medicare Part A and Part B once you turn 65, as Medicare would become your primary insurance. Understanding your options and the rules surrounding Medicare enrollment can help you navigate this process smoothly.
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Conclusion
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Medicare rules and regulations can be confusing. This is especially true when it comes to delaying Medicare. A mistake on delaying Medicare can be very costly. We recommend giving a Medicare Advisor like us at Health & Life Solutions, Inc. a call to make sure you get all of your questions answered. Give us a call at 217-290-1768.
