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SWITCHING FROM EMPLOYER COVERAGE?

It’s finally time to retire. The switch can be tricky. We’ll help you understand your Medicare plan options and timeline.

 

LEAVING EMPLOYER COVERAGE

When switching to Medicare from Group health plan (retiree) coverage, it’s important not to miss your enrollment window, or you may end up with a long gap in coverage.

Have Medicare Part B already?

If you already have a Medicare Part B, your next step is identifying when your employer coverage is going to end. Then you’ll need to enroll in prescription coverage (Part D) or a Medicare Advantage Plan (MAPD) before your employer coverage ends. This will avoid any potential gaps in your health care coverage.

Medicare beneficiaries can enroll in a Medicare Part D or Medicare Advantage plan to help fill gaps in Original Medicare. You have 63 days after your employer coverage ends to enroll in replacement coverage.

Medicare Advantage & Prescription Drug coverage starts at the beginning of the next month or the 1st month you are eligible for medicare.

Part B Re-Enrollment and Medicare Advantage or Medicare Part D Election Period:
Don’t have Medicare Part B?

If you don’t have a Medicare Part B, you have 8-months to apply to enroll. We would highly encourage you to submit your Part B application before your employer coverage ends. Don’t risk going without coverage; plan a 6 week+ window for your Part B to be approved by Social Security.

The Employer/Union Group Health Plan Medicare Advantage or Medicare Part D Special Election Period (SEP):

Avoid late Medicare enrollment fees or getting stuck without coverage. 

 

If you miss that 8 month period, you will have to wait for general enrollment which is January through March. Then, the coverage is not effective until July. If you go too long without creditable coverage, you could face a late-enrollment penalty. For each full year that you should have been enrolled but were not, you’ll be charged 10% of the monthly Part B base premium & 10% of the average monthly cost of a Part D premium, monthly.

Original Medicare
(Part A and Part B)

Original Medicare is managed by the Federal Government and provides Medicare eligible individuals with coverage for and access to doctors, hospitals, or other health care providers who accept Medicare. It does not cover 100% of your medical cost or prescription drugs. Additional coverage will be needed.

Part B Enrollment: It’s your key to additional coverage.

If you choose not to enroll or deny Part B coverage when you were first eligible, you would need to have a valid election period to enroll. Loss of employer coverage is a valid reason to apply. Your employer will have to sign off on the forms below. After completion, you can apply at your local Social Security office or online below.

Enroll Here:
Already too much? Contact us and we can help you through the process.
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PART A

Hospital Insurance

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
  • Part of Original Medicare
PART B

Medical Insurance

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Many preventative services
  • Part of Original Medicare

Medicare Advantage and Medigap
(Part C and Part D)

Part C or Medicare Advantage (MA), is additional coverage that is administered by private health insurance companies. Most MA plans include Part D Prescription drug coverage at no extra cost, they are referred to as MAPD plans.

Why would I enroll in Part C or D?

Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D. They also may offer extra benefits Original Medicare doesn’t cover.

There are a lot of choices when it comes to Medicare. Contact us for professional help, or feel free to window shop through Medicare Value. Simply click the button below and enter your zip code to compare available plans in your area.
CLICK HERE TO COMPARE PLANS
PART C

Parts A & B required to enroll

  • Plans may have lower out-of-pocket costs than Original Medicare
  • Have yearly out-of-pocket maximums for medical services
  • Usually includes Medicare prescription drug coverage (Part D)
  • Most plans offer extra benefits that Original Medicare doesn’t cover — like vision, hearing, dental, and more
PART D

Prescription Drug Coverage

  • Helps cover the cost of prescription drugs
  • Required by CMS to avoid a late enrollment penalty
  • Help lower out of pocket prescription drug costs when compared to retail drug cost
IRMAA WHAT?

Income Related Monthly Adjustment Amount

Don’t forget, Part B Cost $148.50/month at minimum (2021). If you make more than $88,000 as an individual or $176,000 as a joint filer you will pay an IRMAA for your Part B & Part D Benefit.

The government uses your income from 2 years ago. But you can appeal if you’ve had a major change in income Prescription Drug Coverage.

File Appeal:

To request a new initial determination, submit a Medicare IRMAA Life-Changing Event form or schedule an appointment with Social Security.

You will need to provide documentation of either your correct income or of the life-changing event that caused your income to decrease.

Social Security considers any of the following situations to be life-changing events:
  • Loss of pension
  • Marriage
  • Divorce or annulment
  • The death of a spouse
  • You or your spouse stopping work or reducing the number of hours you work
  • Involuntary loss of income-producing property due to a natural disaster, disease, fraud, or other circumstances
  • Receipt of settlement payment from a current or former employer due to the employer’s closure or bankruptcy

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