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Helping Those Turning 65 to Navigate Medicare
Employees need guidance on the complexities of first-time Medicare enrollment

By Stephen Miller, CEBS  7/31/2013
 

As more Baby Boomers approach age 65, they are confronting the complexities of making first-time Medicare enrollment decisions.

“At many companies, retiring used to mean transitioning from your employer’s health plan to a retiree health plan,” said Paula Muschler, manager of the Allsup Medicare Advisor. “Now, rather than selecting from one or two employer-provided options, more individuals are faced with trying to navigate through dozens of different Medicare plan options.”

Only 25 percent of U.S. employers reported offering retiree health benefits in 2012, according to a recent Kaiser Family Foundation survey of employers with more than 200 employees. This represents a 7 percent drop from 2007. By contrast, in 1988, nearly two-thirds of employers (66 percent) offered retiree group health coverage, according to Kaiser data.

The Big Transition

Muschler encourages employers to discuss Medicare plan selection with their employees as they approach their 65th birthday. Employers can help employees navigate the following situations in the Medicare maze.

Employees turning 65 who plan to keep working.

Those turning 65 may make their Medicare plan selections without penalities if they do so three months before their birthday, the month of their birthday, or three months after it; this timeframe is known as the individual's "initial enrollment period.”

Traditional Medicare has two main parts: Part A is hospital coverage, and Part B is medical services. Part D, which became effective in 2006, is a federal program to subsidize the cost of private prescription drug plans.

Generally, all employees will benefit from enrolling in Part A when they become eligible because it is free. Employees have the option of enrolling in and paying monthly premiums for Part B and Part D coverage. Those who don’t enroll in Medicare Part B would need to receive a deferral from Medicare to avoid being subject to penalties when they enroll in the future. 

To Delay or Not

According to the nonprofit California Health Advocates website:

If you delay enrolling in Part B when you are first eligible because you are covered by an employer health plan, you have 8 months to apply for Part B from the date you, your spouse or family member stops working, or the date the Group Health Plan (GHP) or Large Group Health Plan (LGHP) coverage ends — whichever is earlier. This 8-month period is called a Special Enrollment Period (SEP). If you enroll in Medicare Part B during this SEP, you will not be required to pay a late enrollment penalty.

If you do not enroll during this SEP, you won't be able to sign up for Part B until the next General Enrollment Period (GEP), which is from January 1 to March 31 each year. If you wait to sign up during the GEP, your Medicare benefits will not begin until July 1 of that year, and you may be required to pay a late enrollment penalty that will be added to your monthly Part B premium for as long as you are covered.

Regarding Medicare Part D drug benefits, the California Helath Advocates site further advises:

If you don't enroll in a Part D (prescription drug) plan when you are first eligible because your coverage through an employer GHP or LGHP is creditable, you will only have 63 days to enroll in such a plan after your group benefits end. If you enroll in Medicare Part D within this 63-day period, you will not be required to pay a penalty.

Coordinating Coverage

As for coordinating coverage under the group plan with Medicare, employer size is a factor. If an organization has more than 20 employees, in most instances the group health plan is the primary payer and Medicare acts as the secondary payer. According to the Corporation for National and Community Service's Senior Corp. website:

If the husband or wife is still working and has health coverage via their employer or union, Part A may still help pay some medical expenses not covered by any group plan. But that working spouse may choose to delay signing up for Medicare Part B until a later date. … Just remember you will have to pay a higher Medicare Part B premium simply because when you had the chance you didn’t take it.

If an employer has fewer than 20 employees, Medicare is the primary payer and the employer’s plan is the secondary payer. In this instance, it’s generally considered essential that employees turning 65 enroll in Medicare Parts A and B. If they don’t enroll, they will have to pay out of pocket anything that Medicare would have covered.

Employees who are turning 65 and preparing to retire or who have already retired.

For many retirees, employers provide no postemployment health coverage. And for some early retirees, reaching 65 could be the trigger to losing retiree coverage. “Since fewer employers offer retiree coverage, it’s important that people begin to study their options early enough to make good choices based on their needs,” Muschler said.

A key element for seniors in this situation is age; those older than 65 should have enrolled in Medicare when they reached their initial enrollment period. “Retiree coverage is secondary to Medicare, so they already would have Medicare Parts A and B,” Muschler noted. "But losing their group health coverage triggers their option to buy 'Medigap' coverage.” Private Medigap plans pay for services that Medicare doesn't cover.

“We cannot stress enough that turning 65 is a critical time period for Medicare beneficiaries to consider what they need and how they will afford it,” Muschler said. “This is their opportunity to make first-time Medicare decisions that ensure they have the proper coverage and avoid penalties later on.”

Stephen Miller, CEBS, is an online editor/manager for SHRM.

Related SHRM Articles:

Demystifying the Medicare Secondary Payer Rules, SHRM Online Benefits, December 2011

It's Complicated: Coordinating Medicare, Employer Health Plans, SHRM Online Benefits, April 2011

Build a Bridge to Health Exchanges for Early Retirees, SHRM Online Benefits, February 2011

Still Worthwhile? Weighing Retiree Drug Benefits Without a Subsidy Deduction, SHRM Online Benefits, July 2010

Related External Resources:

Should I Sign Up For Medicare Part A And B If I’M Still Working?, Senior Corps

Medicare Sign-Up Information, Medicare.gov

Medicare and Other Health Benefits: Your Guide to Who Pays First, Medicare.gov

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