Medicare Part A Hospital, B Doctor Visits

or my Employer’s Insurance Coverage Group Health Plan?

What about Special Enrollment Periods SEP  when I’m no longer covered by Employer Group Health Coverage?

Introduction

Medicare & Employer Health Plans?

If you are covered by an Employer Group Health Plan Health Care Advocates Definition, then when you or your spouse turn 65 and become eligible  for Medicare Part A Hospital and Part B Dr. Visits, there are several things to look into, check out and make decisions on:

Does your employer have more or less than 20 Employees?

If your Employer Group Insurance has
#Fewer than 20 employees

.

If you work for an employer who has fewer than 20 employees, Medicare will be primary and pays before your other coverage.   You MUST  sign up for Part A and Part B *  when you’re first eligible.

If you don’t enroll in Part B  when you’re first eligible, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.  The  Part B General Enrollment Period is quite confusing and unbelievable on how long you might have to wait. 

Just Turning 65?  Less than 20 Employees

Enroll 1st in Medicare Parts A Hospital and B Dr. Visits

Then we can help you with Medi Gap, Part D Rx  or Medicare Advantage 

FAQ

Staying on Employer Plan

  • I turned 65 a few months ago, I’m still working and I’ve stayed on my employers group plan.
    • 1. If I cancel my current medical insurance, with my employer, then I guess I would need to sign up for Medicare part “B”, right?
    • 2. My income probably falls into the first tier so there would be a premium of $134 +/-
    • 3. Then I would need a Medicare Supplemental plan like my High Deductible F so another premium of $75 or so, right?
    • 4. Then another supplemental Prescription Plan Part D with a premium of around $40
    • 5. Also, my Granddaughter, whom I have legal custody of is on my group plan, so I would need to get individual coverage for her, right?
    • 6. I believe that was around $350 for a plan I liked.
    • 7. So I would end up with an estimated monthly expense of:   Part B Medicare $134   Plan Hi F Medi Gap $75  Part D Rx $40   Individual Plan for Grand daughter   $350   For a total of $599
    • 8. On Medicare Part “B” how would she pay that premium?  A. Monthly bank withdrawal?
  • Answer

Medicare vs employer group when there are 

#more than 20  employees

employer certification of group health insurance for medicare

How you delay your Medicare 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 *

Links, Resources & Bibliography

FAQ’s

#Important
Let your Employer know you’re eligible for Medicare A & B

 

You must tell your employer if you are enrolled, or eligible to enroll, in Medicare (Part A and/or Part B coverage).  Your boss is mandated to tell Medicare who is working there and is eligible for Medicare.

waiver uhc

 

 

General Information on

  • Medicare A Hospital
  • Medicare B Dr. Visits

#Medicare10050 and You  2024
Everything you want to know 

Steve's video on Medicare & You

***********

your medicare benefits # 101116

 

Medicare Part A
(#Hospital Insurance)

Medicare Part A Hospital coverage helps pay for care in hospitals as an inpatient,... skilled nursing facilities, hospice care, and some home health care (see publication # 10969) but not Long Term Care.  

Most people get Part A automatically when they turn age 65 at no charge, since they or a spouse paid Medicare taxes while they were working.  You need to sign up close to your 65th birthday, even if you will not be retired by that time. (If you are getting Social Security benefits when you turn 65, your Medicare Hospital Benefits - Part A - start automatically.) 

Here's a chart it's just a illustration and is NOT official  that shows what Medicare pays, the gaps in Medicare and what you may get when you add a Medi Gap Plan or Medicare Advantage to cover those gaps

.Steve's VIDEO Explanation Comparing what Medicare pays and what you get extra with MAPD or Medi Gap

Part A Coverage medicare - Medi Gap PLan G

Special Enrollment Periods  SEP 
When you lose Employer Coverage

Special Enrollment Period SEP for Medicare Parts A & B 

When you #lose or give up Group Health Coverage
Watch for the Deadlines!

When you retire, decide you don’t want or lose your employer coverage (COBRA doesn’t count! CA Health Care Advocates)   you may then have an SEP Special Enrollment Period to enroll in Part B Doctor visits, without penalty.

Medi Gap

Pays the 20% Medicare doesn’t – ANY MD, ANY Hospital*

Guaranteed Issue for Medi Gap

 

Introduction to #MediGap

2024 Choose Medi Gap Policy

Our video explaining the Governments brochure on choosing a Medi Gap Policy.  Click the little square on the right, to enlarge the video.

When you enroll in Medi Gap beyond age 65 for Part B as you had
Qualifying #Employer Coverage

 

Termination of Employment or Retirement Plan

You have the right to purchase a Medi-gap policy for 6 months if your, your spouse’s or a family member’s current employment or retirement plan coverage terminatesor you lose your eligibility due to divorce or death of a spouse or family member.

The 6-month period to apply for a Medigap policy starts on the date you receive notice that your health benefits will end. If you do not receive advance notice, the 6-month period starts the date the benefits end or the date of your first denied claim. This protection of California law applies whether your group health benefits were primary or secondary to Medicare.

