How confident are you in your understanding of Medicare eligibility and enrollment?
Do you know when eligibility begins, where to enroll, and how?
Do you know the effect Medicare will have on other coverage you may have?
Do you know the costs and penalties associated with Medicare?
These are a few questions to consider when nearing age 65 and/or Medicare eligibility.
Here are important periods to remember when you become eligible for Medicare:
Initial Enrollment Period - The IEP is three months before, the month of, and three months after your 65th birthday. If your birthday is on the first day of the month, your coverage can start the first day of the prior month.
Special Enrollment Period - The SEP is any time after your IEP where you may still have a chance to sign up for Medicare. Usually, you won’t have to pay a late enrollment penalty if you sign up during a SEP, and this period doesn’t apply if you’re eligible for Medicare based on End-Stage Renal Disease.
General Enrollment Period - The GEP is January 1 – March 31 each year. If you don’t sign up during your IEP, and you don’t qualify for a SEP, you can always sign up during this period. Higher Part A and/or Part B premiums may apply for late enrollment.
It’s not recommended to navigate Medicare enrollment alone. Penalties are incurred when enrollment isn’t completed timely, and claims may be billed improperly if other coverage is involved.
Not only do you need to adhere to enrollment periods, but you must also assess whether your Medicare enrollment will disrupt coverage you already have. In some instances, you can keep the coverage you have along with Medicare. In other instances, it may be beneficial to change your coverage altogether. Medicare is not “one size fits all,” it is unique to everyone’s situation.
The smoothest and recommended approach to transitioning to Medicare:
1. Visit your local Social Security Administration during the three months before the month of your 65th birthday, the start of your IEP. You will want to:
i. Enroll in Medicare Parts A and/or B if you aren’t automatically enrolled due to receiving Social Security or Railroad Retirement benefits; being under age 65 and disabled; or having ALS, known as Lou Gehrig’s disease.
ii. Determine your qualification for Extra Help with Part D costs or other state assistance programs based on income and resource limits. You can apply for Extra Help and Medicare Savings Programs at the same time.
2. Talk with your employer or union HR/benefits administrator, Medicaid case manager, or VA representative, to find out how current coverage will work with Medicare once you become eligible.
Additional situations that may affect your transition to Medicare:
If you have employer or union coverage, it might be to your advantage to delay Part B enrollment while you still have health coverage based on your or your spouse’s current employment.
If you have TRICARE, you generally must sign up for Part A and Part B when you’re first eligible, in order to keep it. However, active-duty service or family members don’t have to sign up for Part B to keep TRICARE coverage.
If you have CHAMPVA, enrollment in both Part A and Part B is required to keep CHAMPVA coverage.
If you have Medicaid and don’t have Medicare Part B, Medicaid may help you sign up for it. Medicare will pay first, and Medicaid will pay second.
If you have Health Savings Account-qualified coverage, you aren’t eligible to contribute to an HSA after you have Medicare. To avoid a tax penalty, you should make your last HSA contribution the month before your Part A coverage begins.
If you have Marketplace coverage, you should sign up for Medicare when you’re first eligible to avoid the risk of delayed Medicare coverage and the possibility of a Medicare late enrollment penalty.
Additional Marketplace matters to consider:
End your Marketplace coverage in a timely manner when you become eligible for Medicare to avoid an overlap in coverage.
Once eligible for Part A, or already enrolled, you won’t qualify for help paying your Marketplace plan premiums or other medical costs. If you continue to get help paying Marketplace plan premiums after you have Medicare, you may have to pay back some or all of the help you got when you file your federal taxes.
Set an appointment with a trusted adviser or agent for Medicare education. Whether it’s an in-home visit, lunch date, recorded phone discussion, or virtual meeting, unbiased resources are necessary for appropriate coverage decisions that will serve you best in the long run.
Kim Parker is an independent insurance adviser focused on helping individuals, families, and employers make informed decisions on insurance coverage and benefits. Contact Kim at 810.350.4117 or kim@47benefits.com.
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