Medicare Blog

how to avoid lapse in employer health coverage and medicare upon retirement

by Dr. Gussie Champlin I Published 2 years ago Updated 1 year ago

Apply for Medicare 2 to 3 months before you end employment to avoid a gap in coverage. If you enrolled in Social Security before your 65th birthday, you will be enrolled automatically in Medicare Parts A and B. However, if you are still covered by an employer's health plan, you could be paying for 2 plans.

Full Answer

Can I decline my employer’s plan for Medicare?

You can always choose to have Medicare and decline your group plan, but your employer can never force that decision. Can I drop my employer's health insurance for Medicare? You can drop your employer’s health plan for Medicare if you have large employer coverage.

Can you have a gap between work and Medicare?

You should not have a gap when your work coverage has ended but your Medicare has yet to begin. How do I enroll in Medicare Part B if I have Employer’s Insurance?

How does Medicare work with my employer’s insurance?

If Medicare pays secondary to your insurance through your employer, your employer’s insurance pays first. Medicare covers any remaining costs. Depending on your employer’s size, Medicare will work with your employer’s health insurance coverage in different ways.

What happens to your health insurance when you retire?

Be aware that when you retire, if for some reason you end up continuing your workplace health plan under COBRA — a law that allows you to continue the coverage for a set time if you pay the full premiums — Medicare doesn’t consider that coverage creditable. Same goes for insurance through your ex-employer after you retire.

When you retire from a company do you keep your health insurance?

When you do retire, you will probably have the option of continuing on your employer's health plan for at least 18 months, thanks to a federal law called the Consolidated Omnibus Budget Reconciliation Act (COBRA). It says that when you leave your job, your employer must let you keep your coverage for up to 18 months.

Does Medicare cover lapse?

If you go 63 days or more in a row without Medicare drug coverage or other creditable prescription drug coverage, you may have to pay a penalty if you sign up for Medicare drug coverage later.

Do I have to pay Medicare after I retire?

If you (or your spouse) are getting ready to retire, or if you lose your job-based health insurance before you stop working, you have a limited time to sign up for Medicare without penalty. You may want to start thinking about signing up for Medicare a few months before you retire.

Do you have to pay for Medicare Part B when you retire?

You must continue to pay your Part B premium while in a Medicare Advantage Plan. (Part D) and other benefits that Original Medicare doesn't cover. If you have a Medicare Advantage Plan, you do not need a Medigap policy.

Is Cobra creditable coverage for Medicare?

COBRA is not normally considered to be creditable coverage for Medicare major medical benefits, so people who are enrolled in COBRA and do not enroll in Medicare Part B within 8 months of turning 65 face substantial financial penalties for the rest of their lives, even if they have months or years left on their COBRA ...

How do I delay Medicare enrollment?

Once you have signed up to receive Social Security benefits, you can only delay your Part B coverage; you cannot delay your Part A coverage. To delay Part B, you must refuse Part B before your Medicare coverage has started.

Can you have Medicare and employer insurance at the same time?

Thus, you can keep Medicare and employer coverage. The size of your employer determines whether your coverage will be creditable once you retire and are ready to enroll in Medicare Part B. If your employer has 20 or more employees, Medicare will deem your group coverage creditable.

At what age do you stop paying FICA taxes?

However once you are at full retirement age (between 65 and 67 years old, depending on your year of birth) your Social Security payments can no longer be withheld if, when combined with your other forms of income, they exceed the maximum threshold.

Is it necessary to have supplemental insurance with Medicare?

For many low-income Medicare beneficiaries, there's no need for private supplemental coverage. Only 19% of Original Medicare beneficiaries have no supplemental coverage. Supplemental coverage can help prevent major expenses.

What happens if you don't enroll in Medicare Part A at 65?

If you don't have to pay a Part A premium, you generally don't have to pay a Part A late enrollment penalty. The Part A penalty is 10% added to your monthly premium. You generally pay this extra amount for twice the number of years that you were eligible for Part A but not enrolled.

Do I automatically get Medicare when I turn 65?

You automatically get Medicare when you turn 65 Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Why do I need Medicare Part C?

Medicare Part C provides more coverage for everyday healthcare including prescription drug coverage with some plans when combined with Part D. A Medicare Advantage prescription drug (MAPD) plan is when a Part C and Part D plan are combined. Medicare Part D only covers prescription drugs.

How to avoid Medicare mistakes?

