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

Roadmap to Medicare more than 3 months past your 65th birthday and Retiring

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...

Here is the Request For Employment Information form that you will need to avoid a Medicare Part B penalty when you enroll.

  • Please take this form to the Human Resources Department to complete.
  • You will need a form completed for each spouse that wishes to apply for Medicare.
  • The form confirms you have had creditable coverage since you turned age 65 which will show that you are eligible for enrollment; as well as, waive a late enrollment penalty.

Creditable coverage is verified on the form by:

  • The dates the Employee was Actively Employed.
  • The date you were covered under the Group Health Plan.
  • The start date should reflect the initial enrollment in the group coverage NOT the date of your last enrollment period.

If you have not been covered under the same employer since you turned age 65, you will need an EVF form from each employer that provided group coverage.

Please contact HTA for best practices on how to submit your forms to the social security administration.

If you do not apply in person (ex: mailing/faxing your application or your spouse is visiting the local office on your behalf) a Part B Application is also necessary.

Your Roadmap is based on…

  • You are more than 3 months past your 65th birthday and did not enroll in Medicare A (and/or) B at age 65th birthday
  • Your Primary Insured IS NOT (or WILL NOT be) actively working at the employer providing your benefits
  • You are NOT (or WILL NOT be) covered under group benefits

Recommendation Summary

Since you do not have creditable coverage (group coverage based on current active employment), you are required to enroll in Medicare during your Special Enrollment Period (SEP).

If you do not enroll in Medicare A and B at this time, you will start to accrue a penalty on your Part B premium which will be added when you enroll later, you will only be permitted to enroll once a year in the future, and you may not have full coverage.

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

Yes. You will receive a late enrollment penalty because you will not have creditable coverage for 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 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 for as long as you are enrolled in Medicare Part D.

What is my deadline to enroll?

You can enroll anytime after age 65 up to 8 months after your group coverage or the employment that it is based on ends.

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-SEP: You will have an 8 month Special Enrollment Period from the time your group health coverage or the employment that it is based on ends (whichever comes first) to enroll under a Special Enrollment Period.

  • Severance, COBRA and/or Retiree Plans are not based on current employment. Your 8 month SEP starts the date your employment ends. If you have this type of coverage, you will not be eligible for a SEP when it ends if it is outside of 8 months.

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.

Do I need Medicare to have full coverage?

Yes.  Once you are no longer actively employed, 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 or older and are no longer Actively Employed.

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 your spouse relies on your group health plan for benefits, please be mindful that if you come off your group plan, your spouse will have to go on COBRA, seek benefits through their respective employer, or purchase individual health insurance until they become Medicare eligible.

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.