These days there are a lot of people working past 65, the age when you become eligible for Medicare benefits. As a result, many of them are postponing their Medicare enrollment under the qualifying condition of having “creditable coverage.” This allows them to skip enrolling in Medicare Part B while they continue to have creditable coverage from current employment, without penalty, until they lose their employer coverage. If your clients have postponed Medicare Part B enrollment and are now losing their creditable employer coverage due to retirement or job loss, here is a breakdown on how to transition to Medicare.
Enrolling in Medicare
As you know, they must first enroll in Medicare if they have not already done so during their Initial Enrollment Period. If they did not enroll in Medicare at 65 and maintained creditable coverage, then they would use a Special Election Period to enroll in Medicare Part B, as well as Medicare Advantage Plans and Medicare Supplements.
Medicare Part A (Hospital): If they have worked and paid Medicare tax for at least 10 years, then they are eligible for premium-free Medicare Part A Hospital coverage. Part A coverage begins automatically, without the need to enroll if they are eligible under these circumstances. This is not the case for Medicare Part B.
Medicare Part B (Doctor/Outpatient): Unlike Medicare Part A, they are not automatically enrolled in Medicare Part B. They must actively choose to enroll in Medicare Part B and can so via online at www.socialsecurity.gov over the phone via social security, or in person at a social security office. Without both Parts A and Part B, they will not have the option to choose a Medicare Supplement or Medicare Advantage plan.
How long do you have to enroll in Medicare?
When they lose employer-based creditable coverage, they will have a special enrollment period for 8 months after losing coverage to enroll in Part B. It is very important to note that COBRA coverage is not considered “creditable coverage” by Medicare so they need to enroll in Part B within 8 months of the date that they cease to have coverage from current employment to avoid a penalty. Once they have Part A and B, they can enroll in a Medicare Advantage Plan or a Medicare Supplement Policy. Read below to see the Special Election Period for those plans.
Special Election Period for Medicare Advantage/ Medicare Supplements
If they are looking to add a Medicare Advantage Plan (MA/MAPD) or a Medicare Supplement Plan to fill the gaps of Original Medicare, then they have a completely separate Special Enrollment period as outlined below.
- If you already have Part B before losing creditable coverage, or you enroll in it as soon as you lose your coverage then you have 63 days after the loss of employer coverage to enroll into a Medicare Advantage plan.
- If you don’t take Part B right away but add it within the 8 month Part B window then you would need to pick your Medicare Advantage Plan the month before your Part B becomes effective.
- If you want to buy a Medicare Supplement plan, you will have a guaranteed issue period to buy one with no health questions asked, for 6 months after you first get Medicare Part B
I you have any questions, or would like to speak to our Agent Representatives about contracting, contact us here.