Medicare


Approximately 10,000 Baby Boomers turn 65 each day. As more and more Americans near this milestone age, important decisions about when to retire and when to sign up for Medicare benefits will be on the minds of millions of Americans. Understanding your options when it comes to signing up for Medicare can help you save time, trouble and money.

What is Medicare?

Medicare is a national health insurance program for people age 65 and over. Medicare is administered by the Center for Medicare & Medicaid Services (CMS), however, you apply through the Social Security Administration.There are four major parts to Medicare: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage) and Part D (prescription drug coverage). Learn more about Medicare Parts.

* Medicare also covers some nonelderly people. People who receive Social Security Disability Insurance (SSDI) payments generally become eligible for Medicare after a two-year waiting period. Those who are diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) become eligible for Medicare with no waiting period. The focus of this guide is for those approaching 65 years of age. For more information for nonelderly individuals that may qualify for Medicare please visit: www.hhs.gov

Open Enrollment Period 

For people who already have Medicare, the Open Enrollment Period for 2021 coverage is October 15, 2020 – December 7, 2020. During this period you can switch to a different Medicare plan or enroll in a Part C plan for the first time. The services that your plan covers and the costs associated with your plan may be altered every year, so it is important to consider if you want to make any changes to your coverage during Open Enrollment.
Note: You have a 7-month Initial Enrollment Period around your 65th birthday to sign up for Part A and/or Part B. If you do not enroll in Medicare when you first become eligible at 65 years of age, you may be subject to higher monthly fees after you do enroll.

What if I already have health insurance when I turn 65?

Many employers offer group health plan coverage to current employees or retirees. You may also have health plan coverage through the employer of your spouse or domestic partner.

If you have Medicare and you are offered coverage under a group health plan, you can choose to accept or reject the plan.  If you have a private plan, whether it be through employment or your spouse, when you qualify for Medicare, the decision to sign up for Medicare or delay Medicare is an important one that will have long term effects on your coverage. 

Many private plans change the structure of benefits for enrollees at age 65 to account for Medicare.  If you chose to not sign up for Medicare at 65 because you have a private plan, you may have gaps in your coverage.  If you plan on working past 65, call your health plan and discuss the effects of Medicare eligibility on your coverage and benefits.

If you have Medicare and other health coverage, each type of coverage is called “payer.” When there’s more than one payer, “coordination of benefits” rules who pays first. The “primary payer” pays what it owes on your bills first, and then your provider sends the rest to the “secondary payer” to pay.

Medicare will either be the first or second payer depending on a variety of factors.  The payment arrangement between your private or employer plan and Medicare will determine which plan is the first payer. You should check your insurance policy for the rules about which plan will pay first.

You can also call the Benefits Coordination & Recovery Center (BCRC) toll-free at 1-855-798-2627.  This chart provides an over view of the general rules for first and second payers when you have Medicare and another health care plan.

Military Families  

If you are an active-duty service member or the spouse or dependent child of an active-duty service member and you have TRICARE insurance, you must enroll in Medicare Part A when you are first eligible in order to keep your TRICARE coverage. You must be signed up for both Part A and Part B before the active-duty service member retires in order to keep TRICARE and avoid a break in health coverage. TRICARE, which changes to TRICARE for Life (TFL) when the active-duty service member retires, is coverage that is supplementary to Medicare. This means that when you obtain a Medicare-covered service, Medicare pays first, and then TRICARE pays the applicable Medicare deductible and coinsurance amounts for you. For any service that TRICARE covers and that Medicare does not cover, TRICARE will be the primary insurance. If neither Medicare nor TRICARE covers a service, you will be responsible for the necessary payment. Click here to learn more about health care options for veterans.





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