When you are approaching age 65 or are past age 65 but approaching retirement your insurance situation will change dramatically from what you are familiar with. You will be learning a new language because Medicare operates differently than insurance for any other stage of your life. Many people find it confusing and often aren’t aware of the potential costly mistakes when making decisions about Medicare and what you must do and when.
But don’t worry, we can help make your transition to Medicare easy and painless. Here at McCormack Consulting Group, we have been helping people understand and enroll in Medicare for over a decade and know how to break the complexity down to the basics and ensure that you enroll in the appropriate plan(s) for your circumstances.
To get started, here are some frequently asked questions about the transition to Medicare:
What are the Parts of Medicare?
Medicare Part A (Hospital Insurance) provided by the Federal government and administered by the Center for Medicare Services.
Medicare Part B (Medical Insurance) provided by the Federal government and administered by the Center for Medicare Services.
Medicare Part C (Medicare Advantage) provided by private insurance companies and regulated by the Center for Medicare Services.
Medicare Part D (Prescription Drug Coverage) provided by private insurance companies and regulated by the Centers for Medicare Services.
Medigap (Medicare Supplement) provided by private insurance companies, are standardized and regulated by the Federal government.
Is Medicare Mandatory?
Yes, no and maybe.
NO: If you have creditable coverage (coverage at least as good as Medicare) through an employer and the employer has over 20 employees, then you do not need to enroll in Medicare.
YES: If you are employed by a company that had less than 20 employees, you must enroll in Medicare or face penalties for late enrollment when you enroll later.
AUTOMATIC: If you are collecting Social Security, you will automatically be enrolled in Medicare Parts A & B. If you do not wish to continue with Medicare and have other credible coverage through an employer (self or spouse) and the employer is over 20 employees, then you can cancel your enrollment. If your employer has less than 20 employees, then you will need to continue with Medicare.
ADDITIONALLY: If you are collecting Social Security Disability, you will be automatically enrolled in Medicare after 24 months of disability.
If you have creditable coverage through an employer, union, TRICARE, or Veterans Affairs (VA) coverage you are not required to enroll in Part D.
If you are eligible for both Medicare and Medicaid you are automatically enrolled in Part D and your costs are covered or reduced by those entities
Where do I apply for Medicare?
You apply for Medicare Parts A and B through Social Security, either online through www.ssa.gov or by visiting your local Social Security office. If you apply online, you do not need to be receiving or sign up for Social Security benefits to get Medicare.
You can work with an agent to enroll in Medigap and a Part D plan or a Medicare Advantage plan.
When should I apply for Medicare?
You have an Initial Enrollment Period of 7 months (3 months prior to, your birth month and 3 months after). You should apply at least 1 month prior to when you want to start your benefits.
If you are collecting Social Security you will automatically be issued a Medicare card approximately 2-3 months before you turn 65.
What will Medicare cost?
Medicare Part A has no premium for those who have worked and paid Medicare taxes for at least 40 quarters during their lifetime or can file under their spouse if they have not worked.
Medicare Part B has a premium of $164.90 in 2023 for those with incomes up to $97k single and $194k for a couple. The government sets this premium every year.
There is a surcharge for people with incomes over the threshold on a sliding scale based on your income from two years ago. You can see the chart here: "C:\Users\Karen\OneDrive - McCormack Consulting Group, Inc\Insurance Business\Docs, Forms and Info\Medicare Forms & Docs\2023 IRMAA Chart.pdf" (link to chart and place the chart in the Resources section).
Can you be penalized for not enrolling?
Yes, there are late enrollment penalties for certain parts of the program if you don’t enroll during your initial enrollment period and don’t have creditable coverage.
Medicare Part A (Hospital Insurance): If you don't qualify for premium-free Part A and you don't sign up when you're first eligible, you may have to pay a late enrollment penalty.
Medicare Part B (Medical Insurance): If you don’t sign up for Part B when you’re first eligible and you don’t have other creditable coverage, you may face a permanent penalty while you have Part B.
Medicare Part D (Prescription Drug Coverage): If you go without creditable prescription drug coverage for 63 or more continuous days after your Initial Enrollment Period (IEP) for Part D, you may have to pay a late enrollment penalty when you do sign up for Part D coverage which is permanent.
If you missed your Initial Enrollment Period for Part A or B you will have to wait until the General Enrollment Period to enroll, which occurs from January 1st to March 31st every year.
Other Related Links:
Medicare 101 Video (on Vimeo)