347 N. Pottstown Pike, Suite 200 | Exton, PA 19341

Roadmap to Medicare Individual or No Insurance

Customized Roadmap Report

Click on the image to download your 1 page Roadmap

Enrolling in Medicare

After reviewing ALL of the information on this webpage, click on Enroll Now for detailed enrollment instructions based on your situation.

Since Medicare is most likely your PRIMARY Insurance, and you may have penalties and deadlines for not enrolling in Medicare, you may want to...

Your enrollment process depends on if you are already collecting social security income before your 65th birthday.

Not previously collecting Social Security Income

The easiest way to enroll is to visit www.ssa.gov/medicare.

Click here for step by step Directions – How to Enroll Online

Already collecting Social Security Income

You should not have to take any action to enroll in Medicare. Please expect to see your new Medicare ID card in the mail approximately 3 months before your 65th birthday. Your effective date will be the first of the month of your 65th birthday (unless your birthday is on the 1st, then it will be effective the 1st of the prior month).

Your Roadmap is based on…

  • You are approaching age 65 or over age 65
  • You are not covered under a Group Health Plan 
  • You have Individual Coverage (ACA/Obamacare) or you have No Current Health Insurance

Do I need Medicare to have full coverage?

Yes/Likely.  If you don’t have coverage, you must enroll ASAP to secure benefits.  If you have individual coverage, once you turn 65  it is likely that your Individual coverage will become secondary coverage and Medicare will become the primary insurance.  If you do not enroll in Medicare, you may not have full coverage.

Medicare “Who Pays First” Law states that Medicare becomes your primary insurance once you are age 65 and have Individual Insurance.

Will I receive a penalty if I don’t enroll now?

Yes. You will receive a late enrollment penalty if you do not enroll during your Initial Enrollment Period at age 65 because your current coverage is not considered creditable coverage to Medicare.  Creditable coverage is defined as group coverage based on current active employment.  

Part A: If you are eligible for Premium-Free Part A (you or your spouse has paid 40 quarters of Medicare taxes), you WILL NOT receive a Part A Penalty for enrolling after age 65.

  • Since Part A is Premium-Free for many people, they commonly enroll in Part A even if not necessary (special considerations apply if you have an HSA account).

Part B: You will receive a Part B Late Enrollment Penalty if you do not have creditable coverage after age 65.

  • Creditable coverage is group health insurance coverage while the Primary Insured is actively working for the employer providing the Group Health Plan.
    • Severance, COBRA and/or Retiree Plans are not creditable for avoiding the penalty.

A 10% penalty added for every 12 months you go without creditable coverage. Months need not be consecutive. See Details on how the penalty is calculated.

  • The penalty will be assessed on the Base Medicare Premium ($144.60/month in 2020) for as long as you are enrolled in Medicare.

Part D: You will receive a Part D Late Enrollment Penalty if you do not have creditable prescription coverage after age 65.

  • Creditable prescription coverage is drug coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.

A 1% penalty added for every 1 month you go without creditable prescription coverage. Months need not be consecutive.

  • The penalty will be assessed on the Average Medicare Part D Premium ($32.74/month in 2020) for as long as you are enrolled in Medicare Part D.

What is my deadline to enroll?

Your Initial Enrollment Period (Turning 65) is 7 months surrounding your 65th birthday to enroll online.  Your effective date will be automatically assigned to you based on which month you enroll online.  If you are over age 65 and did not enroll during your IEP, you can only enroll once a year during your General Enrollment Period.

Part A: As long as you are eligible for “premium-free” ($0) Medicare Part A, you can sign up for no cost Part A (if you’re eligible) any time during or after your Initial Enrollment Period. Your coverage start date will depend on when you sign up.

  • If you have to pay a premium for Medicare Part A, you can only sign up during a valid enrollment period (see Part B enrollment periods below).

Part B-IEP: You have a 7 month Initial Enrollment Period when you turn 65 (3 months before birthday, month of birthday, and 3 months following birthday)

  • If you enroll within the 3 months prior to your 65th birthday month
    • Your effective date will be the first of the month of your 65th birthday (unless your birthday is on the 1st, then it will be effective the 1st of the prior month).
  • If you enroll during your birthday month or 3 months following

Part B-GEP: If you miss your Initial/Special Enrollment Period, you will be able to enroll annually during the General Enrollment Period (however, penalties may apply).

  • The General Enrollment Period is from January 1st to March 31st each year. Your Part B effective date will be July 1st following your enrollment.

Secondary Insurance Options

You have the option to purchase secondary coverage to supplement your Medicare A and B.  You will have the option to choose a Medicare Advantage Plan or Medicare Supplement Insurance and a Medicare Prescription Drug Plan.

Premiums, Benefits and Networks may vary by insurance company.  We represent over 30 different insurance carriers to help you review and evaluate which options are most appropriate for your situation.

In addition, you can also voluntarily elect Dental, Vision, Hearing, Cancer and/or Hospital Indemnity coverage.

Please contact us for quotes and benefit information.

Underwriting Considerations

Medicare Supplement Insurance has an Open Enrollment Period for the first 6 months that you are enrolled in Medicare Part B.  During this time, you will be able to purchase ANY medicare supplement plan with no medical underwriting.

Unless you have a Guaranteed Issue circumstance, Medicare Supplement plans are medically underwritten after the first 6 months on Medicare Part B.

Medicare Advantage Plans and Medicare Prescription Drug Plans provide an Initial Election Period when you enroll in Medicare, a Special Election Period when you come off your group plan, and also allow you to change plans once a year during the Annual Election Period (October 15th through December 7th) without medical underwriting.

Additional Considerations

Spouse Under Age 65- If you have a Spouse under age 65, not yet qualified for Medicare, and relies on your health plan for benefits, please check with your current health insurance company to make sure that your spouse can maintain benefits if you come off the plan.

  • Will your spouse’s benefits change?
  • Will your spouse’s premium change?
  • Does any paperwork need to be filed to change your spouse to the primary insured on the plan?

Effective Date Considerations- Reminder, when you apply for Medicare at age 65, you cannot choose a specific effective date for the benefits (and premiums) to start.  The only way to influence the effective date is by which month you enroll online.  Please contact us ASAP if you are trying to achieve a specific start date that is something other than the first of the month of your 65th birthday (possibly to coordinate with your group plan ending).

Important HSA Considerations– You cannot continue to contribute to your Health Savings Account (HSA) once you enroll in Medicare Part A.  If you are enrolling in Medicare after age 65, your Part A effective date may be back dated up to 6 months.  Please contact us to discuss the HSA maximum contribution rate for you circumstances.  Click Here for Details and Rules.

  • This does not apply to Flexible Spending Accounts (FSA) or Health Reimbursement Accounts (HRA).  Medicare does not have any restrictions on these types of accounts.