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January 11, 2024

As individuals approach the age of 65, enrolling in Medicare Part A becomes a crucial step in accessing healthcare benefits. Most individuals should enroll in Part A when they turn 65, regardless of employer-provided health insurance. This is because most people have already paid Medicare taxes during their working years, entitling them to premium-free Part A. However, there are specific scenarios where delaying Medicare Part A may be a consideration worth exploring.

Understanding Medicare Part A Premiums and Eligibility

The majority of individuals do not need to pay a monthly premium for Medicare Part A as they have already fulfilled the requirements through their past Medicare tax contributions. This is known as "premium-free Part A." However, there are situations where individuals may need to pay a premium, referred to as "premium Part A," if they did not meet the necessary Medicare tax payment threshold.

Health Savings Account (HSA) Considerations

If you contribute to a Health Savings Account (HSA), delaying Medicare Part A may be a prudent option. Enrolling in Medicare Part A would make you ineligible to contribute to your HSA. By delaying enrollment, you can continue to utilize the tax advantages of your HSA while maximizing your healthcare savings.

Employer Health Insurance and Coverage

Before making a decision to delay Medicare Part A, it is vital to consult with your employer or union benefits administrator. These conversations will help you understand how your employer-provided health insurance interacts with Medicare. Your employer coverage may require enrollment in both Part A and Part B to ensure comprehensive coverage. Being fully informed will allow you to make a decision that aligns with your healthcare needs and financial situation.

Additional Considerations for Delaying Medicare Part A

While delaying Medicare Part A may have its advantages, there are a few factors to keep in mind:

  • Medicare Part A provides coverage for hospital stays, skilled nursing facility care, and hospice care. Delaying enrollment may result in potential gaps in coverage and potential out-of-pocket expenses for these services.
  • Aging brings the possibility of unpredictable health circumstances. By delaying Medicare Part A, individuals may not have access to comprehensive coverage that can help navigate health challenges.
  • Late enrollment penalties may apply if you delay Medicare Part A despite being eligible. These penalties can result in higher premiums for as long as you have Medicare coverage, potentially impacting your long-term financial well-being.
Delay Medicare Part A

For most people, enrolling in Medicare Part A at the age of 65 is recommended to ensure comprehensive healthcare coverage.

Making the Decision to Enroll in Medicare Part A and Part B at Age 65

How can this information help me?

As you approach the age of 65, it is crucial to make informed decisions about your Medicare coverage. These decisions may feel overwhelming and require careful consideration. This fact sheet is designed to assist you in the following ways:

  1. Understanding your Initial Enrollment Period:
    • Determine the specific time frame called the "Initial Enrollment Period" when you can enroll in Medicare.
    • This period lasts for 7 months, starting three months prior to the month you turn 65, including your birth month, and extending three months after it.
  2. Deciding whether to enroll in Medicare Part A and Part B:
    • Evaluate the benefits and considerations associated with enrolling in Medicare Part A and Part B when you reach 65.
  3. Learning how to sign up for Medicare Part A and Part B or opt-out of Part B:
    • Discover the process and requirements for enrolling in Medicare Part A and Part B.
    • Find information on opting out of Part B if you choose not to enroll.

Note: While this fact sheet provides valuable information to assist in your decision-making process, it may not cover every unique situation. If your specific circumstances are not addressed or if you have further questions about enrolling in Medicare, we recommend contacting your employer or Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

Determining your Initial Enrollment Period

Enrollment in Medicare is only allowed during specific time periods. The first opportunity to enroll is known as the "Initial Enrollment Period." This period spans 7 months and usually starts three months before your 65th birthday month, includes your birth month, and extends three months after it.

Tip: To determine your Initial Enrollment Period, you can utilize the Medicare Eligibility and Premium Calculator. Visit Medicare.gov/eligibilitypremiumcalc or call 1-800-MEDICARE (1-800-633-4227 or TTY 1-877-486-2048). We advise reviewing the information provided in this fact sheet as it will aid in deciding whether to enroll in Part A and Part B during your Initial Enrollment Period. It is recommended to make this decision at least three months in advance of your 65th birthday.

Finding your Medicare Initial Enrollment Period

To discover when your Initial Enrollment Period falls, please use the Medicare Eligibility and Premium Calculator. Visit Medicare.gov/eligibilitypremiumcalc or call 1-800-MEDICARE (1-800-633-4227 or TTY 1-877-486-2048).

