Pre-Retirees & Retirees

Medicare eligibility is primarily based on age, disability, or certain medical conditions. Most people qualify for Medicare at age 65 or older if they or their spouse have worked and paid Medicare taxes for at least 10 years.

You do not necessarily have to enroll in Medicare if you or your spouse have health insurance from an employer-sponsored plan. You can delay enrolling in Medicare until your employment ends or the coverage stops, whichever comes first. In addition, you will have a special enrollment period (SEP) to sign up for Medicare before or within eight months of losing your job-based coverage to avoid a late enrollment penalty. However, it is always in your best interest to contact your employer and verify this information with your group insurer as this information can vary from carrier to carrier.

If you are actively contributing to an HSA through your employer-sponsored plan, you will want to forego Part A until you decide to cease contributions, so long as the insurer allows this. However, you will want to ensure stopping those contributions 6 months prior to starting your Medicare coverage to avoid penalties.

Part A (hospitalization) is $0 if worked 40 quarters (10 years) and paid into Medicare taxes. Part B (medical – doctor visits, lab, etc.) is $202.90 unless IRMAA applies. Additional Medicare costs vary depending on the type of coverage you have as part of original Medicare. The total amount you pay will depend on the type of Medicare plan(s) you choose and the health care services you use during the year.

In general, you become eligible for Medicare after receiving Social Security disability benefits for 24 months. There are exceptions for people with certain medical conditions. It is best to confirm your eligibility directly with Social Security.

Medicare Advantage (Part C) replaces original Medicare (Parts A & B) and is offered by private insurers. It often includes extra benefits like dental, vision, and hearing coverage. Medigap, or Medicare Supplements, help cover out-of-pocket costs like deductibles, copays, and coinsurance left over from original Medicare.

Yes, you can switch from Medicare Advantage to Medigap, but there are specific rules and timing to consider. If you switch outside of a Special Enrollment Period, insurers may require health screening and could deny coverage or charge higher premiums. Medicare Advantage replaces Original Medicare, while Medigap supplements it, so you cannot have both at the same time.

You are eligible to switch from a Medicare Supplement to a Medicare Advantage plan during the Annual Enrollment Period each year from October 15-December 7th for the following year. It is always best to contact us to explore all of your options.