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The Road Leading to Medicare – Planning the Trip

If you or a loved one will be eligible for Medicare soon, it’s important to become educated about the various coverage options available, including Medicare health plans, supplemental (Medigap) health insurance and prescription drug coverage. Planning ahead now and familiarizing yourself can help to avoid potentially costly issues later. This article should help to guide you in the right direction…

Items to consider

  • Ways to prepare for Medicare
  • When and how to enroll in Medicare
  • Choices in health insurance to supplement Medicare
  • Information for those planning to work beyond age 65
  • Resources for obtaining additional information and assistance

Learn more about Medicare and how it relates to your circumstances

  • If you or your spouse has paid into the Social Security System for 10 or more total years (40 quarters), you are eligible for premium-free Medicare Part A (Hospital Insurance) at age 65. Otherwise you may purchase it. Everyone pays a monthly premium for Medicare Part B (Medical Insurance).
  • If you have been on Medicare due to disability, you have a brand new six-month Open Enrollment Period for purchasing Medicare supplemental insurance when you turn 65.
  • If you have an employer group health plan (EGHP) that will continue to pay secondary after you become eligible for Medicare, you’ll want to study the benefits booklet to learn about the cost and benefits of the plan, or speak with your employer’s benefits officer. Then determine if you should keep your EGHP as secondary to Medicare or if you need to drop it and purchase a Medicare supplement policy or join a Medicare Advantage plan. If your EGHP has drug benefits, make sure they are as good as or better than Medicare Part D Prescription Drug coverage.
  • If your EGHP is not an option, investigate other health insurance choices such as a Medicare supplement policy (Medigap), a Medicare Advantage plan or Medicare Prescription Drug Plan.
  • Get a copy of the Medicare & You Handbook or The Guide to Health Insurance for People with Medicare from Medicare. Understanding what Medicare does and does not cover will give you an idea of the health care costs you may incur. Both books are available for instant download. (See the resources below.)

Automatic Enrollment

If you already receive Social Security, Railroad Retirement, or Federal Retiree benefits, your enrollment in Medicare will be automatic. Your Medicare card should arrive in the mail shortly before your 65th birthday. Check it to confirm that you’re entitled to Medicare Part A and B.

Initial Enrollment

If not eligible for Automatic Enrollment, you may contact the Social Security Administration at 800-772-1213, enroll online at www.socialsecurity.gov, or visit the nearest Social Security office to enroll. You’ll have a seven-month window in which to enroll in Medicare without incurring a penalty. This is typically three months before your 65th birthday, the month of your birthday, and up to three months after. ||

During this same Initial Enrollment Period, you may also enroll in a Medicare Prescription Drug Plan (PDP) available under Medicare Part D. Enrollment is voluntary, although penalties may be incurred if you choose to delay enrollment.

General Enrollment

If you do not enroll in Medicare during your Initial Enrollment Period, you will not be able to enroll until the next General Enrollment Period, which is January 1 through March 31 each year (unless you are entitled to a Special Enrollment). Your Medicare eligibility will not begin until the following July 1. Your monthly Medicare Part B premium will also increase to include a permanent 10 percent penalty for each year of delayed enrollment (unless eligible for Special Enrollment).

Working Past 65 (Special Enrollment)

If you are actively working at age 65, are covered by an employer’s group health plan (EGHP) and the company has 20 or more employees, you may be able to delay enrolling in Medicare Part B coverage without penalty. You will still be eligible for Part A without paying a premium (as long as you or your spouse has 40 credits/10-years of work history).

  • Talk to your employer’s benefits officer about company health insurance options for people who continue working past age 65. Ask specifically how many hours you must work to keep your health insurance plan and whether it will be considered as “primary” or “secondary” coverage to Medicare.
  • If your EGHP is primary to Medicare, you do not have to enroll in Medicare Part B at this time. You will need to do so within eight months of the EGHP’s termination of coverage or when it stops being primary. If your EGHP will be secondary to Medicare despite active employment, you must enroll in Medicare Part B during your Initial Enrollment Period to avoid future penalties. If you voluntarily disenroll from your EGHP before terminating your employment, you could lose any EGHP benefits when you retire.
  • Contact the Social Security Administration at 800-772-1213 or www.socialsecurity.gov or the nearest Social Security Administration office to confirm that you have enrolled in Medicare Part A (Hospital Insurance).
  • Give written notice to your company of your intention to continue working after age 65. When you decide to stop working, notify the Social Security Administration immediately. It is also advisable to notify them that you or your spouse, if covered under your EGHP, will continue to work beyond age 65.

Medicare Supplemental Coverage (Medigap)

Medicare is a major medical plan that provides a basic foundation of benefits. However, it does not pay 100 percent of all medical bills. Medicare beneficiaries are responsible for premiums, deductibles, and coinsurance. These amounts can be significant, therefore most beneficiaries need some kind of plan, policy or program to help fill in these coverage “gaps.”

Medicare Supplement Insurance – See the related article.

Medicare Advantage (Medicare Part C) – See the related article.

Medicare Prescription Drug Coverage (Medicare Part D) – See the related article.

Military Retiree Coverage

If you or your spouse have military benefits (TRICARE for Life), you may not need additional insurance. Review the costs and benefits and contact TRICARE or Medicare to learn how your coverage works with Medicare.

Medicaid or Medicare Savings Programs

Medicare beneficiaries with low income or very high medical costs may be eligible to receive assistance from the Medicaid program. There are also Medicare Savings Programs for other low-income beneficiaries that may help pay for Medicare premiums, deductibles, and coinsurance. There are specified income and resource limits for both programs. Contact your local Department of Social Services to apply for one of these programs if you feel assistance is needed.

To Get Help

  • Medicare • 800-633-4227 or www.medicare.gov
  • Social Security Administration • 800-772-1213 or www.socialsecurity.gov
  • Your Employer Benefits Representative
  • Your local Department of Social Services (DSS)
  • TRICARE for Life • 877-TRICARE (877-874-2273) or www.tricare.mil

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