Jane Dotson
Medicare eligibility begins at 65, and signing up on time can help you avoid premium surcharges. However, if you're still working at 65, you may not need to enroll in Medicare right away. If you have coverage under a group health plan through an employer with 20 or more employees, you don't have to enroll in Medicare immediately. On the other hand, if your employer has fewer than 20 employees, you need to take Medicare Parts A and B, as it will be your primary insurance. If you don't enroll, your employer plan may pay less or nothing at all for your care.
| Characteristics | Values |
|---|---|
| Medicare eligibility begins at | 65 |
| Initial window to enroll | seven-month period that begins three months before the month of your 65th birthday and ends three months after it |
| Signing up on time | helps avoid premium surcharges |
| If you're working at 65 | you get a bit more leeway |
| If you have employer-sponsored health insurance | you may be able to keep your insurance until you (or your spouse) retire(s) |
| Medicare Part A | is premium-free for most beneficiaries |
| Signing up for Part A | when you're eligible is a good idea |
| Delay signing up for Part B | until you (or your spouse) retire(s) |
| If you don't sign up for Part B at the appropriate time | you may face a late enrollment penalty that will increase your Part B premium by 10% of the standard monthly premium for each 12-month period that you delayed enrollment |
| If you have coverage through a Marketplace plan | you should sign up for Medicare when you turn 65 and notify your Marketplace plan |
| If you don't have to pay a premium for Part A | you can choose to sign up when you turn 65 or anytime later |
| If you have group health insurance available to everyone at the company | you can choose to sign up when you turn 65 or anytime later |
| If you have retiree coverage from a previous job | it may not pay for your health services if you don't have both Medicare Part A and Part B |
| If you have coverage under a group health plan through an employer with 20 employees or more | you don’t have to enroll in Medicare right away |
| If your employer has less than 20 employees | you need to take Medicare Parts A and B, because that will be your primary insurance |
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What You'll Learn
If you are still working at 65
If you have comprehensive health insurance and are still working at 65, you do not need to enrol in Medicare immediately. However, in some cases, enrolling at 65 is essential to avoid gaps in coverage and premium surcharges. Your initial window to enrol is a seven-month period that begins three months before your 65th birthday and ends three months after it.
If you have coverage under a group health plan through an employer with 20 or more employees, you do not have to enrol in Medicare immediately. However, if your employer has fewer than 20 employees, you need to take Medicare Parts A and B as your primary insurance. If you do not enrol, your employer plan may pay less or nothing at all for your care.
If you have prescription drug coverage, ask if it is considered "creditable". If you have retiree coverage from a previous job, it may not pay for your health services if you do not have both Medicare Part A and Part B. Ask your benefits administrator how your retiree coverage works with Medicare.
If you have employer-sponsored health insurance through your job or your spouse's job when you turn 65, you may be able to keep your insurance until you or your spouse retires. Contact your employer's benefits representative to find out whether they will continue your coverage. Since Medicare Part A is premium-free for most beneficiaries, you may want to enrol in Part A as soon as you are eligible, even if you will continue to receive employer-sponsored insurance. You can delay signing up for Part B until you or your spouse retires. However, check with Social Security or Medicare to confirm that you will not face a late enrollment penalty.
It is important to note that once you are enrolled in Medicare, you are no longer eligible to contribute to a health savings account (HSA). If you continue to contribute to an HSA after you have Medicare coverage, you could face tax penalties.
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If you have employer-sponsored insurance
If your employer decides to continue your insurance, you may want to enrol in Medicare Part A as soon as you are eligible (three months before your 65th birthday) since it is premium-free for most beneficiaries. However, you may choose to delay enrolling in Medicare Part B until you or your spouse retires. It is advisable to check with Social Security or Medicare to confirm that you will not face a late enrolment penalty.
If your employer-sponsored insurance is from a company with 20 or more employees, it is considered the primary payer, and Medicare is secondary. In this case, you may delay enrolling in Medicare Part B to avoid paying premiums for both Medicare and your employer coverage. However, if your employer has fewer than 20 employees, Medicare becomes the primary payer, and your job-based insurance may provide little or no coverage if you delay Medicare enrolment.
