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Under 65 and on Social Security Disability
If you are on Social Security disability, you will be eligible for Medicare on the first day of your 25th month of disability. You will automatically receive your Medicare card about 3 months before this date.
You will have an initial enrollment period just like someone who has turned 65.
If you do not have other health coverage—like from a spouse or employer—you will want to keep Part B and pay the Part B premium, or seek financial assistance if needed. There is no premium for the Part A.
Many people under 65 and on disability do not realize they can purchase a supplement or enroll in a Medicare Advantage plan. I have seen people who have Medicare due to a disability just have Parts A and B without the additional coverage because they don't know or no one is there to help them. This leaves them exposed to a large medical expense.
As a general rule, the expense for a supplement is much greater for someone under 65 than someone 65 or older. This makes the purchase of a supplement impractical in most cases.
People on disability may miss the fact that they can enroll in a low or zero-premium Medicare Advantage plan with drug coverage. Since there may be no additional cost, there is no reason not to do this. They will then have catastrophic protection from large medical bills and drug coverage. There would also be copays, or coinsurance, for medical services, instead of paying the 20% that Medicare does not cover. For primary care doctors, the copay may even be zero.
When turning 65, a person on Medicare due to a disability will have another initial enrollment period. At this time, they will receive favorable supplement rates and can make a choice as to whether a supplement or advantage plan works best.
Turning 65 and Have Employer Health Coverage
When you turn 65 it is always a good idea to enroll in Medicare Part A, since there is not a premium for most people. An exception to this would be if you are contributing to a health savings account and would like to continue doing so. However, Part B does have a premium and if you already have health coverage you need to decide whether it makes sense to discontinue your current insurance or not.
The best place to start is to call your benefits administrator at your place of work. They will let you know how turning 65 will affect your current coverage. There may be no change at all, or you may be required to go on Medicare. There are many complex rules involved here, especially depending on the size of the company.
If your employer has less than 20 employees Medicare will pay first. ln this case you would want to sign up for parts A and B; if you did not, your plan will not pay the cost of what Medicare would have paid. If your employer has more than 20 employees, your health coverage stays the same. You would then decide whether to stay on the employer plan or go on Medicare part B.
Items to consider when comparing your employer plan to Medicare:
- What is the premium you are paying?
- What is your deductible?
- What are your copay's and coinsurance?
- What is your maximum out of pocket expenses?
- How complete is your drug coverage?
- Are you restricted to a provider network?
This gives you an idea and may not be a complete list. There is a lot involved here and you should seek assistance. Should you decide that it makes more sense to go on Medicare, if you change your mind, you may not be able to go back to your previous coverage.
If you decide to drop your employer coverage after comparing, you would enroll in Medicare part A and B and then choose whether you are going to get a supplement or advantage plan.
Over 65 and Leaving Employer Coverage
This section applies if you are on Medicare Part A but have kept working and have employer insurance. The main reasons why you would leave employer coverage are:
- You have decided to stop working.
- Your plan is no longer better than what you can get on Medicare.
- You are on your spouse's plan and your spouse is retiring, or the extra premium for spousal coverage makes Medicare more cost effective.
In order to do this, you would need to follow certain procedures.
First, you would call Social Security (1-800-772-1213) or visit them online. There are 2 forms that need to be filled out: (1) a request to enroll in Medicare Part B, and (2) a request for employment coverage information, which shows Medicare that you had health coverage.
These forms can be filled out online, faxed, or mailed to Social Security. You would pick when you want Medicare Part B to become effective. You then have an enrollment period in which you would set up a supplement or advantage plan with your Part B. You would start paying the Part B premium when it becomes effective, and you would want to coordinate with the employer plan so as not to have to pay two premiums.
When you end your employer coverage, you will be sent a letter stating that you had "creditable coverage," and it will list the coverage dates. It is important that you save this for possible future reference.
Do you still have questions? Take a look at our Medicare Basics outline, or give us a call at (931) 287-0799. We’d be glad to help you!
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**This is a personal website of Steve Walter and is not associated with or endorsed by any government agency. We do not offer every plan available in your area. Currently we represent 8 organizations which offer 56 products in your area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program to get information on all of your options.