Posted on June 28th, 2024.

Medicare is a vital part of the healthcare system in the United States, providing essential health insurance for people aged 65 and older, as well as certain younger individuals with disabilities. 

Many people assume that you must be retired to qualify for Medicare, but this is not the case. 

Understanding the nuances of Medicare eligibility, especially for those who are still working, can help you make informed decisions about your healthcare coverage. 

In this guide, we will explore the basics of Medicare, how you can obtain Medicare before retirement, and provide answers to common questions about Medicare eligibility.

The Basics of Medicare

Medicare is a federal health insurance programme designed primarily for individuals aged 65 and older. It also covers certain younger people with disabilities and those with End-Stage Renal Disease. Medicare is divided into several parts, each covering different aspects of healthcare:

• Medicare Part A: Medicare Part A covers hospital insurance. It includes inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. Most people do not pay a premium for Part A because they or their spouse have paid Medicare taxes while working.
• Medicare Part B: Medicare Part B covers medical insurance. This includes outpatient care, doctor visits, preventive services, and medical supplies. Unlike Part A, Part B requires a monthly premium, which is based on your income.
• Medicare Part C: Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Parts A and B). Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans often include additional benefits like dental, vision, and hearing coverage, and may also include prescription drug coverage.
• Medicare Part D: Medicare Part D provides prescription drug coverage. It is available through Medicare-approved private insurers and helps cover the cost of prescription medications. Part D plans require a monthly premium, which varies by plan.

Now, let’s explore how you can obtain Medicare before retirement and the key aspects to consider.

Understanding Medicare Before Retirement

You do not have to be retired to qualify for Medicare. Many people continue to work past the age of 65 and still benefit from Medicare coverage. This is what you need to know:

Eligibility for Medicare While Still Working

If you are still working and are 65 or older, you are eligible for Medicare. You can choose to sign up for Medicare Part A and/or Part B even if you have employer-based health insurance. It's important to compare your current coverage with Medicare to determine the best option for you.

Working Past 65

For those working past 65, you have the option to delay enrolling in Medicare Part B without a late enrollment penalty, provided you have creditable health insurance coverage through your employer or your spouse’s employer. "Creditable" means that the coverage is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage.

Coordination of Benefits

If you decide to enroll in Medicare while still working, understanding how Medicare coordinates with your employer's insurance is essential. Generally, if your employer has 20 or more employees, your employer's insurance will be the primary payer, and Medicare will be secondary. If your employer has fewer than 20 employees, Medicare usually becomes the primary payer.

So, how to enroll for medicare before retirement? In the next section, we'll outline the steps for applying for Medicare if you are still working.

How to Apply for Medicare If You Are Still Working

Applying for Medicare while you are still employed involves several steps to ensure you receive the coverage you need without unnecessary penalties.

1. Determine Your Initial Enrollment Period

Your Initial Enrollment Period (IEP) is a seven-month period that begins three months before the month you turn 65, includes your birthday month, and ends three months after your birthday month. During this period, you can sign up for Medicare Part A and/or Part B.

2. Assess Your Current Coverage

Evaluate your current employer-based health insurance to determine whether it is beneficial to enroll in Medicare. Consider factors such as coverage, costs, and how the plans work together.

3. Enroll in Medicare Part A

Most people choose to enroll in Medicare Part A when they turn 65 because it’s premium-free if you or your spouse have paid Medicare taxes for at least 10 years. You can apply for Part A online through the Social Security Administration's website or by visiting your local Social Security office.

4. Decide on Medicare Part B

If your employer's insurance is considered creditable, you can delay Part B without penalty. If you decide to enroll in Part B, you will need to pay a monthly premium. Consider your healthcare needs and whether it makes sense financially to add Part B coverage.

5. Complete the Enrollment Process

To enroll in Medicare Part B, you must complete Form CMS-40B (Application for Enrollment in Medicare Part B). If you are delaying Part B because you have employer coverage, you’ll need to submit Form CMS-L564 (Request for Employment Information) to verify your coverage.

6. Review Medicare Advantage and Part D Options

Consider enrolling in a Medicare Advantage plan (Part C) or a stand-alone Part D plan for prescription drug coverage. Compare the available plans in your area to find one that best meets your needs.

FAQs

When Should I Sign Up for Medicare Part B if I Am Still Working?

If you have health insurance through your or your spouse’s current employer, you can delay enrolling in Medicare Part B without a penalty. You should sign up for Part B during the Special Enrollment Period (SEP), which lasts for eight months after your employment ends or your employer-sponsored coverage ends, whichever comes first. It is important to enroll during this period to avoid late enrollment penalties.

Do You Get Medicare if You Never Worked?

Yes, you can still get Medicare if you never worked. If you are 65 or older and do not qualify for premium-free Medicare Part A because neither you nor your spouse paid Medicare taxes for at least 10 years, you can still purchase Part A by paying a monthly premium. You will also be eligible for Medicare Part B by paying the standard monthly premium. Additionally, individuals with certain disabilities or medical conditions may qualify for Medicare regardless of their work history.

Related: Should I Use a Medicare Broker? Yes, and Here's Why!

Wrapping Up

Navigating Medicare eligibility and enrollment can be complex, especially if you are still working or have never worked. Understanding the basics of Medicare, your options before retirement, and how to apply can help ensure you receive the best possible coverage. Whether you choose to enroll in Medicare while working or delay certain parts until you retire, it’s crucial to stay informed and make decisions based on your unique healthcare needs and financial situation.

At Johns Medicare, we specialise in offering Medicare products and services, life insurance, long-term care insurance, short and long-term disability insurance, and annuities. Our team of experienced professionals is here to help you navigate your Medicare options and find the best plan for your needs.

Contact Us Now!

If you have any questions or would like to schedule a consultation, please get in touch with us at (310) 567-5823 or email us at [email protected]. We are here to provide the support and guidance you need to make informed Medicare decisions.