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

Roadmap to Medicare Under 20 Employees

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 or Enroll Later for detailed enrollment/deferral instructions based on your situation.

Since Medicare is most likely your PRIMARY Insurance, 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).

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.

If your Group Health Plan is cost effective AND will REMAIN PRIMARY to Medicare, you may want to...

The Request For Employment Information form provides the creditable coverage information to avoid a Medicare Part B penalty when you enroll after age 65. This form is not required until you are ready to enroll.

There is no need to notify Medicare now if you are not enrolling.

No need to keep this form, we can provide the current version when you are closer to enrollment.

If you change jobs after age 65, you will be required to get this form completed by each employer that provided Group Health Benefits after age 65.

Your Roadmap is based on…

  • Your Primary Insured intends to remain ACTIVELY WORKING (at the employer providing your benefits)
  • You ARE covered under the Group Health Insurance Plan
  • The employer providing health insurance has LESS THAN 20 employees

Do I need Medicare to have full coverage?

Yes/Likely.  Once you turn 65, it is likely that your group 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 since the employer who you get your insurance through has less than 20 employees, Medicare becomes the primary insurance once you turn 65.

If you wish to defer Medicare A and/or B, please confirm from your current group health insurance carrier (in writing recommended) that they will remain the primary payer once you turn 65 or you could have significant gaps in your coverage. If not, we will need to talk again ASAP to make sure you have proper coverage in place.

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

No. You will not receive a late enrollment penalty provided you remain covered under the group creditable coverage and your primary insured remains actively at work at the employer that provides your benefits.  Although you will not receive a penalty with creditable coverage, you may still need medicare for full coverage (see section above).

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.  If you do not enroll during that time, you can enroll anytime up to 8 months after your group coverage or the employment that it is based on ends (Over Age 65).  Although you are not under an immediate deadline to enroll at this time, you may still need medicare for full coverage (see section above).

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-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 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

Since your group health benefits are likely considered secondary insurance to Medicare, you MUST be enrolled in Medicare A and B to have full coverage.  You will have the option to keep your Group Health Plan as secondary or elect a Medicare Supplement and Medicare Prescription Drug Plan as secondary.

Does it make sense to drop my group health plan to enroll in Medicare Supplement Insurance and a Medicare Prescription Plan?

A general rule of thumb is that if your group health plan costs on average less than $150-200/month/person or about $2000-2400/year/person, then your group health plan is more cost effective than Medicare.

  • Please add up the premiums, copays, deductibles and coinsurances (everything except Rx cost) of your current group health plan for comparison.

However, if you think you may pay more than that, or you are seeking lower deductibles and copays, then you may want to explore Medicare further.

Please contact us for a Medicare Cost Analysis to help you better evaluate if your Group Health Plan or a Private Medicare Supplement and Medicare Prescription plan is more cost effective.

  • If Medicare Secondary coverage is more cost effective than your current plan, you may want to replace your current plan.
  • If your employer is paying the premium on your current plan, you may want to approach them to see if they would be willing to reimburse you the amount they are currently paying to your insurance to help you pay for Medicare instead.

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.

If you stay with your group health plan and decide to elect a Medicare Supplement later (when group health ends, but you have already been on Medicare for more than 6 months) you will have SOME plans available on a Guaranteed Issue basis.  There will be less options available that do not require you to answer medical questions to qualify.

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.

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.