medicare sign-up - Life After 50 Expo

Dear Marci,

February 24, 2016 By Medicare Rights Center

Dear Marci,

When I become eligible for Medicare, what do I need to know about signing up for Part D?

– Isaac (Concord, NH)

Dear Isaac,

When you become eligible for Medicare, you can sign up forPart D, the prescription drug coverage part of Medicare, as soon as you are enrolled in either Medicare Part A or Part B. You do not necessarily have to sign up for Part D, but you may face a late enrollment penalty if you do not sign up when you are first eligible. That said, if you have creditable coverage (discussed below), you can delay signing up for Part D and will not have to pay a late enrollment penalty.

Creditable coverage is coverage that is, on average, as good as or better than the Medicare drug benefit. You should receive notice from your plan or employer every year informing you whether your drug coverage is creditable for Part D. If you do not receive this notice, you should contact your plan or employer’s benefits administrator.

Creditable coverage can be from:

Current employer coverage from you or your spouse
Former employer coverage from you or your spouse, such as retiree insurance
Federal Employee Health Benefits
Military coverage, such as TRICARE for Life (TFL) or Veterans’ Affairs (VA) benefits

If you currently have creditable coverage that you like, you may want to keep it. If you join a Medicare prescription drug plan, you may lose your creditable drug coverage and be unable to get it back later. Ask your employer or benefits administrator what will happen to your other drug coverage if you join a Part D plan.

Although you will not face a Part D late enrollment penalty if you have creditable drug coverage, if you do not sign up for Part D when you are first eligible, you will have to wait until Fall Open Enrollment (October 15 through December 7 every year) to do so— unless you have a Special Enrollment Period (SEP). An SEP allows you to enroll in a Medicare Part D plan at other times during the year. For example, if you lose your creditable drug coverage through no fault of your own, you will have an SEP to enroll in Medicare Part D. This Special Enrollment Period lasts for two months after the month you lost creditable drug coverage. For example, if you have creditable drug coverage through your current employer, and you lose that coverage in May because you stopped working, then you would have until the end of July to sign up for Part D. Other SEPs apply to different circumstances and have different durations.

Remember, if you are eligible for Medicare but have prescription drug coverage that you want to keep, it is important to find out if the coverage is creditable. You should keep records of your creditable drug coverage for as long as you have it so that you can provide proof of coverage if needed.

– Marci

Dear Marci !

June 17, 2015 By Jim Long

Dear Marci,

I am turning 65 soon, but I still plan on working for a few years. My employer gives me health insurance, but I am not sure whether I have to enroll in Medicare. Do I have to enroll in Medicare if I am still working?

– Bruce (Cleveland, OH)

Dear Bruce,

You may have to enroll in Medicare while you are still working, but it depends on what type of coverage you have from your current employer and how it works with Medicare.

Medicare Part A (hospital insurance) is premium-free if you or your spouse worked in the United States for 10 years or more. Many people choose to enroll in Part A when they are first eligible, since they do not have to pay a monthly premium. If you qualify for premium-free Part A, you can enroll in Part A at any time.

However, everyone has to pay a monthly Part B premium, which is $104.90 for most people in 2015. When you sign up for Medicare, you are automatically enrolled in both Medicare Parts A and B. However, you have the option to turn down Part B, but you should use great caution before delaying your Part B coverage.

You should only consider delaying Part B coverage if you confirm two things. First, you must have health insurance from a current employer (or a spouse’s current employer). If you have coverage from your (or your spouse’s) current employer, you qualify for a Special Enrollment Period (SEP) to enroll in Medicare Part B later and will not face penalties or periods without coverage. If your insurance does not come from your or your spouse’s current work, you do not qualify for this SEP. Note that retiree insurance and COBRA coverage do not count as coverage from a current employer.

