Today, due in large part to advanced medical technology, people are living longer than ever before. Because of this, many are still exceptionally active, and are working long past the age of 65 when Medicare benefits would typically begin.
Individuals can actually enroll in Medicare Parts A and B, also known as Original Medicare, during a 7-month window of time. This begins three months before they turn age 65. It includes the month of their birthday, and then runs through the three month period after their 65th birthday.
Should you enroll during the first three months, your Medicare coverage will typically begin on the first day of your birthday month. If you wait and enroll during your birthday month, or in the three months thereafter, then the start of your coverage will be delayed.
Those who enroll after this 7-month time frame are allowed to apply for their Medicare coverage every year between January 1st and March 31st. Coverage will start on July 1st of that year. It is likely that if you wait to enroll, will be charged a higher amount of premium for Medicare Part A and / or Part B.
What If You Have Group Health Insurance When You Turn 65?
For those who are age 65 and still carry group health insurance through an employer when they are initially eligible to enroll in Medicare, it is still allowable to sign up for Medicare Part A and / or Part B at a later time and not pay a higher amount of premium in the following situations:
Anytime you are covered by the qualifying group health insurance plan. A qualifying group health insurance plan can be through your own employer, as well as through the employer of your spouse or other qualifying member if you are disabled.
During the eight month period of time that starts the month after your employment ends, or when your group coverage ends – whichever occurs first.
It is important to note that COBRA health insurance coverage does not count as being qualifying employer-sponsored creditable coverage. Therefore, you may need to pay a higher Medicare premium if you are receiving your health insurance benefits under COBRA and you wait for this coverage to end before applying for Medicare.
Considerations for Coverage
While you are not required to apply for Medicare when you turn 65, it is important to consider what – if any – the penalty in premium would be if you waited and applied for coverage after your initial enrollment period. If the premium charged would be considerably higher, it could make sense to keep your employer-sponsored health insurance, while at the same time enrolling in Medicare when you initially turn 65.
If you do have both Medicare and other health insurance, there are special rules that determine which policy will pay first when you file a claim. For example, if you are age 65 and you have group health insurance through an employer that has 20 or more employees, then the group health plan will pay benefits first. Conversely, if you have retiree insurance, then Medicare will pay first.
In either case, the insurance company that pays out benefits first – or the primary payer – will pay up to the limit of its coverage. Then, the secondary payer will only pay benefits if there are expenses that are not covered by the primary payer.
If you do have two carriers such as group health insurance coverage and Medicare, it is important that you notify all of your health care providers – including hospitals if you have an emergency or surgery – as well as your pharmacy.