What If You Are Over 65 and On An Employer Plan?
If you have medical insurance coverage under a group health plan based on your or your spouse's current employment, you may not need to apply for Medicare Part B at age 65. But there are 2 qualifications for this.
First: Your company must have more than 20 employees, and that is the total employees working for the company.
Second: The company health plan must be “creditable”, which means it must be at least as good as Medicare coverage. If in doubt, contact your benefits administrator.
If you satisfy those two requirements, then you will qualify for a Special Enrollment Period (SEP) that will let you sign up for Part B during:
- Any month you remain covered under the group health plan and you or your spouse's employment continues.
- The 8-month period that begins with the month after your group health plan coverage or the employment it is based on ends, whichever comes first.
You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA.
Once you have decided to retire and move off the employer plan. It’s best to start this process 6 to 8 weeks before ending your company plan.
STEP 1: Take form OMB No. 0938-0787 to your HR department and have them complete the form, inserting your start date for the company plan and your ending date of coverage. We have the forms under Resources- Important Forms. You will also need this form for your application to Social Security. OMB No. 0938-1230.
STEP 2: Now that you have the form OMB No. 0938-0787 completed. and have filled out form OMB No. 0938-1230, you need to apply for Part B with Social Security. Call 800-772-1213 and tell Social Security what you want to do. They may make an appointment for you, or they may advise you go online to apply. Prior to the Pandemic, we advised clients to show up at a local Social Security office, but lately people have been turned away without an appointment. It's best to call first.
STEP 3: After you have applied for Part B, it normally takes about 2-3 weeks to get your approval. When you receive your letter of approval or have gone online to your Social Security Account to find your approval, call Professor Medicare to enroll in a plan.
What About Part D?
We covered Parts A and B, but there is also Part D. Just as you needed to provide proof of creditable coverage for Part B, you need to do so for Part D drug coverage. When you contact HR to have them fill out the OMB form for B, also ask HR for a cover letter on company letterhead stating your start and end dates of creditable drug coverage under the employer plan and the insurance company you were insured with. Keep the letter and provide it to your future Part D carrier. The carrier will want that letter to avoid assessing you a fine for Part D late enrollment.
Let’s Recap the steps to enrolling in Medicare if you are over 65, still working and have creditable company coverage.
1. If you are planning to continue working: compare Medicare coverage with your company plan. Determine if you want to continue the company plan or go onto Medicare.
2. Establish your Timeline: when you want the employer plan to end and when to start Medicare
3. Once you decide to enroll in Part B, take this form, OMB No. 0938-0787, to HR and have them complete it with your start and projected end dates for the company plan. Also, get a letter stating you had creditable drug coverage for those same dates.
4. Complete form OMB No. 0938-1230.
5. Call Social Security at 800-772-1213 and tell them you want to apply for Part B. They will advise on your next steps.
6. Once you receive your Part B approval with an enrollment date, call us and we can find the best coverage for your needs.
We have the forms under Resources- Important Forms.
Feel free to call with questions.