Medicare Eligible Employees?

There are only certain times when people can enroll in Medicare. Depending on the situation, some people may get Medicare automatically, and others need to apply for Medicare. The first time you can enroll is called your Initial Enrollment Period. Your 7-month Initial Enrollment Period usually:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

If you don’t enroll when you’re first eligible, you may have to pay a Part B late enrollment penalty.

The size of the employer determines whether you may be able to delay Part A and Part B without having to pay a penalty if you enroll later.

The employer has fewer than 20 employees.

You should sign up for Part A and Part B when you’re first eligible. In this case, Medicare pays before your other coverage.

Note: If you don’t enroll when you’re first eligible, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.

The employer has 20 or more employees.

Ask your benefits manager whether you have group health plan coverage (as defined by the IRS). People with group health coverage based on current employment may be able to delay Part A and Part B and won’t have to pay a lifetime late enrollment penalty if they enroll later. If you want to delay both Part A and Part B coverage, you don’t need to do anything when you turn 65.

If you’re eligible for premium-free Part A, you can enroll in Part A at any time after you’re first eligible for Medicare. Your Part A coverage will go back (retroactively) 6 months from when you sign up (but no earlier than the first month you’re eligible for Medicare).

If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, you may have to pay a penalty.

The size of the employer determines whether you may be able to delay Part A and Part B without having to pay a penalty if you enroll later.

You should sign up for Part A and Part B when you’re first eligible. In this case, Medicare pays before your other coverageLearn more about how to get Parts A and B.

Once the employment (or your employer/union coverage) ends, 3 things happen:

  1. You may be able to get COBRA coverage, which continues your health insurance through the employer’s plan (in most cases for only 18 months) and probably at a higher cost to you.
  2. You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA. To sign up for Part B while you’re employed or during the 8 months after employment ends, complete an Application for Enrollment in Part B (CMS-40B) and a Request for Employment Information (CMS-L564). If you choose COBRA, don’t wait until your COBRA ends to enroll in Part B. If you don’t enroll in Part B during the 8 months after the employment ends:
    • You may have to pay a penalty for as long as you have Part B.
    • You won’t be able to enroll until January 1–March 31, and you’ll have to wait until July 1 of that year before your coverage begins. This may cause a gap in health care coverage.
  3. If you already have COBRA coverage when you enroll in Medicare, your COBRA will probably end. If you become eligible for COBRA coverage after you’re already enrolled in Medicare, you must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have End-Stage Renal Disease (ESRD).

This is high level information. There are many variables and each individual may have a different situation. There are different rules for those that are disabled, veterans and those with certain health conditions.

Concerned about how these guidelines apply to your situation? Contact the Merriam team today to speak with one of our expert advisors.

Lisa Rice

Health Benefits Account Executive at Merriam Insurance Agency
376 Broadway
Schenectady, New York 12305

Toll-Free:
(877) MERRIAM x 213
(877) 637-7426 x 213

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Lisa Rice

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