Retiring past age 65? How to avoid costly Medicare mistakes 1 Part A (hospital coverage) costs nothing for most people. Both Part B (outpatient coverage) and Part D (prescription drug coverage) come with late-enrollment penalties if you miss important deadlines. 2 When your retire and your workplace coverage ends, you get eight months to sign up for Part B and two months to get Part D coverage. 3 If you’re considering a Medigap policy, you get a six-month window when you enroll in Part B to secure coverage without undergoing medical underwriting.

What to do if you are 65 and retiring?

Squawk Box. If you’ve already turned 65 and are getting close to saying goodbye to full-time work, make sure Medicare is on your must-tend-to checklist. While it’s common for people working past that age to stick with a company-sponsored health plan and delay enrolling in Medicare, impending retirement means you should be planning ahead ...

How long does it take to get a Medigap policy?

If you plan to go this route: Once you sign up for Part B, you’re given six months to get a Medigap policy without the insurer being allowed to nose through your health history.

What is the penalty for Part D?

For Part D prescription coverage, the late-enrollment penalty is 1 percent for every month that you could have been signed up. People with qualifying coverage through an employer plan don’t face that life-lasting penalty as long as they secure coverage within two months of their other plan ending.

How long do you have to wait to sign up for Advantage Plan?

Meanwhile, if you want to sign up for an Advantage Plan, you also get two months from when your workplace coverage ends to do so without having to wait until the fall general enrollment window.

What is the penalty for late enrollment for Part B?

If you were to be subject to the late-enrollment penalty for Part B, it would be 10 percent per year that you should have been signed up but were not. The amount would be life-lasting and tacked on to your premium.

When do you sign up for medicare?

Most people sign up for Medicare when first eligible at age 65 either because they no longer are working or don’t have qualifying coverage through a job. For a small but growing contingent of older Americans who continue to work past that age, however, having workplace coverage means having options.

What is a Medicare leave period?

A period of time when you can join or leave a Medicare-approved plan.

When do you need to sign up for Medicare?

If the employer has less than 20 employees: You might need to sign up for Medicare when you turn 65 so you don’t have gaps in your job-based health insurance. Check with the employer.

Do I need to get Medicare drug coverage (Part D)?

You can get Medicare drug coverage once you sign up for either Part A or Part B. You can join a Medicare drug plan or Medicare Advantage Plan with drug coverage anytime while you have job-based health insurance, and up to 2 months after you lose that insurance.

What happens if you don't sign up for Part A and Part B?

If you don’t sign up for Part A and Part B, your job-based insurance might not cover the costs for services you get.

Do you have to tell Medicare if you have non-Medicare coverage?

Each year, your plan must tell you if your non-Medicare drug coverage is creditable coverage. Keep this information — you may need it when you’re ready to join a Medicare drug plan.

Does Medicare work if you are still working?

If you (or your spouse) are still working, Medicare works a little differently. Here are some things to know if you’re still working when you turn 65.

Does private insurance pay for services?

Some private insurance has rules that lower what they pay (or don’t pay at all) for services you get if you’re eligible for other coverage, like Medicare.

How long does Medicare coverage last?

This special period lasts for eight months after the first month you go without your employer’s health insurance. Many people avoid having a coverage gap by signing up for Medicare the month before your employer’s health insurance coverage ends.

What is a small group health plan?

Since your employer has less than 20 employees, Medicare calls this employer health insurance coverage a small group health plan. If your employer’s insurance covers more than 20 employees, Medicare will pay secondary and call your work-related coverage a Group Health Plan (GHP).

Does Medicare pay second to employer?

Your health insurance through your employer will pay second and cover either some or all of the costs left over. If Medicare pays secondary to your insurance through your employer, your employer’s insurance pays first. Medicare covers any remaining costs. Depending on your employer’s size, Medicare will work with your employer’s health insurance ...

Is Medicare the primary or secondary payer?

The first thing you want to think about is whether Medicare will be the primary or secondary payer to your current insurance through your employer. If Medicare is primary, it means that Medicare will pay any health expenses first. Your health insurance through your employer will pay second and cover either some or all of the costs left over. If Medicare pays secondary to your insurance through your employer, your employer’s insurance pays first. Medicare covers any remaining costs.

Does Medicare cover health insurance?

Medicare covers any remaining costs. Depending on your employer’s size, Medicare will work with your employer’s health insurance coverage in different ways. If your company has 20 employees or less and you’re over 65, Medicare will pay primary. Since your employer has less than 20 employees, Medicare calls this employer health insurance coverage ...

