For many, turning 65 is synonymous with Medicare – and for good reason. This is the age when most people start to receive their Medicare benefits.
But how exactly do people receive their Medicare benefits? Do they need to sign up? Is enrollment automatic? To figure this out, let’s take a closer look at Medicare’s eligibility rules.
Social Security and Railroad Retirement Benefits
If you have already taken Social Security or Railroad Retirement benefits prior to age 65, you will automatically be enrolled into Medicare Part A (hospital insurance). Medicare Part B (medical insurance) will be offered to you for a monthly Part B premium payment. In 2020, the standard cost for Part B premium is $144.60.
Then you can enroll in Medicare Part A and/or Medicare Part B in the following ways:
- Online at www.SSA.gov
- By calling Social Security from 7:00 am to 7:00 pm, Monday through Friday, at 1-800-772-1213 (TTY: users 1-800-325-0778)
- In-person at your local Social Security office
You can enroll in Medicare as early as 3 months before you turn 65 and up to 3 months after tuning 65. Your effective date, or when you can start to receive Medicare, will be the month you turn 65; or if you wait to enroll until after you turn 65, the first month after you enroll.
Many older adults are no longer employed at age 65, and thus rush to sign up for Medicare as soon as they’re able. But if you’re still working at 65, and you have coverage under a group health plan through an employer with 20 employees or more, then you don’t have to enroll in Medicare right away. You are covered by your employer’s health plan and can wait until you retire by signing up for Medicare under a Special Election Period.
A Special Election period occurs:
- If you lose your employer health insurance
- You move out of the service area of your current Medicare Advantage plan
- If you change income status and qualify for low income assistance
- If the Medicare Advantage plan you are in goes out of business.
Information on Special Election period is included on page 8 of the Medicare Facts Made Simple booklet. You can download it on our website at medicare.virginiapremier.com
You don’t have to be 65 or older to qualify for Medicare. If you have a qualifying disability under Social Security Disability Insurance (SSDI) benefits, you are also eligible for Medicare after a 24-month qualifying period. The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage.
If you are eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act) from your employer and also eligible for Medicare, be careful. COBRA allows you to keep your group coverage for a limited time, typically up to 18 months, but it does not qualify for creditable coverage under Medicare.
So, what does that mean? COBRA is not considered equal to employer group coverage. So when you take COBRA, it is not considered creditable coverage. Even if the COBRA coverage is identical to what you had as an employee of your former employer, it is not considered creditable coverage. That means once you have lost employer coverage for 8 months or more, you can no longer enroll in Medicare Part B medical coverage without a penalty.
And there is a penalty for not enrolling in Medicare Part B within the 8-month window of losing employer health coverage. Your monthly Part B premium will go up 10 percent for each full 12-month period that you could have had Medicare Part B but did not take it. You will pay this higher premium as long as you have Medicare Part B. So, this is a big deal.
How to Get More Information about Medicare
If you’d like to talk with us, you can call us toll-free at 1-833-688-6747 (TTY:711). We’re available 8:00 am to 8:00 pm, 7 days a week October 1 – March 31, and 8:00 am to 8:00 pm, Monday through Friday, April 1 – September 30.
We also offer additional resources to help you better understand Medicare:
And if you’d like to learn more about the Medicare Advantage plans we offer, go to our Find a Plan page.