Roadmap to Medicare Individual or No Insurance

Roadmap to Medicare

Individual Health or No Insurance

More information on:

Your Roadmap is based on…

You are approaching age 65 or over age 65
You are not covered under a Group Health Plan
You have Individual Coverage (ACA/Obamacare) or you have No Current Health Insurance

Recommendation Summary:

Since you do not have creditable coverage (group coverage based on current active employment), you are required to enroll in Medicare during your Initial Enrollment Period (IEP).

In order to avoid a late enrollment penalty, we recommend that you enroll in both Part A and Part B during your Initial Enrollment period.
Schedule your Roadmap to Medicare appointment with an HTA Medicare Advisor if you have not done so already.
How to Enroll in Medicare Part A and Part B at age 65
How to Enroll in Medicare Part A and Part B if you are over age 65 and missed your Initial Enrollment Period

Will I receive a penalty if I don’t enroll now?

Yes. You will receive a late enrollment penalty if you do not enroll during your Initial Enrollment Period at age 65 because your current coverage is not considered creditable coverage to Medicare. Creditable coverage is defined as group coverage based on current active employment.

What is my deadline to enroll?

Your Initial Enrollment Period (Turning 65) is 7 months surrounding your 65th birthday to enroll online. Your effective date will be the 1st of the following month that you enroll. If you are over age 65 and did not enroll during your IEP, you can only enroll once a year during your General Enrollment Period and may be subject to a late enrollment penalty.

Do I need Medicare to have full coverage?

Yes. Medicare Who Pays First states that Medicare becomes primary insurance once you turn 65. If you have an Individual Health Plan (ACA/Marketplace plan), this coverage becomes secondary. If you do not enroll in Medicare, you may not have full coverage. Additionally, any tax credits or other savings you have been receiving on the Marketplace plan will end.

Secondary Insurance Options

You have the option to purchase secondary coverage to supplement your Medicare A and B. You will have the option to choose a Medicare Advantage Plan or Medicare Supplement Insurance and a Medicare Prescription Drug Plan. Contact HTA to explore the options available.

Additional Considerations
Underwriting Considerations: Medicare Supplement Insurance has an Open Enrollment Period for the first 6 months that you are enrolled in Medicare Part B. During this time, you will be able to purchase ANY medicare supplement plan with no medical underwriting.

Unless you have a Guaranteed Issue circumstance, Medicare Supplement plans are medically underwritten after the first 6 months on Medicare Part B.

Medicare Advantage Plans and Medicare Prescription Drug Plans provide an Initial Election Period when you enroll in Medicare, a Special Election Period when you come off your group plan, and also allow you to change plans once a year during the Annual Election Period (October 15^th through December 7^th) without medical underwriting.

Additional Considerations

Spouse Under Age 65- If you have a Spouse under age 65, not yet qualified for Medicare, and relies on your health plan for benefits, please check with your current health insurance company to make sure that your spouse can maintain benefits if you come off the plan.

Will your spouse’s benefits change?

Will your spouse’s premium change?

Does any paperwork need to be filed to change your spouse to the primary insured on the plan?

Effective Date Considerations- Reminder, when you apply for Medicare at age 65, you cannot choose a specific effective date for the benefits (and premiums) to start. The only way to influence the effective date is by which month you enroll online. Please contact us ASAP if you are trying to achieve a specific start date that is something other than the first of the month of your 65th birthday (possibly to coordinate with your group plan ending).

Important HSA Considerations– You cannot continue to contribute to your Health Savings Account (HSA) once you enroll in Medicare Part A. If you are enrolling in Medicare after age 65, your Part A effective date may be back dated up to 6 months. Please contact us to discuss the HSA maximum contribution rate for you circumstances. Click Here for Details and Rules.

This does not apply to Flexible Spending Accounts (FSA) or Health Reimbursement Accounts (HRA). Medicare does not have any restrictions on these types of accounts.