Frequently Asked Questions
You have a few options when you first become eligible for Medicare:
- Medicare + Employer Plan: You can keep your employer health plan and also enroll in Medicare.
- Medicare Only: You can drop your employer health plan and enroll in Medicare instead.
- Employer Health Plan Only: You can skip enrolling in Medicare and stay on your employer health plan alone.
There are many factors to consider when deciding what to do when you become eligible for Medicare, highlighted below.
First, you’ll need to determine whether your employer health plan will be primary or secondary to Medicare. Generally, if your employer has fewer than 20 employees, Medicare will become your primary coverage and your employer plan will be secondary. If your employer has more than 20 employees, your employer health plan will be primary and Medicare will be secondary.
Primary insurers pay first, and secondary insurers generally pay some or all of the unpaid portion of covered health care expenses after the primary insurer has paid.
It’s important to note that once you enroll in Medicare Part A and/or Part B, the clock will start ticking for the Medicare Part D prescription drug benefit. Normally you must enroll in Part D within a certain time limit of enrolling in Part A and/or B to avoid the Part D late enrollment penalty. However, if your employer health plan offers “creditable” prescription drug coverage (equal to or better than Medicare’s), then you may be able to delay Part D enrollment without penalty.
If Medicare will be your primary insurer, you should purchase both Parts A and B in order to be fully covered for hospital and medical costs. If your employer plan will be primary, you’ll need to determine whether paying for Part B will benefit you by helping to offset out-of- pocket costs. For example, if your employer plan has a high deductible and/or large copayments and coinsurance amounts, you may benefit from having Part B in addition to your employer plan, as Medicare should help pick up some of the unpaid portion of covered health care expenses after your employer health plan has paid. If, on the other hand, your employer offers a good plan with few out-of- pocket costs, taking Part B is probably not necessary—and, keep in mind, Part B has a monthly premium.
Note that some unions and current/former employers will automatically enroll you in a Medicare Advantage (Part C) plan once you become eligible for Medicare. Medicare Advantage plans are Medicare-approved plans administered by private health insurers. If this happens, you’ll have the option to choose Original Medicare (Parts A and B) or switch to a different Medicare Advantage plan instead. If you switch plans, however, your employer or union could terminate your plan or reduce your health benefits, so it’s important to talk to your plan before switching.
Note that COBRA and retiree insurance are not considered current insurance and thus do not qualify for special enrollment.
If you are on a Medicare Supplement and are frustrated with your increasing premiums, we highly suggest that you investigate a Medicare Advantage Prescription Drug plan (MAPD). Unlike a Medicare Supplement, a MAPD’s premium doesn’t increase as you get older, and depending on where you live can be premium free. If you have a MAPD plan, now is the time to shop around. Call our office at 1-800-356-3615to see if your prescriptions will continue to be on the formulary. MAPD plans vary on your specific healthcare needs. You may qualify for a plan that will provide you extra transportation or zero cost diabetic supplies. Some plans have maximum out of pocket that can be thousands less. Don’t wait until it is too late to find out! Let us help you figure out your options during Annual Election Period (AEP).
Begins three months before your 65th birthday, includes your birthday month and ends three months after your birthday month ends.
Annual Election Period (AEP)
Begins October 15 and Ends December 7 for a January 1 effective date.
Special Enrollment Period.
Several circumstances will qualify you for a Special Enrollment Period (SEP):
- Your plan is exiting
- You are leaving your plans service area
- You have left your employer medical coverage within the 8-month period that begins the month after employment ends or the coverage ends, whichever happened first.
You are eligible to enroll in a MAPD or PDP plan if you are enrolled in Medicare Part A & B and don’t have ESRD.