Deciding whether to enroll in Medicare Part A and Part B at age 65

Medicare Part A, also known as "Hospital Insurance," covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care. For most individuals, enrolling in Medicare Part A at age 65 is recommended, even if they have health insurance from their employer. This is because most people have already contributed to Medicare taxes during their working years and qualify for premium-free Part A. However, there are certain situations where delaying enrollment in Part A may be a consideration, such as individuals who contribute to a Health Savings Account (HSA) or those who have to pay a premium for Part A.

Medicare Part B, known as "Medical Insurance," covers services provided by doctors and other healthcare providers, outpatient care, home health care, durable medical equipment, and some preventive services. The majority of individuals should enroll in Medicare Part B at age 65. The only exceptions are those who have health insurance through their current employer or their spouse's employer, allowing them to delay enrolling in Part B.

Medicare premium costs vary depending on your work history, the timing of your enrollment, and your current income. Most individuals do not pay a monthly premium for Part A if they (or their spouse) worked and paid Medicare taxes for a sufficient duration. This is known as "premium-free Part A." However, if you didn't pay enough Medicare taxes, you can still obtain Part A but may need to pay a monthly premium (referred to as "premium Part A"). Everyone is required to pay a monthly premium for Part B, with the amount varying based on income and the timing of enrollment.

Before making a decision about enrolling in Medicare Part A and Part B, consider the following situations:

  1. If you currently have health insurance from a previous employer, including COBRA or retiree health insurance, it is advisable to enroll in both Part A and Part B when you turn 65. Failure to enroll during your Initial Enrollment Period may result in a coverage gap and lifetime late enrollment penalties.
  2. If you have TRICARE or CHAMPVA coverage, your decision to enroll in Part A and Part B depends on your eligibility for premium-free Part A. If you qualify for premium-free Part A, you must enroll in both to maintain TRICARE or CHAMPVA coverage. If you are not eligible for premium-free Part A, enrolling in Part A and Part B is optional, but delaying enrollment may result in late enrollment penalties.
  3. If you have health insurance through your current employer (or your spouse's employer), and the employer has 20 or more employees (including those with Federal Employees Health Benefits), your decision to enroll in Part A and Part B depends on whether you have a high-deductible health plan with a health savings account (HSA). If you don't have an HSA, it is recommended to enroll in Part A when you turn 65, but you can delay Part A if you need to pay a premium. Delaying Part B can help save on premiums and postpone your "Medigap open enrollment period." If you have an HSA, delaying both Part A and Part B may allow you to continue contributing to your HSA. Consult your employer's benefits manager or benefits administrator for guidance on the best course of action.

Remember, if you have any specific circumstances or need further guidance, it is essential to consult your employer or reach out to Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778 for assistance. Or call a qualified agent at Lehigh Partners 1-833-265-9655

Determining Whether to Enroll in Medicare Part A and Part B at Age 65

Here are some guidelines to help you decide whether to enroll in Medicare Part A and Part B when you turn 65 based on your specific situation:

  1. Health Insurance through Current Employment: If you or your spouse have health insurance through a company with fewer than 20 employees, it is advisable to enroll in Medicare Part A and Part B when you turn 65. In this case, Medicare will be the primary payer for your health coverage.
  2. Health Insurance from the Health Insurance Marketplace or Other Private Insurance: If you have health insurance from the Health Insurance Marketplace or privately and you are eligible for premium-free Part A, it is recommended to enroll in both Part A and Part B when you turn 65. Your Marketplace coverage will end once your Medicare Part A starts.
  3. Marketplace Coverage and Ineligibility for Premium-free Part A: If you have Marketplace coverage and do not qualify for premium-free Part A, you have the option to continue your coverage through the Individual Health Insurance Marketplace. However, if you later decide to enroll in Medicare Part A and/or Part B, delaying enrollment may result in a late enrollment penalty, which increases the longer you wait.
  4. Veterans Affairs (VA) Coverage: If you have VA coverage, it is recommended to enroll in both Medicare Part A and Part B when you turn 65. If you also have another type of coverage mentioned above, use that situation as a guide to decide whether to enroll in Part A and Part B.
  5. No Health Insurance: If you do not have health insurance, it is advisable to enroll in both Medicare Part A and Part B when you turn 65. Failing to enroll during your Initial Enrollment Period may result in a lifetime late enrollment penalty, which increases over time.

