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Medicare... and the transitioning from an Employer based health insurance

These days there are many people working past the age of 65, the age when you become eligible for Medicare benefits. Because of this, many workers are postponing their Medicare enrollment under the qualifying condition of having “credible coverage.” This allows workers to skip enrolling in Medicare Part B while they continue to have credible coverage from current employment, without any penalty, until they lose their employer coverage. If you are a worker that has postponed Medicare Part B enrollment and are now losing your credible employer coverage due to retirement or job loss, here is a breakdown on how to transition to Medicare.

Enrolling in Medicare

You must first enroll in Medicare if you have not done so during you Initial Enrollment Period (IEP). If you didn't enroll in Medicare at 65 but you maintained "credible coverage", then you would use a Special Election Period to enroll in Medicare Part B, as well as Medicare Advantage Plans and Medicare Supplements.  

Medicare Part A (Hospital): If you have worked and paid Medicare tax for at least 10 years, then you will be eligible for premium-free Medicare Part A Hospital coverage. Part A coverage begins automatically, without the need to enroll if you are eligible under these circumstances. This is not the case for Medicare Part B. 

Medicare Part B (Doctor/Outpatient): Unlike Medicare Part A, you are NOT automatically enrolled in Medicare Part B. You must actively choose to enroll in Medicare Part B and can so via online at www.socialsecurity.gov  over the phone via social security, or in person at a social security office. Without both Parts A and Part B, you will NOT have the option to choose a Medicare Supplement or Medicare Advantage plan. 

How long do you have to enroll in Medicare?

When you lose employer-based credible coverage, you will have a special enrollment period for 8 months after losing coverage to enroll in Part B.  It is very important to note that COBRA coverage is not considered “credible coverage” by Medicare so you need to enroll in Part B within 8 months of the date that they cease to have coverage from current employment to avoid a penalty. Once you have Part A and B, you can enroll in a Medicare Advantage Plan or a Medicare Supplement Policy.  Read below to see the Special Election Period for those plans. 

Special Election Period for Medicare Advantage/ Medicare Supplements

If you are looking to add a Medicare Advantage Plan (MA/MAPD) or a Medicare Supplement Plan to fill the gaps of Original Medicare, then you have a completely separate "Special Enrollment period" as outlined below. 

  1. If you already have Part B before losing credible coverage, or you enroll in it as soon as you lose your coverage then you have 63 days after the loss of employer coverage to enroll into a Medicare Advantage plan.
  2. If you don’t take Part B right away but add it within the 8 month Part B window then you would need to pick your Medicare Advantage Plan the month before your Part B becomes effective. 
  3. If you want to buy a Medicare Supplement plan, you will have a guaranteed issue period to buy one with no health questions asked, for 6 months after you first get Medicare Part B

I you have any questions, or would like to speak to Amy, a Licensed Agent about your optons, contact us here.


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