What should I know about Medicare eligibility?
- When you turn 65, you have a 7-month Medicare Initial Enrollment Period.
- You may want to enroll in Medicare Part A. Don’t worry, you won’t have to pay a premium fee for that, if either you or your spouse worked and paid Medicare taxes for at least 10 years.
- Enrolling in Medicare is your choice. You will need to sign yourself up. You won’t be automatically enrolled.
- You should know that Medicare will NOT notify you about your Initial Enrollment Period—that is, unless you are currently receiving Social Security or Railroad Retirement Board benefits.
- There’s also a period called your Special Enrollment Period, where you can choose to delay your enrollment in Medicare Part B and Medicare Part D without incurring penalties for enrolling “late.” If you choose to delay your enrollment, you be required to present proof of “credible” health insurance from your current employer.
What are my Medicare coverage options?
Original Medicare is health insurance offered through the US government and helps pay for some, but not all, of your hospital stays and doctor visits. Original Medicare does NOT pay for any of your prescription drug expenses. It also has no coverage for routine dental care, vision or fitness benefits. Still, an Original Medicare plan may be enough for you. Visit medicare.gov to find all the various Medicare plans that are available to you in your area.
What other types of Medicare plans are available?
- Medicare supplement plans
- Medicare Part D prescription drug plans
- Medicare Advantage plans
When do you need to research and enroll?
If you’re interested in exploring and enrolling in one of these plans, DO be sure to start early. And be ready to enroll in the plan you choose about two months before you retire. Remember, processing your application can actually take up to six weeks—you don’t want to have a gap in your health coverage.
Now, if you’re worried you won’t be able to afford a Medicare health plan, we encourage you to visit the Social Security website. You can also call your local Social Security office about extra help paying for a plan with prescription drug coverage. Again, apply early because it can take up to three months to find out if you qualify for this extra help.
Visit medicare.gov for more help understanding your options so you can make informed decisions about your healthcare.
What do my Medicare health coverage options past age 65 depend upon?
- Your age
- Whether you have retiree coverage through your employer or plan sponsor
You may qualify for a Medicare Special Enrollment Period if you are:
- Covered under your spouse’s current employer health plan
- At least 65 years old when your spouse’s employer insurance ends
What are the rules around a Medicare Special Enrollment Period?
Your Medicare Special Enrollment Period begins when you retire or when your employer insurance ends—whatever comes first, if you qualify. There are several important things to consider during your Medicare Special Enrollment Period. First of all, we recommend that you talk with your employer’s health insurance plan administrator before you make any decisions.
You should ask whether your employer’s health insurance plan provider works with Medicare coverage. At age 65, you may have to take full Medicare benefits (Part A & B) instead. Also, if your employer has less than 20 employees, you may be advised to take Medicare coverage only.
During a Medicare Special Enrollment Period, if you qualify, you have up to eight months to enroll in Original Medicare Part A and Medicare Part B. This period begins after your last month of employment or health coverage under your (former) employer.
Also, from the month after your last month of employment or health coverage under your (former) employer, you’ll have two months to enroll in these other Medicare options:
- Medicare Advantage—called Medicare Part C
- Medicare Part D, which is specifically for prescription drug coverage. You may choose to sign up for Medicare Part D now, as a way to prepare for higher prescription costs in the future.
If you are not eligible for a Special Enrollment Period when COBRA or retiree coverage ends, you may be eligible for other enrollment options. We encourage you to call Medicare or meet with your employer’s healthcare administrator to better understand all your options.
We’re here to help.
We hope you find this information helpful and are here to help you navigate through your Medicare journey. Although we are not an insurance plan, we can connect you with trusted, local resources here in southern Nevada who can help you determine the best coverage for you and your health.
Call 702-623-0183 (TTY-711) to reach an Intermountain Health team member. We are committed to helping you feel confident that you have the right plan and the right doctor.