To sign up for Medicare Part A and Part B, refer to the relevant section based on your situation:

Once your Part A and Part B coverage begins, you will have health coverage under "Original Medicare." Consider whether you need additional coverage such as Medicare supplement insurance (Medigap), Medicare Advantage Plans, or Medicare prescription drug coverage. For more information on these options, visit Medicare.gov or call 1-800-MEDICARE. Keep in mind that there are specific enrollment periods for these additional types of insurance, so it is best to make decisions during your Initial Enrollment Period to have the most choices available.

Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65

If you wish to delay Part B but start Part A when you turn 65, please consider the following information:

  • If you will be receiving benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65:
    • You will automatically receive both Part A and Part B starting from the first day of the month when you turn 65 (or the first day of the prior month if your birthday falls on the first day of the month).
    • However, if you want to delay your Part B coverage, you must refuse it before your Medicare coverage starts.
      • Option 1: Follow the instructions that come with the card and send the card back. Remember, by keeping the card, you will have Part B coverage and will need to pay Part B premiums.
      • Option 2: Contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
    • Note: If you live in Puerto Rico and are already receiving benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you will automatically receive only Part A. You don't need to take any action to start Part A or delay Part B.
  • If you won't be receiving benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65:
    • You will need to submit an application with Social Security in order to get Part A. You can apply through these methods:
      • Applying online at SocialSecurity.gov
      • Visiting your local Social Security office
      • Calling Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
      • Calling RRB at 1-877-772-5772 (if you worked for a railroad). TTY users should call 1-312-751-4701.

When should you sign up for Part B?

  • If you (or your spouse) are still working and have employer coverage from your current employer:
    • It is recommended to start Part B coverage as soon as you stop working or lose your employer coverage, even if you sign up for COBRA or retiree health coverage from your employer.
    • You have an 8-month window to enroll in Medicare once you stop working or your employer coverage ends (whichever happens first). Contact Social Security before your employer coverage ends to avoid any gaps in coverage.
    • Note: Failing to enroll in Part B within 8 months of losing employer coverage may result in a lifetime late enrollment penalty. Additionally, you will only be able to enroll during the Medicare General Enrollment Period (from January 1 to March 31 each year), and your coverage won't start until July, which may cause a gap in your coverage.
  • If you (and your spouse) are not still working and do not have coverage from an employer:
    • If you don't enroll in Part B during your 7-month Initial Enrollment Period, you will have to wait until the Medicare General Enrollment Period (from January 1 to March 31 each year) to enroll in Part B, with coverage starting on July 1.
    • Note: Failing to enroll in Part B during your Initial Enrollment Period may incur a lifetime late enrollment penalty. For Part B, the penalty is a 10% increase in your monthly premium for every 12-month period you were eligible for but did not have Part B. You will have to pay this penalty for as long as you have Part B coverage.
  • If you wish to delay both Part A and Part B:
    • Note: If you don't get Part A and Part B when you are first eligible, you may have to pay a lifetime late enrollment penalty. However, you may not pay a penalty if you delay Part A and Part B because you have coverage based on your (or your spouse's) current employment.
    • If you will be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you will automatically receive both Part A and Part B starting from the first day of the month you turn 65 (or the first day of the prior month if your birthday falls on the first day of the month).
    • To delay Part B, you must refuse it before your Medicare coverage has started.
      • Option 1: Follow the instructions that come with the card and send the card back. If you keep the card, you will have Part B coverage and will need to pay Part B premiums.
      • Option 2: Contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
    • Note: The only way to opt out of Part A is to withdraw your original application for Social Security benefits and repay any benefits you've already received.
    • Note: If you live in Puerto Rico and are already receiving benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you will automatically receive Part A. If you want Part B, you'll need to sign up for it.
  • If you won't be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65:
    • If you want to delay both Part A and Part B coverage, you don't need to take any action when you turn 65. You should sign up for Medicare when you stop working or lose your health insurance from your (or your spouse's) current employer.

In conclusion, for most people, enrolling in Medicare Part A at the age of 65 is recommended to ensure comprehensive healthcare coverage. However, individuals contributing to an HSA or facing premium costs for Part A may consider delaying enrollment. It is crucial to evaluate your specific situation, consult with a healthcare professional or Medicare advisor, and weigh the advantages and disadvantages of delaying Medicare Part A to make an informed decision tailored to your needs.

For more information:

  • Contact Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • Visit the Medicare website at Medicare.gov.
  • Look at the most recent "Medicare & You" handbook. You can download it on Medicare.gov.

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