If you decide to enrol in Medicare while keeping your employer-sponsored insurance, it is important to understand how the two coverages will work together. Consult your employer's benefits administrator and ask how your coverage will be impacted by Medicare. Additionally, gather all records and copies of your health insurance for proof of creditable drug coverage.
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If you have retiree coverage
You may need to enrol in both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) to get full benefits from your retiree coverage. If you don't, your retiree coverage may not pay for your health services. You should check with your retiree plan to see if you need to enrol in Part A and Part B. If you don't enrol in Part B at the appropriate time, you may face a late enrolment penalty that increases your Part B premium by 10% of the standard monthly premium for each 12-month period that you delayed enrolment.
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If you have prescription drug coverage
Medicare Part D is typically obtained through a stand-alone prescription drug plan or through a Medicare Advantage plan. The best time to sign up for Medicare Part D coverage is when you first enroll in Medicare. While Part D is technically optional, there is a late enrollment penalty if you go without creditable prescription coverage for 63 days or more.
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If you have a spouse with insurance
If you are covered under your spouse's insurance, you may not need to sign up for Medicare when you turn 65. It depends on the number of employees at your spouse's company. If your spouse works for a large employer, defined as a company with 20 or more employees, you don't need to sign up for Medicare at 65. The company-sponsored health insurance will continue to be the primary payer, and Medicare will be the secondary payer. Employers with 20 or more employees must offer the same health benefits to all employees and their spouses, regardless of age, and they can't require you or your spouse to enroll in Medicare at age 65.
However, if your spouse works for an employer with fewer than 20 employees, Medicare typically becomes the primary payer at age 65, and you will need to sign up during your initial enrollment period, which begins three months before the month you turn 65 and ends three months after your birthday month. In rare cases, some small businesses continue to provide primary coverage after age 65. Check with your spouse's employer to see if you are required to enroll in Medicare as a covered dependent. If they say you don't need to enroll, be sure to get their response in writing.
If you decide to delay enrolling in Medicare, you must have creditable coverage. This means your current prescription drug coverage must be considered as good as or better than Medicare Part D. Get written proof of your creditable prescription drug coverage. If you delay enrolling in Medicare, you will have a Special Enrollment Period of eight months that begins when you lose your spouse's employer coverage or when your spouse retires.
If you have employer-sponsored health insurance through your job when you turn 65, you may be able to keep your insurance until you retire. Contact your employer's benefits representative to find out whether they will continue your coverage. Since Medicare Part A is premium-free for most beneficiaries, you may want to enroll in Part A as soon as you are eligible, even if you plan to continue with your employer-sponsored insurance. If you are covered under an employer plan, you may want to delay signing up for Part B until you retire, but check with Social Security or Medicare to confirm that you will not face a late enrollment penalty.
If you choose to enroll in Medicare Part A and keep your Marketplace coverage, you will have to pay the full price for your Marketplace plan, and Medicare will be the primary payer. If you receive financial assistance for your Marketplace coverage, you will receive a letter informing you that you are no longer eligible for this assistance since you are enrolled in Medicare Part A. Contact your Marketplace plan to ensure that your financial assistance is stopped when your Medicare coverage begins.
If you do not sign up for Part B at the appropriate time, you may face a late enrollment penalty that will increase your Part B premium by 10% of the standard monthly premium for each 12-month period that you delayed enrollment. Similarly, there is a late enrollment penalty for Part D coverage if you do not sign up when you are first eligible and do not have creditable coverage.
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Frequently asked questions
If your employer has 20 or more employees, you don't have to enroll in Medicare right away. However, if your employer has less than 20 employees, you need to take Medicare Parts A and B, as this will be your primary insurance.
If you don't sign up for Part A and Part B when you turn 65, your job-based insurance might not cover the costs for services you get. It is recommended to check with your employer’s benefits representative to find out whether they will continue your coverage when you turn 65.
The initial window to enroll in Medicare is the seven-month period that begins three months before the month of your 65th birthday and ends three months after it.
Medicare is always primary when it is your only form of coverage. When you have additional insurance, predetermined coordination of benefits comes into play.
