If you are approaching your 65th birthday, you are an American citizen AND
- you receive benefits under the Social Security or Railroad Retirement system, OR
- you could receive benefits under Social Security or the Railroad Retirement system but have not filed for them, OR
- you or your spouse had Medicare-covered government employment,
You can get premium-free Medicare Part A benefits. You will also be given the opportunity to enroll in premium Part B for a monthly premium. (2015 amount – $104.90 per month)
If you are working and plan on continuing to work after your 65th birthday, you still may need to contact the Social Security Administration to let them know your intentions. You may still want to enroll in premium-free Part A. If you are covered by a group health plan when you are first able to get Medicare, you may be able to delay enrollment in Part B or premium Part A without premium surcharge and without waiting for a general enrollment period. The group plan must be based on current employment. It cannot be a plan for retired people. The Special Enrollment Period will apply. Contact your local Social Security Administration or the Railroad Retirement Board.
Special Enrollment Period
You can sign up for Part B or premium Part A at any time while you are covered under a group health plan if:
- you are 65 or over and your group health coverage is based on your own or your spouse’s employment, OR
- you are disabled and your group health coverage is based on your own or a family member’s current employment.
ALSO, If you have chosen to delay enrolling in Part B or premium Part A because you don’t need Medicare coverage while you are covered under a group health plan, you may enroll during an eight-month period.
- If you are 65 or over, your eight-month period begins when you or your spouse’s current employment ends or your coverage under the group health plan ends, whichever comes first.
- If you are disabled, your eight-month period begins when the current employment ends; the plan is no longer classifiable as a large group health plan (one that covers 100 or more employees); or when the plan coverage is terminated, whichever comes first.
Contact the local Social Security Administration office as soon as employment ends, or the plan coverage ends or changes, to be sure that you get the information you need about enrolling in Part B. NOTE: Special enrollment period rules do not apply to you if you stop working or lose group health plan coverage during your initial enrollment period.
Medicare as Secondary Payer
If you are in an employer group plan and you are in one of the three groups of people discussed below, Medicare will be your secondary payer. If you are age 65 or over AND:
- You are covered under a group health plan because of your current employment or your spouse’s current employment (your spouse can be any age) AND
- The employer has 20 or more employees.
Medicare is also the secondary payer if you or your spouse are self-employed and covered by a group health plan of a firm that has 20 or more employees. See “Special Enrollment Period” and contact your local Social Security Administration office.
Group health plans must not discriminate against aged workers and spouses in the employee health benefits they offer. That is, group health plans must offer you the same health benefits under the same conditions that they offer to younger workers and spouses.
What if You Lose Your Health Coverage?
You do have some guarantees. Laws protect Medicare beneficiaries who may lose their health coverage. Under certain circumstances, you have sixty-three (63) days to purchase Medicare supplement insurance with no health questions asked. Details for each are described below:
YOU LOSE YOUR MEDICARE ADVANTAGE COVERAGE:
If you lose your coverage for one of the following reasons below, you will be eligible to return to Original Medicare and purchase a Medicare supplement policy (Plan A, B, C, F, K or L) from any company selling these policies in Kansas.
- The Medicare Advantage terminates or stops providing care in your area.
- You move outside the Medicare Advantage service area.
- You leave the plan because it failed to meet its required obligations to you.
YOU MOVE TO A MEDICARE ADVANTAGE:
If you decide to try an Medicare Advantage plan or Medicare SELECT policy, drop your supplement policy, and then decided you don’t like it, you may return to your original Medicare Supplement policy if you meet these requirements:
- This must be the first time that you enrolled in an Medicare Advantage plan or Medicare SELECT plan.
- You must decide to leave the plan within one year after joining.
- You must apply for the Medicare Supplement policy within sixty-three (63) days after leaving the other plan.
If you meet these requirements, you can return to your original Medicare supplement policy, if it is still offered, or choose from policies A, B, C, F, K or L. If you lose employer group health plan benefits… Under certain circumstances, if you are enrolled as an employee under a group health plan and the plan terminates your health benefits, you have the right to purchase a Medicare Supplement policy (Plans A, B, C, F, K or L) from any insurance company selling these policies in Kansas. If you apply within sixty-three (63) days from losing coverage, the company would have to issue you the policy, even if you have a health problem.
YOU LOSE MEDICARE SUPPLEMENT COVERAGE:
If you lose your Medicare Supplement coverage for one of the reasons shown below, you will be eligible to purchase another Medicare Supplement policy. (Plans A, B, C, F, K or L) from any insurance company selling these policies in Kansas. If you apply within sixty-three (63) days from losing coverage, the company would have to issue you the policy.
- Insurance company is insolvent or bankrupt
- Involuntary termination of coverage or enrollment
- Company substantially violates material provision of the policy
- Representative of the company materially misrepresents policy provisions in marketing the policy.
YOU LOSE YOUR MEDICAID:
If you lose eligibility for health benefits under Title XIX of the Social Security Act (Medicaid), you are guaranteed any Medicare supplement offered by any issuer if applied for within 63 days of loss of eligibility.