Frequently Asked Questions

 I will soon turn 65, I am employed by a large firm and am on their group medical plan. I am going to continue working after I turn 65.  What do I need to know, what do I need to do about Medicare?

If you are receiving Social Security benefits, you will automatically be enrolled in Medicare’s Part A and Part B. Part A is usually premium-free and covers you when you are hospitalized. Part B is considered Medical Insurance and covers outpatient procedures and doctor’s visits. (A more detailed description of Parts A & B to follow.) 

If you are covered by your employer’s group plan (employers of 20+ full time employees), you do not need Part B – follow the instructions that came with your red, white and blue Medicare card to cancel Part B. If you keep your large group plan, you will qualify for a ‘Special Enrollment Period’ (SEP) that will let you sign up for Part B during:

Any month you remain covered under the group health plan AND you, or your spouse’s employment continues.

The 8-month period that begins with the month after your group coverage or the employment it is based on ends, whichever comes first.

If you do not receive SS benefits, you will need to go to www.ssa.gov before the month you turn 65, and follow the instructions to enroll in Part A ONLY. You can also go to your local Social Security office and have them help you enroll in Part A.

 I will soon turn 65, I am employed by a small company (19 or fewer employees) and I am on their group plan. I am going to continue working after I turn 65. What do I need to know, what do I need to do about Medicare? This same information is relevant for all self-employed individuals.

If you are receiving Social Security benefits, you will automatically be enrolled in both Parts A and Part B of Medicare. 

IMPORTANT: If your employer group has 19 or fewer employees, or if you are self-employed, DO NOT CANCEL PART B. With this size group, Medicare will become the Primary Payer and your group coverage will be secondary. You will also need to enroll in a: 

Medicare Supplement (Medigap) plan AND a Part D Prescription Drug plan, or,

Medicare Advantage Plan, (Part C of Medicare) that includes Prescription Drug coverage.

Please take care of enrollment in these plans before the month you turn 65! 

Why would I need to go to www.ssa.gov or go to a local Social Security office to enroll in Medicare’s Part A and/or Part B? Aren’t they completely separate departments?

Social Security enrolls you in Original Medicare (Part A and Part B). Beyond that, CMS – Centers for Medicare and Medicaid Services takes care of the rest. Please do not ask why then is it not, CMMS?

What are the parts of Medicare?

Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care. For most of us Part A will be premium-free.

Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient surgery and care, home health care, durable medical equipment and some preventive services. Your monthly premium for Part B in 2020 starts at $144.60. Some beneficiaries with higher incomes will pay a higher monthly Part B premium.

Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.

Medicare Supplement (Medigap) policies help pay Medicare out-of-pocket copayment, coinsurance, and, deductible expenses – known as Medicare’s Part E.

Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. You MUST purchase a Part D if you enroll in any Medicare Supplement Plan. 

Medicare Advantage Plan (known as Part C of Medicare). If you choose to not enroll in a Medigap plan and a Part D, you will enroll in a Medicare Advantage plan. This includes all benefits and services covered under Part A and Part B – prescription drugs and additional benefits such as vision, hearing, and dental – bundled together in one plan. You must have Medicare’s Parts A & B to qualify for a Part C plan.