Can an employer refuse to pay Medicare?

The first problem is that your employer can legally refuse to make any health-related medical payments until Medicare pays first. If you delay coverage and your employer’s health insurance pays primary when it was supposed to be secondary and pick up any leftover costs, it could recoup payments.

When Can I Enroll in Medicare Part B if I have Employer’s Insurance?

There are two main times when you can enroll in part B when you are over 65 and covered by your employer’s insurance:

What is the phone number for Medicare?

If you have an urgent matter or need enrollment assistance, call us at 800-930-7956. By submitting your question here, you agree that a licensed sales representative may respond to you about Medicare Advantage, Prescription Drug, and Medicare Supplement Insurance plans.

Can seniors over 65 delay Medicare?

Senior65 generally recommends those over 65 delay enrolling in Medicare Part B if they are offered coverage through work (including spouse’s work). We all want to stay clear of paying Medicare late-enrollment penalties while avoiding gaps in coverage. This is where Senior65 comes in to make sense of it all.

Does Senior65 sell your information?

Senior65 believes in your privacy. We will not sell your personal information. This is a solicitation for insurance.

Does Medicare Part B start at the same time?

That way you can time it that when your work coverage ends, your Medicare Part B (and any supplemental or drug coverage you may purchase) all start at the same time. You should not have a gap when your work coverage has ended but your Medicare has yet to begin.

What Happens to My Medicare if I Go Back to Work?

Often, you might retire and later go back to work. If you pause your retirement and your large employer offers you group insurance, you can cancel Part B. When you retire again; you can enroll back into Part B with no penalties.

What happens if you leave Medicare without a creditable coverage letter?

Without creditable coverage during the time you’ve been Medicare-eligible, you’ll incur late enrollment penalties. When you leave your group health coverage, the insurance carrier will mail you a creditable coverage letter. You’ll need to show this letter to Medicare to protect yourself from late penalties.

Does Medicare Work With Health Savings Accounts?

When enrolled in any Medicare parts, you CANNOT contribute to a Health Savings Account (HSA). Your employer also can’t contribute to your HSA once your Medicare is active. If you continue to add to your HSA, you could face tax penalties.

What Forms Do I Need to Show Creditable Coverage From an Employer?

You will need your employer to fill out the CMS-L564 form . This form is a request for employment information form. Once the employer completes section B of the form, you can send in the document with your application to enroll in Medicare.

What determines if you are a primary or secondary employer for Medicare?

The size of your employer will determine how your Medicare benefits will coordinate with your employer coverage. If you’re aging into Medicare while working for an employer with over 20 employees, your group plan is primary and Medicare secondary.

How many employees are eligible for creditable insurance?

For your outpatient and medication insurance, a plan from an employer with over 20 employees is creditable coverage. This safeguards you from having to pay late enrollment penalties for Part B and Part D, respectively.

What happens if you don't have Part B insurance?

If you don’t, your employer’s group plan can refuse to pay your claims. Your insurance might cover claims even if you don’t have Part B, but we always recommend enrolling in Part B. Your carrier can change that at any time, with no warning, leaving you responsible for outpatient costs.

What are the parts of a retirement plan?

PART 1. Easing into Retirement. Part 2. Targeted Benefits for Aging Workers. PART 3. Lifetime Income Prospects. Part 4. Preparing for Health Care in Retirement. O lder workers face a number of decisions about health care coverage, such as whether to enroll in Medicare while still employed and if so, which parts.

How much does it cost to retire at 65?

A 65-year-old couple retiring in 2019 can expect to spend $285,000 in health care and medical expenses throughout retirement, she noted, while for single retirees, the health care cost estimate is $150,000 for women and $135,000 for men, based on Fidelity's research.

What is the lowest cost Medicare plan?

Phil Moeller: If your health is good, your lowest-cost Medicare solution would be a zero-premiums Medicare Advantage plan. You most likely would have to continue to pay that monthly premium, which is for Part B coverage. Part B doesn’t cover all your needs. But a zero-premium Medicare Advantage health maintenance organization (HMO) plan with a bundled-in Part D drug plan (normally abbreviated as an MA-PD plan) would protect you from catastrophic health and drug expenses. Of course, you’d need to be comfortable with using the doctors, hospitals and other health care providers in the plan’s network. You don’t say if you also are eligible for Social Security benefits, but if you qualify for premium-free Part A Medicare coverage (which I assume you do if your only current Medicare payment is for Part B), then you might explore whether you could earn some extra income from Social Security. As you might know, your British pension might reduce your Social Security income due to Social Security’s Windfall Elimination Provision. The United States and the United Kingdom have what’s called a totalization agreement that might affect your WEP reductions in Social Security. Here’s an online tool you can use to find out more.

