What is Medicare?

  • Medicare is an insurance program ran by the federal government.

  • It is for:

    • People 65 years of age or older

    • Certain young people with disabilities

    • People with ESRD (End-State Renal Disease) meeting certain requirements

    • Medicare is overseen by the Department of Health and Human Services (HHS) and the U.S. Centers for Medicare & Medicaid Services.

How Do I Sign Up For Medicare?

  • Enrolling into Medicare is done through your local Social Security office or online at SSA.gov.

  • If you have been on Social Security at least 4 months prior to turning 65, Medicare will enroll you automatically into Medicare Parts A & B. You will get your card in the mail about 3 months prior to turning 65.

  • If not automatically enrolled, you can sign up online through SSA.gov if you want Medicare to start on your 65th birthday.

  • If you are enrolling and you are past your 65th birthday, you will need to get forms filled out by your employer. You can find them above on the "Forms" page. You will have to send these forms to the social security office and sign up over the phone or in-person.

When Does Medicare Start?

  • Medicare starts on the 1st of the month prior to your 65th birthday.

  • If you are born on any day during the month 2-31, Medicare will start on the 1st of that month. (Birthday May 5th, Medicare starts May 1st)

  • If you are born on the 1st of the month, Medicare will start on the 1st of the previous month. (Birthday May 1st, Medicare starts April 1st.

  • If you are on Social Security Disability (SSDI), Medicare starts 2 years after

Do I Need Medicare if I have Insurance through my employer?

  • You do not have to if you meet certain criteria and if it makes more sense financially.​

  • You will not be penalized if:

    • Your employer has more than 20 employees

    • Your health insurance is "group coverage- defined by the IRS"

    • Your health insurance has "creditable drug coverage" (as good or better than Medicare's)

  • We always advise people to meet with us or another trusted Medicare broker to compare the costs between staying on your employer plan vs. going on Medicare. We look at the premiums, deductibles, co-pays, coinsurance and max-out-of-pocket. I would say 60% of the time it makes more sense financially to go onto Medicare rather than stay with your employers plan.

  • After you retire and lose your health insurance through your work, you will have 60 before your end date and 60 days after to sign up for Medicare and a Medicare plan. We recommend calling us at least 4 months before you are ready to retire to get all of your ducks in a row.

Will I be penalized if I don't sign up for Medicare?

You will not be penalized if:

  • You or your spouse is still working and you have creditable health coverage through your/your spouse employer.

  • Creditable Coverage Means:

    • More than 20 employees

    • Group Coverage as defined by the IRS

    • Creditable drug coverage - as good, or better than Medicare's drug coverage standards.

How Do I pick the right Medicare Company or plan to Supplement the parts Medicare does not cover?

  • There are so many things to look at. Each company and plan makes sense for a different person. We recommend looking at:

    • Budget - How much can you afford? Typically you will be retired and that means learning to live on a reduced income. How much can you afford to pay each month? Are you more comfortable paying a higher premium and want more comprehensive coverage? Do you feel better paying less each month and saving money so that you have money to spend on expenses if you need to?

    • Network - How much do you travel? Are you okay with having to stay inside a network or do you prefer to have an open network and go anywhere Medicare is accepted?

    • Co-pays, Coinsurance and Max -out-of-pocket - are you comfortable with what each plan charges and know your risk if you get sick or need medical services?

    • Drugs - Each prescription company and plan changes a little each year. They change which drugs they cover (formularies), deductibles, and co-pays. We help all of our clients look at their drug list each year to make sure their company is going to continue covering their drugs and to make sure there is not something that would cover more next year.

The information on this website is for educational purposes only. While we have taken every precaution to ensure all information is accurate, errors can occur. Health Insurance Advisors, LLC assumes no responsibility for any errors on this page. Sources: Medicare.Gov & SSA.Gov