Dear Marci, - Life After 50 Expo

Dear Marci,

I am going to be 65 soon but am still working and covered by my employer plan. I qualify for premium-free Part A, but do not want to take Part B yet. Should I enroll in Part B when I become eligible?

– Mia (San Luis Obispo, CA)

Dear Mia,

The answer to this question depends on your specific situation. Generally speaking, you can delay enrolling in Part B (and not enroll during your Initial Enrollment Period (IEP)) without incurring a late-enrollment penalty if you are still working or your spouse is still working and you have insurance from that work. Before delaying Part B enrollment, there are a few things you should consider.

The first is how and when you will sign up for Part B when your employer insurance ends. Because you are still working, you will be eligible for a Part B Special Enrollment Period (SEP). This enrollment period allows beneficiaries who delay Medicare enrollment while they are covered by their or their spouse’s current employer insurance to enroll later. You will not have to wait for the General Enrollment Period (GEP) that runs from January through March, and you will not have a penalty for delaying enrollment. Your SEP runs from now through eight months after the month in which you stop working, or your insurance ends, whichever comes first.

The next thing you should consider is how Medicare will work with your current employer insurance. When someone has Medicare and an employer group health plan, Medicare either pays first or second in coordination with the employer plan.

1. Medicare pays secondary to your current employer insurance if your company has 20 or more employees. This means that your employer insurance will pay first on health care claims, and then Medicare may pick up some or all of the remaining costs. If this is the case, you can delay Part B without creating a gap in coverage.

2. Medicare pays primary to your current employer insurance if your company has fewer than 20 employees. In this case, should sign up for Part B. If you delay Part B enrollment and continue to use your employer coverage as your primary insurance, you may run into problems. For example, your employer insurance may take back payments it made mistakenly as the primary insurance while you were Medicare-eligible.

If you decide to delay Part B enrollment you should call the Social Security Administration at 800-772-1213 or visit a local office to let them know. You should ensure you fully understand the consequences of delaying enrollment. Keep a record of your conversation with the Social Security staff. You should also keep record of your employer coverage for the time you are covered because you will need this information when you sign up for Part B at a later time.

Delaying Part B enrollment involves making sure you can enroll in Part B later without a penalty or gap in coverage. You should also make sure your current insurance will continue to provide adequate coverage. It is important to consider your situation carefully before delaying enrollment in Part B.

– Marci