Signing up for Medicare

[alamonica]

I need some advice. I will be 70 years old in November. I am still working and have my health insurance through my employer.  Because my Primary care physician does not belong to my insurance group I had to switch to a much more expensive tier in order to keep my primary care physician that I’ve had for over 20 years not to mention that it is costing me about two hundred more each pay period. I’m confused as to what I should do.   I’m not sure if I should apply for Medicare or stay where I am. 
 
Any help would be greatly appreciated. 

Thank you!!!

Anthony LaMonica alamonica@aol.com

[GailL1]

@alamonica 

Your questions are very open ended and Medicare has lots of twist and turns.  I urge you to get some basics by reading or listing to “Medicare and You” and begin reading the Basics of Medicare on the website.

Medicare.gov - Medicare and You 

Medicare.gov - Get Started 

You can contact your state’s State Health Insurance Programs (SHIP) for more info or more specific help OR contact a knowledgeable LOCAL. MEDICARE Insurance broker that covers lots of different companies that offer either Medicare Supplemental coverage (Medigap) that works with original or traditional Medicare or Medicare Part C coverage - a Medicare Advantage plan that is an options for getting your Medicare benefits.   

When one reaches 65 years old and is still working especially if there is health care coverage thru the employer, one has to determine IF that coverage works with Medicare and how - as primary or secondary.

That determination is made by the type of coverage the employer is subsidizing and is based mainly on the number of employees the employer has and whether or not the employee is required by the plan to sign up for Medicare at 65.

Medicare.gov - How Medicare Works With Other Insurance  

Follow this link along, answering the questions about your other coverage and it will guide you to the answer.

Now turning 70, you are gonna want to sign up for Social Security - at age 70 your benefits into the Social Security system stop growing so you need to sign up - you can keep working and your benefit will get bigger from more work time but not from the benefits growing.  When you sign up for Social Security, you will automatically be signed up for Medicare Part A - Inpatient or Hospital Insurance - the part of Medicare you have been paying your payroll deduction for during your lifetime of work.  Part A will be premium free if you have worked the required time - 10 years.  Sounds like you easily meet this criteria.

For Medicare Part B, you will have to pay a monthly premium - deducted from your Social Security benefit check monthly.  Part B is the Medicare outpatient care or provider care and is the day to day healthcare we often get on an outpatient basis.  Most Beneficiaries pay $ 185 a month for this coverage, higher income earners pay a bigger premium.  

You are most likely gonna have to get your employers to complete a CMS L-564 and your will need to complete a CMS-40B in order to sign up for Medicare since you have continued to work past 65 years old with employer group coverage.

CMS - L-564 - CMS-L564: Request for Employment Information

CMS - 40B - 

APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL INSURANCE)

There will also be a coverage for Medicare prescription drug coverage that you will need to make sure you have under your choice of plan coverage - traditional Medicare or Medicare Advantage.

As to your doctor that you want to keep - ask them what Medicare they accept, if any.  Or you can look them up on the Medicare Provider compare list.

Medicare.gov -Does your provider accept Medicare as full payment? 

Medicare.gov - Find and Compare Providers Near You 

I know I haven’t answered everything but this may get your started - once you lose employer group coverage, you only have a specific time period to sign up for Medicare without being assessed a late sign up penalty. You will need to fill out these forms to get that special enrollment period. 

Start reading and learning, see the Medicare Insurance broker or SHIP agent, complete the forms and sign up - pick your way of getting benefits, signup also for Social Security at least at 70 - no later. 

Jump in and get those feet wet as the ole saying goes - will it be cheaper or better than employer group coverage - ????? - it is good, but cheap, not so much since you will need to make some choices over how any of your out of pocket cost will be covered or paid.  Most people get a Medigap plan to fill in with Trad. Medicare - others use Medicare Part C - Medicare Advantage plan.  Your choice.

[Winter2025VA]

@alamonica , Gail will be able to answer your questions when she is back on the site. She knows all about Medicare. But I will say this, IF you DONOT sign up for Medicare when you turn 65, I "think" there is a Part B "penalty". Also, this is a PUBLIC SITE, so best NOT to post your Email Address. AARP @AARPConsumerCare , can you remove Email Address to protect this member from scammers. Nicole!

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@alamonica wrote:

I need some advice. I will be 70 years old in November. I am still working and have my health insurance through my employer.  Because my Primary care physician does not belong to my insurance group I had to switch to a much more expensive tier in order to keep my primary care physician that I’ve had for over 20 years not to mention that it is costing me about two hundred more each pay period. I’m confused as to what I should do.   I’m not sure if I should apply for Medicare or stay where I am. 
 
Any help would be greatly appreciated. 

Thank you!!!

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