I’m Turning 65, Do I have to Sign Up For Medicare Or Can I Keep My Employer Coverage?

You May Be able to keep your Employer Coverage if certain conditions are met. But you may want to compare your current coverage with Medicare

Employer Coverage and Kantime Medicare

Your Kantime Medicare Employer Has More Than 20 Employees-

If you have health insurance through your current Kantime Medicare employer or your spouse\’s employer, you may be able to keep that coverage when you become eligible for Medical. In fact, if your employer has 20 or more employees, they are required by law to offer you the same health insurance coverage they provide to younger employees; therefore, you may delay signing up for all or part of Medicare. Many who qualify for Free Part A will often sign up for Part A only and Sign up for Part B when they retire.

When you have both Medicare and employer coverage, one of them will be your primary insurer, and the other will be secondary. The primary insurer pays first, and the secondary insurer may cover some of the remaining costs. If your employer has 20 or more employees, your employer plan is typically primary, and Medicare is secondary.

Your Employer Has Less Than 20 Employees

However, if your employer has fewer than 20 employees, Medicare is usually the primary plan, and your employer plan is secondary. Signing up for Medicare is mandatory to avoid Penalties.

Evaluating Your Options

When deciding whether to keep your employer coverage or switch to Medicare, there are several factors to consider:

Cost: Compare the premiums, deductibles, and out-of-pocket costs for both your employer plan and Medicare. Don\’t forget to factor in the cost of Medicare Part B premiums, which are based on your income.

Coverage: Review the benefits and coverage provided by your employer plan and Medicare. Consider your current and future healthcare needs, including prescription drugs, and ensure that your chosen plan adequately covers them.

Provider Network: Check if your preferred healthcare providers and facilities are included in your employer plan\’s network and Medicare\’s network. If you have established relationships with certain providers, you may want to choose the plan that allows you to continue seeing them.

Prescription Medications—As a rule, Drug Coverage with large companies is more affordable for expensive Medications, but it does pay to compare and know your options.

Conclusion-

Ultimately, the decision to keep your employer coverage or switch to Medicare depends on your individual circumstances and healthcare needs. It\’s essential to review your options and consider the factors mentioned above carefully. If you\’re unsure about which path to take, consult with your employer\’s benefits administrator, a Medicare specialist, or a financial advisor who can help you make an informed choice.

Remember, if you decide to keep your employer coverage and delay enrolling in Medicare Part B, you\’ll need to enroll during the Special Enrollment Period (SEP) when you retire, or your employer coverage ends to avoid penalties. This SEP lasts for eight months after your employment or coverage ends, whichever comes first.

Summary-

While you can keep your employer health plan when you become eligible for Medicare, it\’s crucial to weigh your options carefully. By understanding how Medicare and employer coverage work together and evaluating your healthcare needs and preferences, you can make a decision that ensures you have the right coverage for your unique situation.

Frequently Asked Questions

Can I Delay Signing Up For Medicare If I'm Still Working And Have Insurance?

Maybe. If your employer has over 20 employees you can delay signing up. If your employer has under 20 employees you will have to sign up.

Are Medications Less Expensive With Medicare?

Not Necessarily. Company Plans usually have lower copays for expensive Medications.

My Employer takes money out of my paycheck every month for my Health Insurance. Is there a Monthly Charge for Medicare?

Yes, the Base Premium for Medicare Part B in 2024 is $174.70 per month.

I can keep my employer coverage, is it better to sign up for Medicare?

Compare your cost sharing with both. Employer coverage usually has higher deductibles but lower cost share on expensive meds.

Does Medicare have Dental and Vision Coverage?

No, but there are Medicare Advantage Plans available that do.

I'm covering my spouse through my company plan, if I give it up to go on Medicare will Medicare cover my spouse?

No, only if he or she is Medicare eligible.

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.

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.