Our webpage on the pros & cons of Employer Coverage vs Medicare

Loss of COBRA or Cal Cobra

You are also entitled to this protection when you become eligible for COBRA  (Our webpage on COBRA)  or have used up all your COBRA benefits. It does not apply if you stop paying COBRA premiums before you use all your benefits. COBRA benefits are always secondary to Medicare benefits unless you have ESRD Renal Kidney Failure and are in a 30-month coordination period. For more information on COBRA, see Medicare & Other Health Insurance.  CA HealthCare Advocates *

COBRA and Medicare are VERY VERY confusing.  Double check with us [email protected]  on your specific situation!!!

Situation 4  From Medi Gap Guaranteed Issue Guide

Guaranteed Issue Loss of Employer Coverage

You received notice of termination, or your coverage was terminated from any employer-sponsored health plan, including an employer-sponsored retiree health plan. This includes termination for loss of eligibility due to divorce or death of a spouse.

Situation  11 from Medi Gap Guaranteed Issue Guide 

 

situation 11 employer plans

 

  • You enrolled in an employer-sponsored health plan that supplements Medicare, §419 (e) Welfare Benefit Plans   and either of the following apply:
    • The plan either terminates or ceases to provide all of those supplemental health benefits to you; or
    • The employer no longer provides you with insurance that covers all of the payment for the 20% coinsurance.
  • Why is there Both situation 4 and 11?
  • See our main page on loss of employer coverage

MAPD  Medicare Advantage &

Part D Rx 

#Understanding Medicare Advantage Plans (PDF) #12026

Watch Steve's Video Seminar

Insurance Companies get a average $2k  fee from the Federal Government, when you enroll in an MAPD plan. Kff *   MAPD Plans must cover all A & B services Medicare.Gov *

That's why the premium is very low or ZERO!

Prescription Drug 2022 #RxGuide
PDF # 11109

part d video explanation

 

*****************

Coverage Gap - Donut Hole $2,000 Cap

******************

Medicare Advantage Guaranteed Issue 

When you lose Employer Coverage

guaranteed issue MAPD & Rx loss of employer plan

Our webpage on Guaranteed Issue & Enrollment Periods for MAPD Medicare Advantage & Part D Rx

Just Enter your census or securely send us an excel spreadsheet or a list of employees and get instant proposals for California

employer small group quotes

 

Schedule a Skype, Zoom, Phone or Face to Face meeting

 

  • I’ve retired early, I’m not 65 yet  What do I do for Health – Medical Insurance?
    • ***There are plenty of Health Plans in the Individual Market.  Get quotes hereIf your MAGI income is below 400% of Federal Poverty Level you may even qualify for subsidies – tax credits.  Get a complementary quote, benefits, rates & subsidy calculation for California here.   If you are 62+ and getting Social Security some of your Social Security is taxable and counts towards MAGI income for subsidies.  If you are disabled, you get Medicare after two years of SSDI.   If you can really live on a budget or are unfortunately forced to,  there is Medi-Cal if you are under 138% of Federal Poverty Level.  We don’t get paid to help you with that, so just contact Medi-Cal directly.   Check out the Retirement Section of our website.
  • I retired from North Carolina State University july 2018.   They told me that they would supplement my medicare to the same level of medical insurance I had before, but when I asked them how to enroll for that they were less than helpful.   I have social security and they pay a monthly premium  I don’t know whether I am enrolled or what to do to enroll or what exactly I am covered for or what to do.
  • Are Medigap policies written during the 8-month Special Enrollment Period issued subject to the same terms as terms, with regard to pre-existing conditions, as those written during the Initial Enrollment Period?
  • How do I show Medicare that I had qualifying employer coverage?
  • What Happens If I Don’t Take Part B as Soon as I’m Eligible?
    • ***If you do not enroll in Medicare Part B during your initial enrollment period, you must wait for the general enrollment period (January 1- March 31 of each year) to enroll, and Part B coverage will begin the following July 1 of that year. If you wait 12 months or more, after first becoming eligible, your Part B premium will go up 10 percent for each 12 months that you could have had Part B but didn’t take it. You will pay the extra 10 percent for as long as you have Part B.
    • If you didn’t take Part B at age 65 because you were covered under as an active employee (or you were covered under your spouse’s group health insurance plan and he/she was an active employee), you may sign up for Part B (generally without an increased premium) within 8 months from the time you or your spouse stop working or are no longer covered by the group plan. You also can sign up at any time while you are covered by the group plan. opm.gov/medicare-part-b-coverage/
  • This is a wonderful service you’re providing and I will be sure to refer my friends to you for their insurance needs.
    • ***Thank you
  • I’m disabled and covered under my Dad’s retirement plan. I just qualified for Medicare. Must I enroll in Part B or can that be postponed as I have employer coverage?

Anthem Medicare Supplement

Anthem Medicare Supplement - Get Quotes, Information and ONLINE Enrollment - No extra charge for our help

Links, References & Resources

official Medicare  link  to enroll in Medicare Part A Hospitalization and Part B Doctor Visits.

Learn More ===>

4 comments on “Medicare enrollment, if covered by Employer Plan? Retiring?

  1. I misunderstood and did not file for Medicare part B in time when I retired in June.

    Now Kaiser has terminated my health care retirement benefit. I am enrolling now. [In Part B]

    What options do I have or have I lost retirement health care through Kaiser forever?

  2. Can I keep my group plan with over 20 employees and get an MAPD plan. I want the hearing aid benefits.

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