Forms necessary to enroll in Medicare A and/or B

Question from Elaine: I'm 66, still working, and getting health insurance through my employer. I'd like to continue to work for at least a couple more years. However, there's talk that my office branch may close, I may be let go and lose my insurance somewhat abruptly. I already have Medicare Part A. How fast can I enroll in Medicare Part B and get a Supplement or Advantage Plan?

Answer: You can literally apply for Part A and/or B on the last day of the month for an effective date the first of the following month. However, if it's been more than seven months since your 65th birthday, you must have CMS form L564, titled "Request for Employment Information", filled out by your employer in order to apply and have the application processed. Often, this can be tough to get done quickly and Human Resources personnel don't always have the sense of urgency to complete it in a timely manner.

How to enroll in Medicare A and/or B and the form that's necessary

For those in Elaine's situation, enrolled in Part A only, there are two ways to apply. You can walk into any local Social Security office with CMS Form L564 (no appointment necessary) or apply online on the official Social Security website, www.SSA.gov. If you do the latter, you will need to upload the CMS Form L564. If you apply within seven months of your 65th birthday, that form is not necessary.

With more and more employers providing their workers with High Deductible, Health Savings Account compatible health insurance plans, many people who get their insurance at work opt out of both Parts A and B. For those in this situation, to apply at a local Social Security office, you must have an appointment, and often the earliest available are two to six weeks out. You can still enroll online, but again, if it's been over 7 months since your 65th birthday, you will need Form L564.

As part of our no-cost services for new clients, we will walk you through enrolling in Medicare A and/or B, provide you with Form L564 and instructions, facilitate and submit the online application with you, and help you choose an Advantage Plan or Supplement.

What if I can't get enrolled in Medicare quickly enough?

Here's a tip so people don't stress themselves out in a situation where time is of the essence to enroll in either or both Parts of Medicare. Everyone who has health insurance through an employer qualifies for COBRA, which is an extension of your current plan at work, although at full cost to you. In other words, your employer no longer pays any portion of the premium. You are responsible for it in entirety. Employer insurance has become extremely expensive and the average monthly premium for those who elect COBRA ranges from $700 to $1,400.

Medicare part B is $203 per month, the most popular Advantage Plans are $0 to $30, and Plan N Supplements are as low as $71. So obviously, if there is time to get on Medicare A and B along with an Advantage Plan or a Supplement, that's the way to go.

But in the event it simply isn't possible to enroll in Medicare quickly, enrollment in COBRA retros back to the day employer coverage was terminated. And more importantly, there are 63 days to opt in. This means you have protection in case there's an unexpected or expensive health event in between losing employer coverage and your Medicare and Supplement or Advantage Plan effective date. But the best part is COBRA premiums don't have to be paid unless there is.

For example, let's say Elaine loses employer coverage on January 21st. She would have until March 25th to enroll in COBRA that would be retroactive back to January 21st and cover any medical care needed in between. However, if no claims were made, Elaine need not pay any COBRA premium prior to Medicare starting. So if Elaine didn't have time to get her Form L564 filled out by her employer and enroll in Part B for a February 1st effective date, she could apply for a March 1st start and have the peace of mind knowing if she wound up in the Emergency Room or hospital prior, she could pay the COBRA premium and be covered. We call this "floating COBRA" and quite often recommend taking advantage of the grace period that's offered.

Medicare becoming better option than employer coverage for many

One last bit of advice to everyone who is working past the age of 65 and getting health insurance through an employer. Check with us here at The Health Insurance Store to see if going on Medicare and opting out of employer coverage is a better choice. It rarely was five years ago. But today, with the cost of group plan premiums substantially increasing each year, and the burden of that extra expense often being passed on to employees in the form of higher paycheck deductions or large deductibles, I estimate around 35% or more of those on employer plans are best to go on Medicare. You don't have to wait until your next benefit election time at work or Medicare's Annual Enrollment Period to make that move. It can be done anytime.

No need to ever panic when losing employer or other health insurance

If you find yourself in a situation where health insurance is lost abruptly or unexpectedly. Just reach out to us here at The Health Insurance Store. Every agent is experienced helping find workable solutions and there is almost never a situation where a lapse in coverage is necessary. All advice and consultations on matters related to health, Medicare, and Life Insurance are always provided at no cost. Call the office at 724-603-3403 or email me personally, [email protected] to make an appointment or if you have any questions.