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When to Join Medicare

If you are a U.S. citizen or a legal resident who lived in the United States for the last five consecutive years you qualify for Medicare at age 65. As you get closer to this age and depending on your individual situation you may have to decide whether Medicare should be your health coverage from now on.

For those without employer insurance, the decision about enrollment in Medicare is easy, but many people who have the option to remain on their or their spouses’ group plans may greatly benefit from switching to Medicare.

Let’s look at the two most common scenarios:

Scenario #1.

You turn 65 and you do not have employer or union group insurance coverage.

When you turn 65 and you do not have your own or your spouse’s health insurance coverage, then Medicare is most likely the only and the best available option for you. You will have a 7-month period when you can sign up for Original Medicare and then for Medicare Advantage or Part D plan. It’s called Initial Enrollment Period or IEP for short. Your IEP includes the month of your 65th birthday, and the 3 months before and 3 months after. During this period, you should apply for Medicare parts A and B. If you don’t do this during your IEP timeframe you will most likely be subject to a Late Enrollment Penalty and you may have to wait several months to re-apply.

Therefore, if you don’t have any insurance through your employer or other coverage, which is considered Medicare creditable, you should enroll with Medicare when turning 65.
Please note that individual plans including the Affordable Care Act plan (Obamacare), extension plans under COBRA, or short-term plans are not considered creditable coverage.

Scenario #2.

You turn 65 and you have health insurance coverage through your or your spouse’s employer.

In this case, delaying your enrollment in Medicare is a potentially valid option. If your employer provides your health insurance plan and employs 20 or more people, you may remain on your existing policy, and it will not cause any Late Enrollment Penalties in the future. Just remember that it must be Medicare creditable coverage. However, depending on your employer’s plan coverage and cost, remaining on it may not be the best option, and switching to Medicare could be more beneficial.

Let’s look at a couple of the most common examples:

You turn 65, you have your own or your spouse’s employer coverage.

In this scenario, it makes sense to compare your options. You should look at both plan choices: Employer’s plan vs. Medicare. Calculate the cost of your monthly premiums in both scenarios, compare the benefits, deductibles, providers network, cost of your medications, cost of the ancillary benefits such as dental and vision coverage and decide what makes better fit given your health and financial situation. This could be the most difficult process in choosing your health coverage. If you are not sure how to do this, contact one of our agents at Find an agent, and he or she will provide you with a no cost plan comparison.

You turn 65, you have your employer’s coverage, but your younger spouse is on your employer’s plan as well.

Just like above, a comparison of available options should take place. If you decide to switch to Medicare, your younger spouse will most likely lose his or her coverage and will need to look for alternatives. Several different options could be available, of which some may include short-term health plans, plans under Affordable Care Act (Obamacare) or if your spouse is still working his or her employer’s plan. When you do the comparison, you may decide that maintaining your existing employer’s plan makes more sense, and you can delay enrollment in Medicare. For our professional assistance, just click on Find an agent.

You turn 65, you have your employer’s coverage, but your employer has less than 20 employees.

This is a tricky one. If the employer’s plan is multi-employer or multiple employer group health plan than you may remain on that plan as your primary insurance and treat it just like the plan from and employer with 20 or more employees (see above). However, if you plan is not part of the multi-employer or multiple employer group health plan, you should enroll in Medicare, which will become the primary payer and either drop your employer’s coverage or keep it as it becomes a secondary payer. To compare the most suitable option for you, contact one of our agents at Find Your agent.