Medicare Information and Resources

If you work for an employer that has 20 or more employees and you are enrolled on a group health plan, then you may be able to delay enrolling in Medicare. If you work for an employer that has less than 20 employees on payroll, you may need to sign up for Medicare when you are 65 so you don’t have gaps in your coverage.

Medicare costs include premium for Original Medicare, Part C, Part D, and/or Medicare Supplement, as well as cost shares for services. Part A coverage is premium free for qualified citizens that have worked for 40 quarters. If you don’t qualify for premium-free Part A, you may be able to buy it.

Because Medicare Parts A and B have unlimited out-of-pocket each year, it is wise to review your options for additional coverage. High income earners may also pay an Income Related Monthly Adjustment Amount (IRMAA)

More information can be found HERE.

If someone is receiving significant tax credits through the exchange, it may be tempting to delay enrollment in Medicare. It is important to remember that once someone is enrolled in Medicare Part A, they no longer qualify for tax credits from the Affordable Care Act. If someone enrolls in Medicare Part A after their initial eligibility date, the effective date will be retroactive to 6 months prior to the enrollment. Any tax credits received during this time would need to be paid back.

The Medicare Initial Enrollment Period (IEP) is the window in which you can enroll in Medicare when you first become eligible. It is a seven-month window that generally starts three months prior to your birth month and ends three months after your birth month. Anyone born on the first of the month will have a window that starts four months prior to their birth month and a Medicare eligibility date that is the first of the month prior to their 65^th birth month.

Anyone already receiving social security income will automatically be enrolled in Medicare Parts A and B. Anyone that is not receiving Social Security will need to apply through the Social Security Administration. https://www.ssa.gov/benefits/medicare/

You become eligible for Medicare when you turn 65, and you can enroll anytime during your Initial Enrollment Period. Your IEP is a seven-month period, including the three months before, month of, and the three months following your 65th birthday. The date your Medicare coverage begins depends on when you sign up. If you are collecting Social Security, you will be automatically enrolled in Medicare Parts A & B, which will usually start the first day of the month you turn 65. If you are NOT collecting Social Security, you may want to enroll in Medicare online at www.ssa.gov, or call them directly at 800-772-1213. Postponing your enrollment in Medicare until after your IEP, you may receive a Late Enrollment Penalty (LEP) on future Part B & Part D premiums, and you may not have another chance to enroll until the annual General Enrollment Period, which lasts from January 1st through March 31st each year for coverage that would start on July 1st.

If you did not sign up for Part A (for those who have to buy it) or Part B during your IEP because you had employer-sponsored coverage, you may be eligible for a Special Enrollment Period in which you can enroll in Medicare. The employer group health plan must have been provided through current employment, either yours, your spouse’s, or another family member’s (if you have a disability), and that employer group plan must have had at least 20 people enrolled on it. If you are still part of such a plan, you are eligible to enroll in Medicare anytime while it is still in effect and on through the 8-month period that begins the month after that coverage or employment ends, whichever comes first.

Please note that COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, retiree health plans, VA coverage, and individual health coverage (like through the Health Insurance Marketplace) are not considered coverage based on current employment. You are not eligible for a Special Enrollment Period to sign up for Medicare when that coverage ends. To avoid paying a higher premium, make sure you sign up for Medicare when you’re first eligible.

If you didn’t sign up for Part A (if you have to buy it) and/or Part B (for which you must pay premiums) during your Initial Enrollment Period, and you don’t qualify for a Special Enrollment Period, you can sign up between January 1-March 31 each year. Your coverage will not start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium for late enrollment.

Medicare Part D, offered by private insurance companies, helps cover prescription drug costs. Many carriers in the state of Washington offer plans with various levels of cost coverage and different formularies (lists of medications that they cover). Not all plans cover all drugs. Medicare Part D Plans may require payment of deductibles and copays for medications, and they can have limitations based on drug formularies and their network of preferred pharmacies. You can enroll in a Part D drug plan during your Medicare IEP, the Annual Enrollment (AEP) each year, or with certain circumstances with a Special Enrollment Period (SEP). It is imperative that Medicare Beneficiaries understand how their Part D drug plan works to obtain the best possible coverage for both costs and medications. Like Parts A & B, Part D is most affordable if you enroll during your IEP. Without other creditable prescription coverage in place, a late-enrollment penalty will be added once you do sign up.

Each fall, Medicare Part D clients are responsible for reviewing their plans and prescriptions to ensure they are still enrolled in the right plan to fit their needs. The Annual Enrollment Period (AEP) runs from October 15th through December 7th. This is generally the only time of year you can enroll or make changes to your Part D drug plan. Changes made during this time will take effect on January 1st of the following year. Our office can help you review your options to ensure you have the best plan to fit your needs.

Medicare Supplement plans help pay the deductibles and coinsurance you would normally pay under Medicare. Plans are “standardized” with the basic benefit structure for each plan being the same, regardless of which insurance company you choose. These plans, identified in most states by letters, will allow you to see any doctor nationwide that accepts Medicare, and no referrals are needed to see a specialist. In Washington, you can enroll on a supplement plan with guarantee issue for up to 6 months after your part B effective date. That means you can enroll without having to answer health questions.

In many circumstances, loss of other coverage opens a 60-day Special Enrollment Period to sign up for a supplement plan with guarantee issue. Once enrolled on a Medicare supplement plan, Washington State residents can change their existing supplement plan any month of the year. As a broker, we work with several carriers who offer Medicare Supplement plans, and we would be happy to meet with you and review all your options.

Medicare Advantage plans, sometimes called Part C or MA Plans offer an all-in-one alternative to Original Medicare provided by private insurance companies. If you join a Medicare Advantage Plan, you still have Medicare. These bundled plans include the benefits of Original Medicare Part A (Hospital Insurance), Part B (Medical Insurance) and usually Medicare prescription drug benefits (Part D).

Some plans also offer extra benefits like vision, hearing, and dental coverage. Each Medicare Advantage plan can charge different out-of-pocket costs. They also can have different rules for how you obtain services like whether you need a referral to see a specialist or whether you have to use their preferred providers for non-urgent care. These rules can change each year. Medicare Advantage plans are only available in certain counties in Washington State, and availability is based on the zip code in which you reside.