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Information about Medicare enrollment

Do you have employees or retirees who are eligible to enroll in Medicare?  

People who are still working (or have retiree, COBRA, or other types of coverage) have important decisions to make about their health coverage when they become eligible for Medicare.  The rules about how other insurance works with Medicare—and considerations that people should weigh when deciding whether to enroll in Medicare when they become eligible—vary based on:

• The reason(s) they’re eligible for Medicare
• If they, a spouse, or a disabled family member are still working, and
• If they have employer-sponsored group health plan coverage based on that active employment  

Signing up for Medicare late can increase the premium costs for your employees for as long as they have Medicare (and well after they retire from your company), and can result in gaps in coverage. We ask that you and your benefits administrators become familiar with this information. You can send people to Medicare.gov for more information to help them make informed decisions about their health coverage.

 

Medicare basics

Medicare Part A, which helps cover inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care, is free for most people.  However, there’s a monthly premium for Medicare Part B, which covers certain doctors' services, outpatient care, medical supplies, and preventive services.  

Medicare is health insurance for people:

• 65 or older,
• Under 65 with certain disabilities, or
• Who have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant), regardless of their age

Most people get Part A for free, but some have to pay a premium for this coverage.

To qualify for premium-free Part A, a person must be eligible for Medicare based on their own earnings, or the earnings of a spouse or a parent. They must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required depends on whether the person is filing for Part A on the basis of age, disability, or End-Stage Renal Disease (ESRD).

To be eligible for premium-free Part A on the basis of age, a person must be:

• 65 or older
• Eligible for monthly Social Security or Railroad Retirement Board (RRB) cash benefits

To be eligible for premium-free Part A on the basis of disability, a person must be:

• Entitled to monthly Social Security or Railroad Retirement Board (RRB) benefits after being disabled for 24 months, or
• A disabled federal, state, or local government employee not eligible for monthly Social Security or RRB benefits. They may be automatically enrolled in premium-free Part A after being disabled for 29 months.

People who are eligible for premium-free Part A on the basis of ESRD:

• Must have worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
• Are getting (or are eligible for) Social Security or RRB benefits, or
• Are the spouse or dependent child of a person who has worked the required amount of time under Social Security, the RRB, or as a government employee; or are getting Social Security or RRB benefits.

 

If a person who is eligible for premium-free Part A doesn’t sign up for Part B when they’re first eligible, they may enroll later, but only during the General Enrollment Period between January 1–March 31 each year (unless they qualify for a Special Enrollment Period (SEP)). They also may pay a late enrollment penalty for as long as they have Part B.

 

Signing up during a Special Enrollment Period (SEP)

Some people 65 or older don’t sign up for Medicare Part B when first eligible because they or their spouse are working and they’re covered by an employer or union group health plan (GHP). They can sign up later using the SEP Related to Coverage Under Group Health Plans.

People who have Medicare based on disability can sign up using this SEP if they, their spouse, or their family member are working and are covered by an employer or union GHP with at least 100 employees (also known as a Large GHP). People who qualify for Medicare based on End Stage Renal Disease (ESRD) aren’t eligible for this SEP.

If eligible for this SEP, a person can sign up for Part B without a penalty:

• Anytime while they’re covered by the employer or union GHP based on current employment, or

• Up to 8 months after the GHP coverage or the employment ends, whichever happens first.

Some important things to know about what is and isn’t considered group health plan coverage:

• COBRA coverage and retiree health plans aren’t considered coverage based on current employment. People who have COBRA or retiree coverage aren’t eligible for this SEP when their coverage ends. Individuals who remain in COBRA and don’t sign up for Medicare coverage when first eligible may have to pay a life-long late enrollment penalty.
• Plans that only cover self-employed individuals aren’t considered GHPs. People with this type of coverage aren’t eligible for this SEP.   
• Coverage where the employer pays a stipend for the employee to get insurance (such as coverage through the Health Insurance Marketplace® or private insurance) isn’t considered group health plan coverage. People with this type of coverage aren’t eligible for this SEP.
• The Small Business Health Options Program (SHOP) in the Health Insurance Marketplace® is group health plan coverage. People covered by a SHOP plan because of their or their spouse’s current employment can use this SEP.

Knowing who pays first

When deciding to sign up for Part B, people must consider whether Medicare or their employer-based insurance will pay first. If Medicare pays first and a person isn’t enrolled in Part B, the other insurance may not pay all the uncovered costs.  

• If a person is eligible for Medicare due to age, their employer-based insurance from current employment will pay first if the employer has more than 20 employees.  
• If a person is eligible for Medicare due to disability, their employer-based insurance from current employment will pay first if the employer has more than 100 employees
• If a person is eligible for Medicare due to ESRD, other insurance (from work or from other sources) will pay first for the first 30 months starting the first month the person is eligible for Medicare, whether or not the person signs up for Medicare.

Contact us

For questions about signing up for Medicare, call Social Security at 1-800-772-1213 or visit socialsecurity.gov. TTY users can call 1-800-325-0778.  For those who worked for a railroad or get Railroad Retirement Board (RRB) benefits, call the RRB at 1-877-772-5772 or visit rrb.gov. TTY users can call 1-312-751-4701.

For questions about Medicare benefits, call 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov.  TTY users can call 1-877-486-2048.

Contact a local State Health Insurance Assistance Program (SHIP) to get free personalized counseling on Medicare coverage, claims, appeals, and help for people with limited income and resources. Call 1-800-MEDICARE or visit shiptacenter.org to get the phone number of your local SHIP.