If you or your spouse continued to work past age 65 and continuously covered by EGH (Employer Group Health) as your primary insurance, you can still enroll in Medicare Part B without delay or LEP (Late Enrollment Penalty)
Table of Contents
How to Enroll in Medicare When SSA Offices are Closed
Social Security offices are now closed to the public for in-person service. Traditionally, this was the only way to get Part B when you already had Part A (such as for those coming off a group). There are new procedures in place due to the Covid-19 pandemic.
Now, Social Security is allowing folks with Part A to fax in the CMS-40B (application for Part B) as well as the L564 (Request for Employment Information) along with proof of employment or Group Health Plan to 833-914-2016.
The employer does NOT currently need to sign Part B of that form, just go ahead and send it. Local offices may only check their mail once a week, so faxing to this main number is best. It is currently taking about a week to process the paperwork. For updates, see the Social Security Coronavirus web page as well as the Information for Groups page.
Send BOTH forms (CMS-40B and L564) at the SAME TIME.
Get Your Medicare number When You Don’t Have Your Card
Log in to your MySSA account and look for a link labeled View Benefit Details under the Benefits and Payments section. Click the link and scroll down to Get a Benefit Determination Letter. Click that link and it will open a window with a Benefit Letter. You can save and/or print the letter. Scroll down about 3/4 of the way and will see your Medicare number.
Note When you want to enroll in Medicare and are completing the CMS L564
- State on the form “I want Part B coverage to begin (MM/YY)”
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
- income tax form that shows health insurance premiums paid;
- W-2s reflecting pre-tax medical contributions;
- pay stubs that reflect health insurance premium deductions;
- health insurance cards with a policy effective date;
- explanations of benefits paid by the GHP or LGHP; or
- statements or receipts that reflect payment of health insurance premiums.
Eighteen Months to Enroll in Medicare or Two Months?
Remember, coming off of Cobra is NOT the same as coming off of a group where you are covered as an Active Employee. Beneficiaries have 8 months from the time they are covered as an Active Employee to apply for Part B. If they miss that window, even if they are covered by Cobra, they will have to enroll in Part B during the General Enrollment Period, which means applying January through March for a July effective
Avoid the COBRA Trap!
CMS rules grant you an 8 month window after leaving employer group health insurance if you need to enroll in Medicare Part B. If you are 65 or older you have 8 months to enroll in Medicare Part B without penalty or delay.
But if you take COBRA the 8 month window no longer applies. Enrolling in COBRA means you could wait a year or longer before your Medicare Part B is effective. And you will pay a LIFETIME late enrollment penalty.
As if that isn’t enough, without Medicare Part A and B in place you cannot buy a Medigap plan or enroll in an Advantage plan. All you could have is Part A and a Part D drug plan.
Employer group health insurance is considered creditable DRUG coverage but the health coverage is NOT deemed creditable by Medicare.
If you follow all this you can enroll in Medicare without falling into the trap.
Do I have to enroll in Medicare if I am still working?
You are not REQUIRED to enroll in Medicare at age 65 if you are covered under an employer group health insurance plan. SOME employer plans are secondary to Medicare. If that is the case for you, then you will WANT to sign up for Medicare.
What qualifies as a Medicare SEP (Special Enrollment Period)?
Involuntary loss of employer group health insurance can create an SEP for you. You may also be entitled to enroll in a Medicare supplement plan without answering health questions.
Can I have employer group health insurance AND Medicare?
Yes, you can have BOTH employer group health insurance AND Medicare. But doing so may be a waste of money. It is unlikely that Medicare Part B will pay any claims if they are secondary to your group health plan. Also, enrolling in Medicare may disqualify you from making HSA contributions.
Can I drop employer group health and have Medicare as my primary coverage?
I have clients who have continued to work past age 65, dropped their group health insurance, and used Medicare as their primary plan. Often their out of pocket savings for medical claims is thousands of dollars LESS than it would be under a group health insurance plan.