The need to sign up for Medicare when covered by a spouse’s employer-based health insurance plan is largely dependent on the number of employees your spouse’s company employs.

Let’s review some options:

 Spouse’s employer employs less than 20 employees:

 ·         You usually need to sign up for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) during your initial enrollment period.

 ·         Once you turn 65, Medicare usually pays its part of insurance claims first, and employer coverage becomes secondary. To avoid facing late enrollment penalties and possible coverage gaps, it is generally a good idea to make sure you sign up for Medicare during your initial enrollment period.

 Spouse’s employer has more than 20 employees:

·         You may be able to delay signing up later without any issues. If you like your current health insurance coverage, you can keep it and delay signing up for Medicare until your coverage ends on your spouse’s employer health insurance plan.

 ·         If you would like to continue making payments to your HSA, you should be ok delaying enrollment in Part A and Part B until you and your spouse stop working and lose employer coverage.

 Important! It is important that you enroll in Medicare within eight months of losing your employer health coverage, or you will face a Medicare late enrollment penalty.

Do I have to sign up for Medicare if my spouse is still working?

Most people are first eligible to sign up for Medicare health insurance three months before they turn 65. If you are turning 65 and covered by your spouse’s employer-sponsored insurance plan, you may not have to sign up for Medicare, and you have a few options to consider:

 ·       Enroll in Medicare when you turn 65 (or three months prior)

·        Enroll in just Medicare Part A when you turn 65 (or three months prior)

·       Delay enrolling in Medicare until your spouse stops working and/or no longer has employer-sponsored insurance.

 Let’s review your options in a little more detail.

If you decide to enroll in Medicare…

 You have the option to enroll in the following:

Medicare Part A (hospital insurance):

 ·         People commonly decide to enroll in Medicare Part A when they turn 65, even when their spouse’s employer-sponsored health plan covers them because most people do not pay a premium. This is because most people have paid Medicare taxes while working (for at least 10 years), so they do not have to pay a monthly premium for Medicare Part A.

 ·         If you are eligible for a premium-free Medicare Part A, you may want to consider signing up for it. Even if you have employer health coverage, the employer health insurance generally pays out claims first and Medicare second, which may help fill in coverage gaps.

 ·         Whether Medicare or your other insurance pays first depends on a few factors described above regarding the number of employees and what type of insurance. Medicare.gov has a helpful guide that outlines who pays first when you have Medicare and other insurance.

 When is this a bad idea?

·         If you have high deductible health plan (HDHP) coverage and have a health savings account (HSA), you will likely want to avoid this, as rules do not allow you to continue contributing pre-tax dollars to your HSA.

Important! It is important to note that if you qualify for premium-free Part A, your coverage will go back (retroactively) up to 6 months from when you sign up. So, you should stop contributing to your HSA 6 months before enrolling in Part A and B. If you wish to collect retirement benefits before you stop working, you should cease making contributions to your HSA 6 months before enrolling in Part A and B when you apply for Social Security benefits.

 Medicare Part B (medical insurance):

 ·         Medicare Part B is voluntary coverage, and beneficiaries pay premiums for this coverage.

·         If your spouse works for a company with more than 20 employees, You should be able to wait to enroll in Medicare Part B, and it may be a good idea if the coverage you have is through your spouse’s employer since the coverage may be better and to avoid paying for another premium.

 ·         If your spouse works for a company with less than 20 employees, the same applies. You should be able to wait to enroll in Medicare Part B, but you (or your spouse) should find out from your spouse’s benefits department for the employer-sponsored health plan whether you should sign up for Medicare Part A and Part B when you reach 65. Sometimes, if you don’t sign up for Part A and Part B, your employer-based health insurance may not cover the costs of services you get.

Delaying enrollment in Medicare? Remember the following:

 ·         If you are already a Social Security beneficiary, Social Security will automatically enroll you in Medicare Part A and Part B starting on the first day of the month when you turn 65. If you have comparable coverage and do not want to pay another premium, you must inform Social Security that you want to delay Part B enrollment.

 ·         It is a good idea for you (or your spouse) to schedule a time to talk to their employer’s benefits manager to determine if it makes sense to delay signing up for Medicare Part A and B.

 ·         It is important to start Part B coverage immediately after you (or your spouse) stop working or lose your current employer coverage. Medicare gives you eight months from the time you stop working or your employer-based health coverage ends to enroll in Medicare. When in doubt, contacting Medicare or Social Security is wise to confirm that you will not face any late enrollment penalties.

If I delay enrolling, is there a penalty?

 If you elect to delay enrolling in Medicare, you have a Special Enrollment Period (SEP).  If you are 65 or older and either you or your spouse are still working, and their employer-based health plan covers you, you may qualify for a special enrollment period:

 ·     During any month if you remain covered under their employer-based health plan, and their employment continues.

 ·     The eight-month period starts the month after your spouse’s employment or employer-based health coverage ends.

 ·     Make sure that you have creditable coverage and can delay enrolling in Medicare.

 ·     Make sure your current prescription drug coverage is considered creditable coverage by Medicare.

·      Get proof that your prescription drug plan coverage is creditable in writing for backup.

 Important! You are not eligible for the special enrollment period if your spouse’s employer-based health coverage ends while you are still in your Original Medicare Part B enrollment period. Your initial enrollment period is three months before your 65^th birthday and three months following your birthday.

Still have questions? Hella Health has a wealth of helpful information on its website, such as answers to common Medicare questions.

Visit  Hella Health for additional help and assistance navigating Medicare enrollment challenges.