[x_blockquote cite=”Amanda (Olive Branch, MS)” type=”left”]Dear Marci,
Is it ever permissible to delay enrolling in Medicare altogether? I’m still a year off from turning 65, I’m working and covered by my workplace health plan, and I’d like to weigh all options open to me.
Anyone covered by current employee insurance thinking about delaying Medicare enrollment should consider which part of Medicare they want to delay: Medicare Part A (hospital insurance), Part B (medical insurance), or Part D (prescription drug coverage).
Before delaying Part A enrollment, consider the following questions:
- Am I eligible for premium-free Part A? If you are eligible for premium-free Part A because you or your spouse worked more than 10 years in the United States, you can sign up for Part A at any time and will not have a late enrollment penalty for delaying enrollment. Many people are eligible for premium-free Part A. Many also choose to enroll when they first become eligible, even if their employee coverage pays primary, because they do not have to pay a premium.
- I am not eligible for premium-free Part A. Will I have a Special Enrollment Period (SEP) to sign up for Medicare later? If you are not eligible for premium-free Part A, you should think carefully before delaying Part A enrollment because you will need a Special Enrollment Period to sign up for the first time without penalty. If you are covered by insurance based on current work, you can use this SEP to sign up for premium Part A without penalty. If you do not qualify for an SEP, you will likely have a late enrollment penalty for delaying premium Part A enrollment. In addition, you will have to wait for the General Enrollment Period to enroll in premium Part A.
Before delaying Part B enrollment, consider the following questions:
- Will I have a Part B SEP to sign up for Medicare later? If you are entitled to a Part B SEP, you will be able to enroll in Part B outside of your Initial Enrollment Period (three months before, the month of, and three months after your 65th birthday month) or the General Enrollment Period (from January 1 through March 31 each year, with coverage becoming effective on July 1). If you have a Part B SEP, you will not have a late enrollment penalty for delaying Part B enrollment.
- Will my other coverage pay primary or secondary to Medicare? If your employee health coverage will pay secondary to Medicare once you are eligible, it is usually not advisable to delay Medicare enrollment. Secondary insurance may take back any payments that it has made, or refuse to make future payments on health care costs until you enroll in Medicare.
Before delaying Part D enrollment, consider the following questions:
- Is my current drug coverage creditable? Creditable drug coverage is coverage whose value is at least the same as the value of Medicare Part D. If your current drug coverage is creditable, you can delay Part D enrollment without penalty. You should receive a notice around September of each year informing you if your prescription drug coverage is creditable. If you have not received this notice, you should contact your human resources department. You should keep this notice for your records for each year that you have creditable drug coverage because you may need this paperwork to sign up for Part D later.
- Will I have a Part D SEP to sign up for Medicare later? You will have an SEP to sign up for Medicare Part D later if you lose employer-based coverage (regardless of whether your employee drug coverage is creditable). You are also eligible for an SEP if you lose creditable drug coverage through no fault of your own. Both of these SEPs last for up to two months after the month that you lose your drug coverage. If your coverage was creditable, you will not have a Part D late enrollment penalty.
Amanda, to fully review your Medicare enrollment options, reach out to your State Health Insurance Assistance Program (SHIP). To find your SHIP’s contact information, you can go to www.shiptacenter.org or call 1-877-839-2675 for assistance. A SHIP counselor can help you understand your situation and discuss your specific health insurance needs.