As Medicare offers healthcare coverage at potentially low-to-no-cost, many Americans wonder if they still qualify if they’re working at age 65. The short answer is “yes,” as long as you’ve paid Medicare taxes for a sufficient amount of time. Moreover, there are penalties for late enrollment, so it’s often better to sign up for Medicare sooner rather than later.
Read on to learn everything you need to know about Medicare eligibility, enrollment periods, and how it works with employer-sponsored healthcare.
When do I qualify for Medicare?
All American citizens and permanent legal residents of at least 5 years qualify for Medicare once they reach age 65. If you’ve worked at least 40 quarters (10 years) in a job that applied payments toward Medicare, at least part of your coverage should be fully covered.
If you haven’t paid enough Medicare taxes through enrollment, you’ll still be eligible, but you’ll have to pay a premium for Part A. Parts B, C, and D always require a premium.
Your Initial Enrollment Period begins on the 1st day of whichever month is 3 months before your 65th birthday and ends in the third month after your birthday.
Am I required to enroll in Medicare when I turn 65?
Even if you have coverage through your job, it’s a good idea to enroll because Medicare becomes the primary payer. This means that any claims go to Medicare first. Plus, you can avoid any gaps in coverage when you do retire.
If you don’t qualify for full premium coverage for Part A, you may wish to delay your enrollment. In that case, your Special Enrollment Period starts when your current coverage ends and lasts 8 months. Note that your Initial Enrollment Period still ends 3 months after your 65th birthday and trumps any Special Enrollment Period. So, if you retire on your 65th birthday, you will NOT have 8 months to enroll.
That said, you may elect COBRA coverage through your employer upon retirement, and that can buy you some time. However, don’t wait until COBRA ends to sign up for Medicare, or you’ll have to delay your enrollment until the next General Enrollment Period (January 1 to March 31). That could cause a long gap in coverage as well as late-enrollment penalties.
Can I have both employer-sponsored health coverage and Medicare?
You may enroll in Medicare within your Initial Enrollment Period even if you have insurance through your employer. As long as you’ve worked at least 40 quarters, your Part A premium should be $0. This can be beneficial as Medicare is designed for senior care, so it can help cover medical expenses your employer-sponsored plan does not.
That said, remember that for employers with fewer than 20 employees, Medicare will become the primary payer. Therefore, some smaller employers’ insurers are reluctant to provide coverage for Medicare recipients, as there is a risk they won’t get reimbursed.
Also, you will incur a penalty if you’re not enrolled by the end of your enrollment period. It’s, therefore, a good idea to enroll to protect yourself. Evaluate your options to delay enrollment in case your employer-based coverage will drop.
What if I have health coverage through my spouse or a Marketplace plan?
As long as you have employer-sponsored healthcare coverage, you may wait to enroll in Medicare until that coverage is ending. However, any other sort of coverage is typically trumped by Medicare. This means you must enroll during your Initial Enrollment Period (3 months before and after your 65th birthday) for the following situations:
• If you have a Marketplace plan because your employer does not offer coverage or you are self-employed
• If you receive coverage through your spouse’s or domestic partner’s employer-sponsored insurance
• If you have COBRA from your previous employer
• If you have no health insurance at all
In sum, if you’re still working but do not have your own coverage through an employer, it’s best to go ahead and sign up for Medicare. This protects you against gaps in coverage and any late-enrollment penalties.
What if I can’t afford the premiums?
While Medicare Part A should be covered if you worked at least 40 quarters in a qualifying job, Parts B, C, and D do require premiums. Parts B and C cover outpatient, specialized, and home health care. Part D covers prescriptions. All of these are crucial for many seniors’ health.
You may be able to defer Part B if you have employer-sponsored coverage through yourself or your spouse. However, the late enrollment penalty will kick in if you become eligible for Medicare Parts A and B and you DON’T have other coverage. Also, if you’re collecting Social Security benefits, you MUST enroll in Part A.
If you’re still working and you have creditable drug coverage, you can delay Part D enrollment. After that ends, you have 60 days to enroll in Part D until you incur a penalty.
Low-income taxpayers may qualify for a stipend to help cover Part B, C, and D premiums.
Medicare enrollment can be quite complicated, especially if you and/or your spouse are still working. If you’re still working, always check with your benefits administrator to learn how your Medicare eligibility will affect any current coverage.
In general, though, it’s usually a good idea to go ahead and enroll in Part A. This ensures that you’ll have coverage and avoid any penalties. Medicare can also help cover expensive hospital bills and other medical expenses.
Need guidance on how and when to enroll in Medicare? The team at Coverage2Care is happy to answer your questions.