Approaching age 65 is an important milestone — in your life and in healthcare coverage. If, like millions of older Americans, you, your spouse, or both are still working and enrolled in an employer (group) medical insurance plan, there are critical decisions to weigh now to avoid financial penalties or gaps in coverage later.

Part A

Many people enroll in Medicare Part A (hospital insurance) at 65 because it’s usually premium-free. However, if you’re contributing to a Health Savings Account (HSA), enrolling in any part of Medicare means you can no longer contribute to your HSA. That’s an important planning detail to review.

Part B

If you’re covered by an employer plan (yours or your spouse’s), you may be able to delay Medicare Part B without penalty if the employer has 20 or more employees. However, if you do enroll and stay on the employer plan, the employer plan usually pays first, and Medicare would pay second. If the employer has fewer than 20 employees, Medicare generally becomes primary at age 65, and delaying Part B enrollment could lead to coverage gaps or penalties.

When You Retire

If one spouse over age 65 retires and loses employer coverage, that spouse may qualify for an 8-month Special Enrollment Period (SEP) to sign up for Medicare Part A or B without penalty. The SEP starts the month after employment ends or employer coverage ceases, whichever comes first. There is also a 2-month (63-day) window to join Part D or Medicare Advantage drug plan. Critical factors:

• You must enroll during this time to avoid steep penalties
• COBRA and Retiree Coverage do not count as current coverage. The SEP clock starts counting down when you stop working or regular employee coverage ceases.

How an Expert Can Help

While working and planning your transition to retirement, there are numerous complex questions to consider:

• How much does the employer plan cost compared to Medicare?
• Are your doctors and prescriptions covered the same way?
• Do you travel often or live in more than one state?
• Are you coordinating coverage for a spouse?
• What is your projected financial situation and healthcare usage over the coming years?

Everyone’s needs and goals are a little different. Addressing these questions now can make the transition smooth and stress-free. Let us guide you into the next phase with a strong plan for Medicare enrollment.

As in every industry sector, in the Medicare realm, bad actors are getting more sophisticated at scamming unsuspecting seniors. This is especially true during Open Enrollment Period, costing our country billions in fraudulent claims and causing immeasurable aggravation and potential harm resulting from delays in care and reimbursement.

Awareness is a powerful tool! You can fight fraud and watch for impersonators with some simple steps:

1. Always double-check email addresses and phone numbers before responding to any inbound inquiry from Medicare, your healthcare provider or insurance company. The spoofers are getting very good!
2. Never click on an unknown link.
3. Check your explanation of benefits (EOB) to ensure the dates of service, services received, and amounts charged are correct. Make sure there is no billing for services not actually provided, for services not medically necessary, or for a more costly service than was actually performed.
4. Guard your ID number as closely as you would financial information or your social security number.
5. Sign one claim form per visit.
6. Fill in the date on your claim forms. This makes it easier for you to match bills with your EOB.
7. Do not fall prey to threats of Medicare termination, pressure to change plans or promises of free services that seem too good to be true.

If you suspect fraud, report it to Medicare directly at 1-800-MEDICARE.

Resources: medicare.gov; ncoa.org