Ask The Medicare Specialist

Welcome to the first of the 10-part series, “New to Medicare,” designed to help educate those going on Medicare Parts A and B in the near future. Please be advised copies of the columns can only be found in the print and digital editions of the Pittsburgh Post-Gazette and on our Facebook Group. You can join by going to our website, getyourbestplan.com and clicking the blue banner at the top of the page.

Question: When do people who are turning 65 or retiring need to start thinking about Medicare plan options? What steps need to be taken to enroll and when will Medicare Part A and B go into effect?

Although you can’t enroll in Original Medicare until three months prior to your desired effective date, about six months in advance is a good time to start preparing, although you can take all the stress out of the process by contacting us. Open since 2008, The Health Insurance Store has time tested approach of explaining Medicare and plan options in a way that’s easy to understand. We’re also brokers, meaning we’re able to provide plans from every competitive Supplement, Advantage, and Part D company on the market, which ensures unbiased advice.

The most common scenario where someone becomes eligible and needs to enroll in Medicare Parts A and B for the first time is turning 65. The initial effective date for those who are “aging in” is the first day of the month of their 65th birthday. For example, if you were born on November 24th, 1959, and you want to enroll in Medicare as soon as possible, your Part A and B effective dates will be November 1st, 2024.

How do you enroll? Those who are already collecting Social Security prior to their 65th birthday don’t need to do anything. There are no forms to fill out or applications to be completed. A red, white, and blue card with both Parts A and B will automatically be mailed from the Social Security Administration about 100 days prior to your effective date. To use the prior example, anyone born in November 1959 who is already collecting Social Security should expect their card mid-July of this year. Those who started collecting Social Security pre-65 but do not want Medicare Part B need to sign the back of their Medicare card to make that request and return it via mail.

Those who are going to postpone collecting Social Security until a date after their 65th birthday but want to enroll in Medicare must apply. The easiest way to do that is at Social Security’s website, ssa.gov. Before an online application can be started, however, an account must be created. The entire process from beginning to end is pretty straightforward. You can also apply for Medicare over the phone or in person at your local Social Security office.

It seems like more and more people are working full time past their 65th birthday while continuing to get their health insurance through an employer. THOSE IN THIS SITUATOIN DO NOT NEED TO ENROLL IN MEDICARE PART B AND THERE WILL BE NO FUTURE LATE ENROLLMENT PENTALTY FOR OPTING OUT! I’m emphasizing this because so many people get bad advice on this topic. If you or your spouse are working and getting health insurance from that employer, it’s not necessary to enroll in Part B unless the group policy is with UPMC and has less than 20 members. I estimate 75% or more who are getting their health insurance from an employer after age 65 are best to opt out of Part B and enroll in Part A only. However, it’s always advisable to reach out to us to make sure because there are still many who can save thousands of dollars in premiums and out of pocket medical costs by going on Medicare Parts A, B, and a Supplement or Advantage Plan versus their employer health coverage. Also, those who have a plan at work that is compatible with a Health Savings Account usually don’t want to enroll in Part A. It’s confusing. I know. That’s why it’s always advisable to reach out to us to make sure you get it right. Again, there is no charge for this consultation or advice.

Those who opted out of Part B and want to enroll later, either upon retirement or when their insurance at work becomes less valuable than Medicare and a Supplement or Advantage Plan, can apply for Parts A and B at any time. For those who are retiring, I recommend planning a hard date at least four months in advance if possible and reaching out to us after that decision has been made. This allows time for us to walk you through the process, so it’s done correctly. It also provides a cushion of time to fix any errors that might be made by you, Social Security, Medicare, insurance companies, etc. Once someone who has opted out knows when they want Part B to go into effect, they can apply up to 90 days prior, but all effective dates must be the 1st of a month, no other day. This is an important nuance.

I often hear people who retire after 65, or are considering doing so, say they were told Part B can only be applied for in January, February, or March for an effective date of July 1st or during the Annual Election Period that runs every year from October 1st through December 7th. That’s not true. Only those who will be assessed a Part B late enrollment penalty have this restriction. Again, anyone who is getting health insurance as an active employee or is a spouse of an active employee can enroll in Part B any time during the year with an effective date the 1st of any month they choose. Enrollment in a Supplement and Part D prescription coverage or an Advantage Plan HMO or PPO can also be completed during the same time frame. However, a “Request for Employment Information” form must be filled out by the employer that states the dates the Medicare beneficiary was insured and that it is currently active or what date it ended. The completed form then needs to be submitted to Social Security when applying for Medicare Part B, which we suggest doing online or in person at your local office. Don’t mail it! They get lost too often!

Our staff can provide the necessary forms and walk you through the process as your retirement approaches.

Call one of our office locations or reach out to me directly with any Medicare related questions or to set up an appointment for a free consultation.

Part two of “New to Medicare” will cover the confusion of who must enroll in Medicare and when as well as who can and should opt out.

Thanks for reading everyone!