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Vol. 14, Issue 12 – June 15, 2015

Do I have to enroll in Medicare if I am still working?

Dear Marci,

I am turning 65 soon, but I still plan on working for a few years. My employer gives me health insurance, but I am not sure whether I have to enroll in Medicare. Do I have to enroll in Medicare if I am still working?

– Bruce (Cleveland, OH)

Dear Bruce,

You may have to enroll in Medicare while you are still working, but it depends on what type of coverage you have from your current employer and how it works with Medicare.

Medicare Part A (hospital insurance) is premium-free if you or your spouse worked in the United States for 10 years or more. Many people choose to enroll in Part A when they are first eligible, since they do not have to pay a monthly premium. If you qualify for premium-free Part A, you can enroll in Part A at any time.

However, everyone has to pay a monthly Part B premium, which is $104.90 for most people in 2015. When you sign up for Medicare, you are automatically enrolled in both Medicare Parts A and B. However, you have the option to turn down Part B, but you should use great caution before delaying your Part B coverage.

You should only consider delaying Part B coverage if you confirm two things. First, you must have health insurance from a current employer (or a spouse’s current employer). If you have coverage from your (or your spouse’s) current employer, you qualify for a Special Enrollment Period (SEP) to enroll in Medicare Part B later and will not face penalties or periods without coverage. If your insurance does not come from your or your spouse’s current work, you do not qualify for this SEP. Note that retiree insurance and COBRA coverage do not count as coverage from a current employer.

Second, you should only consider delaying Part B coverage if your current employer coverage pays first and Medicare pays second. In other words, only consider delaying Part B if your employer coverage does not change how much it pays for your care after you qualify for Medicare. If you are 65 of older, health insurance from your (or your spouse’s) current employer pays first if the organization has 20 or more employees (note that if you are under 65 and disabled, the organization must have 100 or more employees).

On the other hand, you should enroll in Medicare Part B when you first qualify if your employer coverage only pays for your care after Medicare pays. If Medicare pays first and you fail to enroll, your employer coverage can reduce its payment or refuse to pay anything for your health care. Medicare usually pays first if you work for an organization with less than 20 employees.

To find out how your specific employer coverage works with Medicare, talk to your employer and get the information in writing. Also, confirm this information with the Social Security Administration (SSA), especially if you plan on delaying Part B enrollment. When you call Social Security, it is important to write down who you spoke to and the details of your conversation.

-Marci

Health Tip
A recent study published in the Annals of Family Medicine suggests that family doctors who provide more care themselves—rather than referring out to specialists—can save the health care system money. The study examined the work of approximately 3,600 family doctors with 555,000 Medicare patients across the country. Patients with doctors who provided a wider range of services experienced fewer hospitalizations that those with doctors who provided fewer services. The more comprehensive a doctor was, the less likely a patient was to end up in the hospital. Doctors who provided more services also reduced overall patient costs. The results point to good primary care as a key way to reduce health care costs.

To read the coverage of this study from NPR, click here. To read the full study, click here.

Need to Know
Medicare Rights University, a comprehensive online training curriculum for professionals, provides a guided learning experience complete with a self-assessment tool, in-depth and user-friendly Medicare content, quizzes to test your knowledge, and downloadable materials.This unique resource provides professionals with a clear path to learning Medicare through a Core Curriculum—four levels of Medicare instruction designed to build on information learned as you progress through each level. Medicare Rights University also offers a Special Topics section which provides an in-depth look at subjects not covered in the Core Curriculum, such as Medicare’s coverage of durable medical equipment and Medicare from a policy perspective.Check out Medicare Rights University today by going online and visiting www.medicarerightsuniversity.org.

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