Medicare is a program for those who are over 65 years old, or under 65 with certain disabilities. The most important thing is knowing when to apply for Medicare. The timing will determine everything. If you apply too late you could face a penalty for the rest of your life. If you apply too early you could, without knowing it, exclude yourself from extra coverages. This might include certain Medicare Supplement plans. Additionally, when you apply for Medicare parts A and B, the government could take months to send you cards. When the cards arrive start dates of several months ago. This would make you ineligible for extra coverage. Timing is critical.
WHEN TO APPLY
When you apply for Medicare it’s a two-step process. The first step is with the Social Security Administration. The second step is with private insurance for extra coverage.
The Social Security Administration handles Medicare applications. Medicare eligibility starts when you turn 65. This is regardless of when you decide to start taking social security. When you apply for Medicare there is an option to decline Social Security benefits. If you’re taking both, it’s a one-step app.
HOW TO APPLY
There are 3 ways to sign up. The preferred and easiest way is to visit ssa.gov and create an account (if you haven’t already). The next option is to call 800-772-1213. Finally, the last resort would be to visit a local social security office. Calling and visiting their office is best done with an appointment. You can usually schedule appointments online.
Original Medicare is also known as Medicare Parts A and B. These come from the federal government. Part A covers the hospital and Part B covers the doctor’s office, in general. Original Medicare Parts A and B only cover roughly 80% of your medical expenses.
Many people are turning 65 and continuing coverage through their job. If this is the case, it’s going to be important to find out if your company had more or less than 20 employees last year. This will determine who will pay bills first, your company insurance or Medicare.
OVER 20 EMPLOYEES
If your group has more than 20 employees, the insurance company available through your work will be the “primary payor”. They will pay the bills first. Medicare will pick up the remaining cost if it’s covered. Most people who continue to work either choose one of two options. A. Not to enroll in Medicare, or B. enroll only in Medicare part A. Part A does not have a monthly cost (premium) if you’ve worked in the US for more than 10 years. Part A can pick up anything Medicare eligible expense that the group plan doesn’t cover.
UNDER 20 EMPLOYEES
For groups with less than 20 employees, it’s important to elect Medicare parts A and B. In this circumstance Medicare will be the primary payor. Many insurance companies don’t check if their members sign up for Medicare. They won’t verify that the company you work for has less than 20 employees. But, it’s important to remain insured regardless. If they do end up checking they could decide to not cover the bill. It doesn’t matter if you actually signed up for parts A and B, if you could have but did not, you could end up paying the bill yourself.
As I mentioned before, timing is important. The plans you’re eligible for and the penalty that could affect you are all based on when you apply.
I’m over 65 and signed up for part A in the past. I’m ending employer coverage
This is one of the most common situations. In this case, you’re eligible to sign up for part B without a late enrollment penalty. You can also sign up for a Medicare Supplement + Part D or a Medicare Advantage plan. In this case, you’re enrolling under the initial eligibility period.
I’m over 65 and signed up for Part A and B in the past. I’m ending employer coverage
This sign up would fall under the guaranteed issue eligibility. Ending employer coverage would create a special event. It allows you to enroll in specific plans offered by Medicare Supplement companies. For Medicare Advantage plans, you could enroll in any plan that’s available in your area.
I signed up for part A only and kept my personal health insurance
Personal health insurance is not “qualified” for the sake of Medicare. Even though it’s qualified for ACA and tax purposes, and certified by the state, it’s still not Medicare qualified. This is disappointing and a fault that needs to be fixed with Medicare. This means for Medicare purposes, it’s as if you’ve been without coverage this entire time. You would likely owe a penalty when you enroll in Parts B and D. Also, you would only be eligible to enroll in these parts during the General Enrollment Period (January 1st to March 31st). It would be effective on July 1st. On July 1st you can also sign up for a Supplement + Part D or a Medicare Advantage plan.
I’m under 65 and on Medicare due to a disability
Medicare can be available to those under 65 years old who have certain disabilities. There are three main ways to sign up for Medicare Disability. 1. The member must have received social security disability benefits for 24 months. 2. The member has End-Stage Renal Disease. Or 2 The member has or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease). In Nevada, if you enroll in Medicare due to a disability, you are ineligible to buy a Medicare Supplement plan until you turn 65. You can however buy a Medicare Advantage plan. The initial enrollment period for Medicare Advantage plans runs for 7 total months. It begins 3 months before you are eligible for Medicare, includes the month of your eligibility. The enrollment window ends 3 months after the month you’re eligible for Medicare. No matter how early you enroll, the effective date will be no earlier than the date you’re eligible for Medicare. If you miss this window you can enroll during the MAPD annual enrollment period. This runs from October 15th to December 7th.