Turning 65? Your Medicare Enrollment Pathway

The Medicare Pathway

Original Medicare (Part A & B) eligibility beings on the first of the month in the month you’ll turn 65 or after 24 months of Social Security Disability Income.

Your Medicare Enrollment Pathway begins 4 to 6 months prior to eligibility and will involve different steps depending on your circumstances.

We recommend, as your first step on the pathway, that you attend our monthly Medicare Seminar/Webinar https://wheelersinsurance.com/mep/seminar to learn more about the process, when to do what and what your options are. There is no additional cost to work with Wheelers, so hopefully we can save you some time and money.

We'll discuss original Medicare (Parts A &B), Part C (Medicare Advantage), Part D (Drugs Plans), and Medicare Supplement.

I HAVE A PLAN THROUGH COVERME.GOV - Can I keep it?

If you are a subscriber in an Individual Health Plan, you are no longer eligible for a Premium Tax Credit once you become eligible for Medicare.

If you are the sole subscriber under the policy, the policy should be cancelled at the end of the month prior to your Medicare start date. If you are not the sole subscriber, the policy should be kept in place but changed: you are Not Seeking Coverage – but you are still a household member, with your income included in the determination of your household’s eligibility for a Premium Tax Credit.

Our team can help you cancel or change your existing Individual Health Plan at the correct time.

CHOOSE MEDICARE OR EMPLOYER COVERAGE

Which is better? It depends.

FIRST, ASK YOUR EMPLOYER SOME QUESTIONS:

Are you required to drop the employer coverage? Or could you delay your Part B enrollment to stay on the employer plan?
Is your employer's prescription drug coverage "Creditable Medicare Coverage"?
What is the cost for each family member to be enrolled in the Employer's Plan? How much might you save if they were not enrolled in that plan?
Would the employer contribute to the cost (via a buy-out) of your Medicare coverage if you continued to work but withdrew from the Employer's plan?
Will the employer continue to contribute to your existing Health Savings Account if you stay on the Employer's Plan?

THEN ASK WHEELERS:

Could you save money and/or get better coverage with Medicare?
If you have family members under 65, what coverage, at what cost, is available in the Individual Market (coverme.gov)?

IF YOU DECIDE TO STAY ON THE EMPLOYER’S HEALTH SAVINGS ACCOUNT COMPATIBLE PLAN:

Do NOT enroll in Medicare Part A OR B at this time. Enrollment in Part A, while free, will disqualify you (or the employer) from making tax deductible contributions to the Health Savings Account.

Contact Social Security to Enroll in Part A only. You will refuse Part B now, but take it later once the employer coverage ends. You can bill hospital claims to BOTH Medicare Part A AND your employer coverage. How To Get Parts A/B.

IF YOU DECIDE TO SWITCH TO MEDICARE AT AGE 65?

Contact Social Security to Enroll in Original Medicare Parts A & B within three months of turning 65. How To Get Parts A/B.

IF YOU DECIDE TO SWITCH TO MEDICARE AFTER TURNING 65?

Contact Social Security at least 3 months in advance of your desired Part B start date and request a Part B Special Enrollment Period. How To Get Part B Later

If you want Medicare when you first become eligible AND are currently collecting Social Security, just wait for your Medicare card to come in the mail

If you are not collecting Social Security benefits but want Medicare at age 65

Enroll (at age 65) in Parts A & B, or in Part A only

You are enrolling in a government program, so you have to contact the government to do it: Call the Social Security Administration at 1-800-772-1213 from 7am to 7pm, Monday through Friday or enroll online at https://www.ssa.gov/medicare

If you are currently enrolled in Medicare Part A only and want to add Part B, you must:

Enroll (after age 65) in Part B

Visit https://www.ssa.gov/benefits/medicare/#anchor6 “Already Enrolled in Medicare”
Use Option 1 to complete forms online and upload evidence of your existing (and ending) health insurance: https://www.ssa.gov/Medicare-PartB-SEP OR use Option 2 to fax or mail the two forms (current versions are attached) and secondary evidence (if needed) to the correct local Social Security office. Find the correct office using this lookup tool: https://secure.ssa.gov/ICON/main.jsp
Be sure to state in the remarks when you want Part B to start (Month and Year)
If the employer cannot complete Section B, submit secondary evidence as listed here: https://www.ssa.gov/benefits/medicare/#anchor6
If follow up is needed, call the Social Security Administration at 1-800-772-1213 from 7am to 7pm, Monday through Friday.

There is a monthly premium for Part B. In 2023 the base premium is $164.90 a month. If your income in the tax year 2 years prior (so, 2021) was more than $97,000 Single / $194,000 Married, your Part B premium will be higher. Check here: https://www.medicare.gov/your-medicare-costs/part-b-costs
If you are collecting Social Security, the premium is deducted from your social security payment

Otherwise, it is billed quarterly (although your first bill could be for as much as 5 months). Visit https://www.medicare.gov/your-medicare-costs/how-to-pay-part-a-part-b-premiums to review your options for paying this bill monthly via your Medicare.gov account, via EFT, via bank payment service or through the mail.

One in five retired individuals qualifies for financial help with premiums and out of pocket costs.

The Medicare Savings Program can help pay for Premiums and Out of Pocket Medical Costs. This program is managed by the State of Maine
Extra Help with Prescription Drugs can help reduce your pharmacy costs. This program is managed by the U.S. Government.
In 2022, you may qualify if you have up to $20k in yearly income ($28k for a married couple) AND up to $50k in cash or investments ($75k for a married couple).
Apply online no more than three months prior to your Part B Start Date: https://www.ssa.gov/extrahelp and ask that your application be shared with the State of Maine. One application can be used for both MSP and Extra Help.
If you need assistance, let us know.

Once a Medicare card arrives (but no later than 7 days prior to expected Part B effective date), schedule an appointment here: https://calendly.com/wjwi. We’ll review:

Choosing between a Medicare Advantage plan (including prescription drug coverage) or a Medicare Supplement plan (with a standalone prescription drug plan).
With consideration given to: provider network, medications needed, ratings & reputation of insurers, your health and financial status.
Medicare coverage takes effect the first of the month a person turns 65 so ideally, four weeks prior to that date, we’ve completed a review of needs and finalized an enrollment in a plan.

After you go through all the steps above, click here as it’s time to move onto Phase 2.

“We do not offer every Medicare plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”