When you retire, lose your employer coverage (COBRA doesn’t count! CA Health Care Advocates) you may then enroll in Part B Doctor visits, you will also have a special enrollment period to get Part D Rx and enroll in a Medi Gap Plan and Medicare Advantage. Yes, we know this is very confusing and hard to explain. If you would like to do a Zoom meeting, here’s our calendar to set it up.
So, basically, as long as you have great coverage at work, just sign up for Part A Hospital and then get Part B, supplements and Part D Rx when you retire. There might be issues if your wife wants to sign up late for Part B, as there are technical rules about it being employee coverage not COBRA, which could affect you too if you go on COBRA.
See Medicare & You Page 26 – Part B Special Enrollment Period. Be sure to review the brochures & links below or in the right hand column!
Anthem Medicare Supplement - Get Quotes, Information and ONLINE Enrollment - No extra charge for our help
If I have Employer Group Health Coverage
do I need to enroll in Parts A Hospital & B Doctor Visits?
No, as long as your employer coverage is credible. Check with your HR department and get it in writing.
Fewer than 20 employees.
You should sign up for Part A and Part B when you’re first eligible. Medicare will be primary and pays before your other coverage.
Ask your benefits manager whether you have group health plan coverage (as defined by the IRS). People with group health coverage based on current employment may be able to delay Part A and Part B and won’t have to pay a lifetime late enrollment penalty if they enroll later.
How you delay your coverage depends on your situation:
- If you’ll be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you’ll automatically get Part A and Part B. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday. If you don’t want Part B, follow the instructions that came with the card. If you keep the card, you keep Part B and will pay Part B premiums.
- If you won’t be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you don’t need to do anything when you turn 65.
It’s illegal for an employer to offer any incentives to encourage you to take Medicare and drop the employer plan! Coremarkins * The Age Discrimination in Employment Act (ADEA) prohibits employers with 20 or more employees from cancelling group health coverage for current employees due to age, even when such employees become eligible for Medicare. SHRM *
- Centers for Medicare & Medicaid Services employer web page
- Fact Sheet: Medicare decisions for someone nearing age 65
- Fact Sheet: Deciding whether to enroll in Medicare Part A or Part B when you turn 65
- Fact Sheet: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
- See our module in the upper right on Should I get A & B?
If you aren't eligible for premium-free Part A, and you don't buy it when you're first eligible, your monthly premium may go up 10%. You'll have to pay the higher premium for twice the number of years you could have had Part A, but didn't sign up.
Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period (SEP). If you're covered under a group health plan based on current employment, you have a SEP to sign up for Part A and/or Part B anytime as long as:
- You or your spouse (or family member if you're disabled) is working.
- You're covered by a group health plan through the employer or union based on that work.
You also have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
- The month after the employment ends
- The month after group health plan insurance based on current employment ends
Usually, you don't pay a late enrollment penalty if you sign up during a SEP.
COBRA and retiree health plans aren't considered coverage based on current employment. You're not eligible for a Special Enrollment Period when that coverage ends. This Special Enrollment Period also doesn't apply to people who are eligible for Medicare based on having End-Stage Renal Disease (ESRD).
If you have a Health Savings Account (HSA) with a High Deductible Health Plan (HDHP) based on your or your spouse’s current employment, you may be eligible for an SEP. To avoid a tax penalty, you should stop contributing to your HSA at least 6 months before you apply for Medicare. You can withdraw money from your HSA after you enroll in Medicare to help pay for medical expenses (like deductibles, premiums, coinsurance or copayments).
If you’re eligible for premium-free Part A, you can enroll in Part A at any time after you’re first eligible for Medicare. Your Part A coverage will go back (retroactively) 6 months from when you sign up (but no earlier than the first month you are eligible for Medicare).
If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, you may have to pay a penalty.
Premium-free Part A coverage:
- Begins 6 months back from the date you apply for Medicare (or Social Security/RRB benefits). To avoid a tax penalty, you should stop contributing to your Health Savings Account (HSA) at least 6 months before you apply for Medicare.
- Begins no earlier than the first month you were eligible for Medicare.
NOTE – WARNING!!!
Most people should enroll in Medicare Part A (Hospital Insurance) when they're first eligible, but certain people may choose to delay Medicare Part B (Medical Insurance). In most cases,
it depends on the type of health coverage you may have.
- You must pay your Part B premium every month for as long as you have Part B (even if you don’t use it).
- I'm currently working, and I have coverage through my job.
- I have coverage through my spouse who is currently working.
- I have retiree coverage (from my former employer or my spouse’s former employer) or COBRA coverage.
- I have TRICARE, and I'm a retired service member.
- I have TRICARE, and I'm an active-duty service member.
- I have CHAMPVA.
- I have End-Stage Renal Disease (ESRD).
- I have Marketplace Covered CA or other private insurance.
- I don't have any of these.
Medicare #Enrolling in Parts A & B # 11036
Our Webpage on Enrolling in Medicare A & B
- Part A Hospital rules for zero premium
- Part B – Doctors – How to sign up – Benefits
- How to apply for Part B during your special enrollment period # 10012
- Fact Sheet
Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65 15 pages
- Here's the CMS form to fill out L 564 E to get a special enrollment period, when you retire. VIDEO
- Here's the actual form to get Part B, if you already have Part A OMB No. 0938-1230 !
- If you need both, see our main webpage on Medicare Enrollment.
