Enrolling in Medicare
After reviewing ALL of the information on this webpage, click on Enroll Later or Enroll Now for detailed enrollment/deferral instructions based on your situation.
If Group Health Plan is lower cost than Medicare, you have a choice:
Defer Medicare Part B and Enroll in Part A only (recommended)
If Medicare is lower cost than Group Health Plan, your enrollment instructions depend on your age.
I am younger than age 65 and 3 months
Your Roadmap is based on…
- Your Primary Insured intends to remain ACTIVELY WORKING (at the employer providing your benefits)
- You ARE covered under the Group Health Insurance Plan
- The employer providing health insurance has MORE THAN 20 employees
Since you have creditable coverage (group coverage based on current active employment), you are NOT required to enroll in Medicare at this time. However, if you do not have a Health Savings Account, we recommend that you enroll in Medicare Part A and defer your Part B.
If you do not enroll in Medicare A and/or B at this time, you will not accrue a penalty. You will have a Special Enrollment Period (SEP) when your group coverage and/or your employment end to enroll in Medicare. You will need to show proof of creditable coverage when you go to enroll later (it is not necessary at the time you defer).
Will I receive a penalty if I don’t enroll now?
No. You will not receive a late enrollment penalty provided you remain covered under the group creditable coverage and your primary insured remains actively at work at the employer that provides your benefits.
Part A: If you are eligible for Premium-Free Part A (you or your spouse has paid 40 quarters of Medicare taxes), you WILL NOT receive a Part A Penalty for enrolling after age 65.
- Since Part A is Premium-Free for many people, they commonly enroll in Part A even if not necessary (special considerations apply if you have an HSA account).
Part B: You will receive a Part B Late Enrollment Penalty if you do not have creditable coverage after age 65.
- Creditable coverage is group health insurance coverage while the Primary Insured is actively working for the employer providing the Group Health Plan.
- Severance, COBRA and/or Retiree Plans are not creditable for avoiding the penalty.
A 10% penalty added for every 12 months you go without creditable coverage. Months need not be consecutive. See Details on how the penalty is calculated.
- The penalty will be assessed on the Base Medicare Premium for as long as you are enrolled in Medicare.
Part D: You will receive a Part D Late Enrollment Penalty if you do not have creditable prescription coverage after age 65.
- Creditable prescription coverage is drug coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.
A 1% penalty added for every 1 month you go without creditable prescription coverage. Months need not be consecutive.
- The penalty will be assessed on the Average Medicare Part D Premium for as long as you are enrolled in Medicare Part D.
Do I need Medicare to have full coverage?
No. Your group coverage should remain primary insurance as long as the employment that it is based on continues.
Medicare “Who Pays First” Law states that your Group Health Insurance will remain primary insurance at age 65 or older as long as you remain covered by Group Insurance based on Current Active Employment through an employer with more than 20 employees.
What is my deadline to enroll?
You can enroll anytime after age 65 up to 8 months after your group coverage or the employment that it is based on ends.
Part A: As long as you are eligible for “premium-free” ($0) Medicare Part A, you can sign up for no cost Part A (if you’re eligible) any time during or after your Initial Enrollment Period. Your coverage start date will depend on when you sign up.
- If you have to pay a premium for Medicare Part A, you can only sign up during a valid enrollment period (see Part B enrollment periods below).
Part B-SEP: You will have an 8 month Special Enrollment Period from the time your group health coverage or the employment that it is based on ends (whichever comes first) to enroll under a Special Enrollment Period.
- Severance, COBRA and/or Retiree Plans are not based on current employment. Your 8 month SEP starts the date your employment ends. If you have this type of coverage, you will not be eligible for a SEP when it ends if it is outside of 8 months.
Part B-GEP: If you miss your Initial Enrollment Period, you will be able to enroll annually during the General Enrollment Period (however, penalties may apply).
- The General Enrollment Period is from January 1st to March 31st each year. Your Part B effective date will be the 1st of the month following your enrollment.
Does it make sense to drop my group health plan to enroll in Medicare?
A general rule of thumb is that if your group health plan costs on average less than $300/month/person or about $3600/year/person, then your group health plan is more cost effective than Medicare.
- Please add up the premiums, copays, deductibles and coinsurances (everything except Rx cost) of your current group health plan for comparison.
However, if you think you may pay more than that, or you are seeking lower deductibles and copays, then you may want to explore Medicare further.
Please contact us for a Medicare Cost Analysis to help you better evaluate if your Group Health Plan or a Medicare plus a Private Medicare Supplement and Medicare Prescription plan is more cost effective.
- If Medicare coverage is more cost effective than your current plan, you may want to replace your current plan.