What If I Don’t Want To Sign Up For Medicare?

Sign Up or Not Sign Up-

Most individuals turning 65 will have to enroll in Medicare, while others may delay it if certain conditions are met. Which one are you?

Some individuals elect to continue to work and are covered by their employer or their spouses. The size of the company matters as it dictates whether the coverage is considered creditable, meaning the coverage is as good if not better than Medicare’s.

If you have coverage from an-

Employer-

If your employer has over 20 employees, then the coverage is considered “creditable,” which means that it is as good if not better than Medicare, and you don’t have to sign up. Most people sign up for Hospital Part A because, for most people, it is Free, and Medicare will pick up what is not covered by the Employer plan. In this scenario, the Employer coverage is the Primary Payer, and Medicare is secondary. If you have an HSA, then it is advisable not to sign up because then your contributions become taxable. If your employer has less than 20 employees, then you will have to sign up, and in this scenario, Medicare will be the Primary payer, and the Employer coverage is secondary. Even if you don’t have to sign up it is a good idea to ask your Medicare Advisor (me) to do a comparison between getting on Medicare and keeping your current coverage. Some company plans have steep deductibles and are expensive.

State Health Exchange –

You will have to sign up for Medicare Parts A and B.
Union – It is advisable to connect with Human Resources because most unions require members to sign up for Medicare parts A and B when first eligible. Also, some Union retirement coverages come with premiums and deductibles so it is prudent to compare your coverage with a suitable Medicare Health Insurance plan. Care should be taken though because in most cases once the Union retirement coverage is forfeited you cannot re enroll in it.

Penalties–

Part A –

If you are entitled to Free Medicare Part A (All of those who were employed for 10 years or more), then you don’t have to sign up if you have creditable coverage. Most people who continue to work and have employer-provided insurance from a company that has over 20 employees sign up for Hospital Part A only and activate their Medical Part B later when they decide to retire. For those that have to pay for Part A, they will incur a penalty of 10% if they do not sign up when first eligible.

Part B –

Some individuals elect not to enroll in Part B because of the premium and do not have creditable coverage. If they let their initial 7-month window lapse, they will have to wait for the Part B enrollment period, which runs from 1/1 to 3/31 and has an effective date of the 1st of the following month. The penalty is an additional 10% for every year not enrolled.

Part D –

Some individuals who do not take medications decide against signing up for a Part D Drug plan because of the premium and have no creditable coverage. This is a big no-no. If they go 63 consecutive days without creditable Prescription Drug coverage, then the penalty will be 1% of the national monthly average premium(About $30) times the number of months they were without it added to their Rx plan monthly premium.
In short, the individuals who get penalties have nothing and do nothing. Keep in mind that there are $0 Premium Medicare Advantage Plans in your area that include Part D Prescription Drug Coverage.

Your Enrollment period for Medicare begins 3 months before the month of your birthday and continues through your birthday month plus another 3 for a total of 7 months. If you are definitely going to sign up, do it during the first 3 months to ensure it begins on the first day of your birthday month(Which is the earliest it can start). The choice to sign up or not depends upon your current coverage. If you are collecting Social Security you will be automatically enrolled in both Medicare Part A and Medicare Part B.

Frequently Asked Questions

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:

Original Medicare (Parts A & B): Allows you to see any doctor or
hospital that accepts Medicare but does not include prescription drug
coverage (Part D) or additional benefits.
Medicare Advantage (Part C): Offers bundled coverage with
potential extra benefits but may require using a network of providers.
Medigap (Medicare Supplement Insurance): Helps cover
out-of-pocket costs not covered by Original Medicare, such as
copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:

Initial Enrollment Period (IEP): A seven-month window starting
three months before your 65th birthday month.
General Enrollment Period (GEP): From January 1 to March 31
each year for those who missed their IEP.
Annual Election Period (AEP): From October 15 to December 7,
allowing you to switch or enroll in Medicare Advantage and Part D
plans.
Open Enrollment Period(OEP): From January 1 to March 31 for
those who missed AEP and want to make certain changes.
Special Enrollment Period(SEP): Can be used anytime during the
calendar year for those that meet certain criteria such as moving to a
new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.

By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.

Do I have to sign up for Medicare?

It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.

Does Medicare cover Prescription Medications?

No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.

I want to be able to go to any doctor/hospital, are there networks with Medicare?

There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.

Mike Miligi- Owner

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental and Vision programs.

Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.

Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.