#Medicare10050 and You 2021
Everything you want to know - Read Along
- Enroll in Blue Cross
- Learn about UHC United Health Care
- Enroll in Blue Shield
- Don't like computers? Prefer a printed version be mailed to you? Audio MP 3
- Use our scheduler to Set a phone, Skype or Face to Face meeting
- #Intake Form - We can better prepare for the meeting
Plain English Medicare.Gov Special Enrollment periods
Official Details & Rules from
Medicare Managed Care Manual Chapter 2 Enrollment and Disenrollment
All Special Election Periods (SEP);
- Special election periods constitute periods outside of the usual times when an individual may elect a plan or change his or her current plan election.
- Here's the official technical Medicare Marketing Manual or simple
- plan English, Understanding Medicare C & D enrollment periods Pub # 11219 or see
- our section on materials & guides below, there are 36 various types of SEPs, including SEPs for dual eligibles, and for individuals whose current plan terminates, who change residence and who meet “exceptional conditions” as CMS may provide, consistent with §1851(e)(4) of the Act and §422.62(b) of the MA regulations.
- check with us about special enrollment, like when you turn 65 or lose coverage at work.
- Here's the official technical Medicare Marketing Manual or simple
How the Medicare Advantage Application #typically asks the "Special" Enrollment Period questions:
- I am new to Medicare.
- It's Open Enrollment October 15th through December 7th
- I am enrolled in a Medicare Advantage plan and want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP).
- I recently moved outside of the service area for my current plan or I recently moved and this plan is a new option for me. I moved on (insert date) –––––––––––.
- I recently was released from incarceration. I was released on (insert date) –––––––––––.
- I recently returned to the United States after living permanently outside of the U.S. I returned to the U.S. on (insert date) –––––––––––.
- I recently obtained lawful presences status in the United States. I got this status on (insert date) –––––––––––.
- I recently had a change in my Medicaid (newly got Medicaid, had a change in level of Medicaid assistance, or lost Medicaid) on (insert date) –––––––––––.
- I recently had a change in my Extra Help paying for Medicare prescription drug coverage (newly got Extra Help, had a change in the level of Extra Help, or lost Extra Help) on (insert date) –––––––––––.
- I have both Medicare and Medicaid (or my state helps pay for my Medicare premiums) or I get Extra Help paying for my Medicare prescription drug coverage, but I haven’t had a change.
- I am moving into, live in, or recently moved out of a Long-Term Care Facility (for example, a nursing home or long-term care facility). I moved/will move into/out of the facility on (insert date) –––––––––––.
- I recently left a PACE program on (insert date) –––––––––––.
- I recently involuntarily lost my creditable prescription drug coverage (coverage as good as Medicare’s). I lost my drug coverage on (insert date) –––––––––––.
- I am leaving employer or union coverage on (insert date) –––––––––––.
- I belong to a pharmacy assistance program provided by my state.
- My plan is ending its contract with Medicare, or Medicare is ending its contract with my plan.
- I was enrolled in a plan by Medicare (or my state) and I want to choose a different plan. My enrollment in that plan started on (insert date) –––––––––––.
- I was enrolled in a Special Needs Plan (SNP) but I have lost the special needs qualifications required to be in the plan. I was disenrolled from the SNP on (insert date) –––––––––––.
- I was affected by a weather-related emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA). One of the other statements here applied to me, but I was unable to make my enrollment because of the natural disaster
You must let United Health care know if you are enrolled, or eligible to enroll, in Medicare (Part A and/or Part B coverage). UnitedHealthcare is typically primary (that is, UnitedHealthcare’s benefits are determined before those of Medicare) to Medicare for some initial period of time, as determined by the Medicare regulations. After the initial period of time, UnitedHealthcare will be secondary to Medicare (that is, the benefits under this Health Plan will be reduced to the extent they duplicate any benefits provided or available under Medicare, if the Member is enrolled or eligible to enroll in Medicare.)
If you have group health insurance through a plan that either you or your legal spouse received through and Employer Group that you are actively working at, that insurance is primary over Medicare. However, there are three exceptions to this rule:
1. Employer Group with less than 20 Eligible Employees;
2. Disabled individual; or
3. Members who are entitled to Medicare due to End Stage Renal Disease (ESRD).
Medicare is primary for Employer Groups that have fewer than 20 full-and part-time Eligible Employees. Also, Medicare is primary for disabled Members if their Employer Group has fewer than 100 Eligible Employees.
If you have questions about the coordination of Medicare benefits, contact your Employer Group or our Customer Service department. For questions regarding Medicare eligibility, contact your local Social Security office. Or email [email protected] UHC EOC Evidence of Coverage *
Employer Dependent Definition – Up to Age 26
Excerpt from Medicare Rights.org
Links, References & Resources
See Medicare Publication 02179 for information on having dual coverage with Medicare.
Kaiser Information & FAQ’s
Transition Employer Plans to Medicare
Since you have coverage through work, you can probably postpone enrolling in Part B – Doctor Visits and Part D Rx.
Learn More ===>
- Medicare.gov – should I get part B?
- Publication 11036 Enrolling in Parts A & B and
- Medicare & You #10050
- Can you postpone Part A enrollment if you are covered under a Employer Group Plan?
- Early Retirement – What Health Insurance?
- Transitioning from Employer Group Coverage to Medicare
- Dual Coverage?
the horses mouth on if you should get Part B Doctor Visits, how to enroll, COBRA Traps, etc.