Turning 65? Medicare Enrollment Help in Cape Coral
You have a seven-month window, a few decisions to make inside it, and a mailbox that has started filling up. Here is the order to do things in, and what changes if you are still working.
Your seven-month Initial Enrollment Period
Most people get a one-time window around their 65th birthday called the Initial Enrollment Period. It runs seven months: the three months before your birthday month, your birthday month itself, and the three months after.
The half you act in matters. Enrolling in the three months before your birthday month generally means coverage starts at the beginning of your birthday month. Waiting until your birthday month or later generally means a delay before coverage begins.
That is the whole reason people are told to start early. Not urgency for its own sake, the calendar simply works better from the front half of the window.
What to do if you are still working at 65
Turning 65 does not automatically mean signing up for everything. If you are still working and covered by an employer group health plan, the right move depends on details that vary.
- The size of the employer matters. Whether Medicare or your employer coverage pays first depends partly on how many employees the company has, and that affects whether delaying is safe.
- Some coverage lets you delay without penalty; some does not. Employer coverage that qualifies generally allows you to enroll later through a Special Enrollment Period. COBRA and retiree coverage are commonly assumed to qualify and commonly do not.
- Health savings accounts have their own rule. Enrolling in Medicare affects your ability to contribute to an HSA, which can matter if you were planning to keep contributing.
- Drug coverage is a separate question. Whether your employer's prescription coverage counts as creditable determines whether a penalty accrues. More on that.
Get this confirmed rather than assumed. Your HR or benefits administrator can answer the employer-side questions in writing, and Sue can tell you what follows from their answers.
Part A and Part B: what to sign up for and when
Parts A and B together make up Original Medicare, and they are enrolled in through the Social Security Administration rather than through an insurance agent.
Some people are enrolled automatically, generally those already receiving Social Security benefits before turning 65. Everyone else has to actively sign up, and assuming you are in the automatic group when you are not is a common and avoidable problem.
Most people do not pay a monthly premium for Part A, based on their work history. Part B carries a monthly premium set by the federal government. Whether to take Part B right away is the question that depends on your working situation above.
Choosing your path
Once you have Original Medicare, there are two broad structures to build from. They work differently, and the right one depends on your doctors, your prescriptions, how you travel and how you prefer to handle costs.
Read how each is structured: Medicare Advantage (Part C) and Medicare Supplement (Medigap). Then see how prescription coverage fits.
A simple month-by-month order
Counting from your 65th birthday month.
Months before
Confirm with HR whether your employer coverage lets you delay, and whether its drug coverage is creditable. Get it in writing.
Months before
Your window opens. Enroll in Part A and, if appropriate, Part B through Social Security. Start the conversation about which structure fits.
Month before, and after
Finalize your choice so coverage begins when you need it. If you missed the front half, act promptly, the window closes three months after your birthday month.
Penalties worth avoiding
Two of them, and both are permanent in most cases.
- Part B late enrollment. Delaying Part B without qualifying coverage in place can add a permanent amount to your Part B premium, calculated on how long you waited.
- Part D late enrollment. Going without creditable prescription drug coverage after becoming eligible can add a permanent amount once you do enroll.
Separately from penalties, higher-income households may see an income-related adjustment added to their Part B and Part D amounts. It is based on a tax return from two years earlier, which catches a lot of people in their first year of retirement. Ask Sue about how IRMAA works and how to appeal it.
Questions people ask at 65
Start before the mail piles up.
One conversation early is worth three later. Sue will tell you which window you are in and what actually needs deciding.
Sue Kneeland Insurance is an independent, licensed insurance agency and is not connected with or endorsed by the United States government or the federal Medicare program.