Second, you should only consider delaying Part B coverage if your current employer coverage pays firstand Medicare pays second. In other words, only consider delaying Part B if your employer coverage does not change how much it pays for your care after you qualify for Medicare. If you are 65 of older, health insurance from your (or your spouse’s) current employer pays first if the organization has 20 or more employees (note that if you are under 65 and disabled, the organization must have 100 or more employees).

On the other hand, you should enroll in Medicare Part B when you first qualify if your employer coverage only pays for your care after Medicare pays. If Medicare pays first and you fail to enroll, your employer coverage can reduce its payment or refuse to pay anything for your health care. Medicare usually pays first if you work for an organization with less than 20 employees.

To find out how your specific employer coverage works with Medicare, talk to your employer and get the information in writing. Also, confirm this information with the Social Security Administration (SSA), especially if you plan on delaying Part B enrollment. When you call Social Security, it is important to write down who you spoke to and the details of your conversation.

-Marci

Dear Marci !

June 2, 2015 By Jim Long

Dear Marci,

I turn 65 this December, and I’m anxious about enrolling in Medicare on time. I do not want to miss my first chance to enroll, because I heard that you pay penalties if you don’t enroll right away. What steps should I take to make sure I don’t make Medicare enrollment mistakes?

– Lara (Baton Rouge, LA)

Dear Lara,

The steps you should take to enroll in Medicare on time will differ depending upon whether or not you already collect Social Security retirement benefits when you turn 65.

If you already receive Social Security when you turn 65, the federal government will automatically enroll you in Medicare. Your Medicare will start on the first of the month you turn 65, which is December. You do not need to sign up for Medicare.

On the other hand, if you do not receive Social Security when you turn 65, you must take action to apply for Medicare. To avoid higher costs down the line, you must enroll during your Initial Enrollment Period (IEP). Your IEP includes the three months before, the month of, and the three months following your 65th birthday. For you, your IEP will span from September 2015 to March 2016, since your 65^th birthday is in December. If you enroll in Medicare during this seven month period, you will avoidlate enrollment penalties and gaps in health insurance coverage.

The date your Medicare coverage begins depends on when you enroll during your IEP. For your coverage to begin as soon as possible, it is best to enroll in the first three months of your IEP (the three months before the month you turn 65). Your Medicare coverage will then go into effect starting the first day of the month you turn 65. If you enroll during the month you turn 65, your Medicare coverage will go into effect the following month. If you enroll during the fifth month of your IEP, your Medicare coverage begins two months after you enroll. If you enroll during the sixth or seventh month of your IEP, your coverage begins three months after you enroll.

If you enroll in Medicare at any point during your IEP, your enrollment will be considered timely. You will not face any late enrollment penalties. To enroll in Medicare, you can call the Social Security Administration at 800-772-1213 or you can visit your local Social Security office.

When you enroll in Medicare (either actively during your IEP or automatically), you receive Medicare Parts A and B. Most people do not pay a premium for Part A, but almost all people owe a premium for Part B.

Understand that you will have the option to turn down Part B, but you should use great caution before declining Part B coverage. You should only consider delaying Part B if you confirm two essential things. First, you must have coverage from your or your spouse’s currentemployer. If are insured by your own or your spouse’s current employer, you have special permission, called a Special Enrollment Period, to enroll in Part B later without risking higher costs and periods without coverage. Second, you must verify that your current employer coverage will pay the same amount for your care as it did before you qualified for Medicare. In other words, ensure that your employer coverage pays first on claims before Medicare pays. Insurance that pays first on claims is called primary coverage. You should always enroll in Medicare Part B right away if your employer coverage is not primary to Medicare (meaning it pays after Medicare on insurance claims). If Medicare is supposed to pay first and you fail to enroll, the employer plan may pay little to none of your health care costs.

Keep in mind that how your current employer coverage is affected by your Medicare eligibility largely depends on the size of the employer. If you have current employer coverage, talk to your employer to find out how yourcoverage works with Medicare. Verify this information with Social Security before making any final decisions about Part B coverage.

-Marci