How often do you have to pay Medicare premiums?

As for your Medicare premiums, you will need to pay them directly to Medicare every three months. You can sign up for a program that will deduct these payments from your bank account. Robert – N.Y.: I have employer-provided health insurance.

Does turning 65 require you to take Medicare?

By law, employer group health insurance plans must continue to cover you at any age so long as you continue working. Turning 65 would not force you to take Medicare so long as you’re still working.

Can you collect Social Security if you have polio?

As for your childhood polio, this condition might have entitled you to earlier Social Security Disability benefits, but it will not be the basis of any benefits now since you have been retired for several years. Besides, these benefits would not increase the amount of money you might be due from Social Security. If your pension is your only source of income, you should explore whether you’re eligible for low-income assistance programs. You could call a counselor for the State Health Insurance Assistance Program (SHIP). There are broader old-age programs that you also could explore. A good source here would be the Arizona affiliate of the National Association of Area Agencies on Aging. Good luck to you.

Does FEHB have to pay Medicare?

Your retiree coverage should continue to pay primary and you might not even need Medicare. Check with your benefits folks on this.

What happens if you lose your Medicare?

If you lose your current coverage, you must sign up for Medicare within a certain time frame. If you don’t, you’ ll incur penalties that may last your whole life.

How long do you have to enroll in Medicare if you have lost your current plan?

No matter your reasons for deferring, you must enroll in Medicare within 8 months of losing your current coverage.

How much is Medicare Part B in 2021?

Medicare Part B covers outpatient medical costs and comes with a monthly premium for all Medicare beneficiaries. The standard premium is $148.50 per month in 2021, but this rate could be higher based on your income. You can also defer Part B coverage. However, if you defer Medicare Part B coverage, you may receive significant financial penalties ...

What happens if you don't wait for Medicare open enrollment?

If this happens, don’t wait for the next Medicare open enrollment period, otherwise you may have a lapse in coverage and owe penalty fees.

How long do you have to work to get Medicare Part A?

Medicare Part A covers hospital expenses. If you or your spouse worked for at least 10 years (40 quarters), you will most likely be eligible for premium-free Part A when you turn 65 years old. You can defer Medicare Part A.

What happens if you miss your Part A?

If you miss both initial enrollment and special enrollment, your late enrollment penalties may be steep and may last a long time. If you’re not eligible for premium-free Part A and buy it late, your monthly premium will rise by 10 percent for double the number of years you didn’t sign up.

How many employees can you defer Medicare?

To defer Medicare, you must have qualifying health insurance, such as through a large group plan that covers 20 or more employees.

What happens if you miss a Medicare enrollment window?

If you miss that window, you could face a late-enrollment penalty. That amount is 1% of the national base premium for each full month that you could have had coverage but didn’t. Additionally, the Social Security Administration will want to talk to you before you make the decision to drop Medicare.

How long do you have to re-enroll in Medicare if you stop working?

As long as your employer-sponsored health care is considered qualifying coverage by the government, you get an eight-month window to re-enroll in Part B when you stop work or lose the group coverage.

How much does Medicare Part A cost?

Part B, which covers outpatient care, comes with a standard monthly premium of $135.50 for 2019 (although higher earners pay more). Part D, which provides prescription drug coverage, has a 2019 base premium of about $33. Higher earners pay more for that coverage as well.

How long does it take to get a Medigap policy?

And, Barry said, it might be difficult to get another policy down the road. When you first sign up for Medicare, you get six months to buy a Medigap policy without the insurer charging you more or denying coverage due to your health status or pre-existing conditions.

How many people are on medicare at 65?

Roughly 52.2 million Americans age 65 or older are on Medicare. Another 8 million or so beneficiaries are younger people with disabilities.

What is the maximum deductible for 2019?

For 2019, a high-deductible health plan is one with a deductible of at least $1,350 for an individual and $2,700 for a family, with maximum annual out-of-pocket costs (not counting premiums) of no more than $6,750 and $13,500, respectively. That excludes out-of-network costs.

How long is the Advantage Plan enrollment period?

If you’re going to enroll in an Advantage Plan, that also can be done during your eight-month special enrollment period.

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