If you are about to turn 65 or already eligible for Medicare, but currently receiving health coverage through your spouse, you may be wondering if you need Medicare. Part A is free for most people, and it doesn’t hurt to sign up even if you have group insurance through an employer. However, there are some things to consider that can help you decide when to enroll in Medicare.

Determine if Medicare or Group Insurance is the Primary Insurer

The size of your employer often decides whether or not you can delay enrollment in Part B without paying a penalty. In companies with fewer than 20 employees, Medicare automatically becomes the primary insurer, with group insurance secondary. If you learn that your current insurance will become secondary to Medicare, then you should take Part A and Part B when you are first eligible. The reason for this is that secondary insurance only pays after the primary insurer pays, and pays very little. If you choose to delay Medicare, you will not have a primary insurer, and your out-of-pocket costs will be high.

On the other hand, if your employer has more than 20 employees and you learn that your group health insurance will remain the primary insurer with Medicare coverage second, then you may not need to enroll in Part B immediately as your current coverage will cover your needs.

Find Out if Your Group Insurance Changes After You Become Eligible for Medicare

After determining who will be the primary insurer, look to your benefits. In some cases, group insurance works differently once you become eligible for Medicare. Learn if your benefits will change, and then decide if it’s worth having both types of coverage or delaying enrollment in Part B. Unlike Part A, Part B isn’t free—once enrolled, everyone pays a monthly premium. Find out how your current coverage works once you or your spouse turn 65 and then decide if it makes sense to enroll in Part B or delay enrollment until a later date.

With Group Coverage, You Qualify for a Special Enrollment Period to Enroll in Medicare

The good news is, that if you have group coverage and missed your Medicare Initial Enrollment Period, you can still enroll in Part B without paying a penalty. As long as you have group coverage, you qualify for a Special Enrollment Period. And, you have an additional 8 months after losing group coverage to enroll in Medicare without paying a penalty. You’ll also get a guaranteed right to buy Medicare Supplement Insurance for six months after enrolling in Medicare Part B.

References:

https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/should-you-get-part-b/should-i-get-part-b.html#collapse-5783

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