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Losing your job unexpectedly, without any preparation, can be financially and emotionally crippling. If you’re past age 65, quickly figuring out Medicare is a daunting priority. When all you’ve known is employer health coverage, Medicare and all of its nuances can be intimidating.
The first piece of information you need to get the Medicare ball rolling is the number of employees where you or your spouse worked. If there were 20 or more employees, then the large employer insurance is creditable for Medicare. The great news about having large employer insurance past 65 is you qualify for a Special Enrollment Period (SEP) when you lose coverage.
What this means is that you can apply for Medicare right when you lose coverage and don’t need to wait for the General Enrollment Period (GEP). However, applying during a SEP isn’t always a smooth process. There are some things you’ll want to know to be fully prepared.
If you already have Part A, that is great news since you already have a Medicare number. But, if you don’t have Part A, you’ll want to log into your SSA.gov account and apply for Part A as soon as possible. If you don’t want to do it online, you can call a local Social Security office or visit one in person, but there may be long wait times. Once you apply for Part A, the next step is Part B.
When you apply for Part B through a SEP, there are two forms you will need – CMS form 40B and CMS form L564. The 40B form is your Part B application that you will complete. The L564 form is completed by you and the HR department of the employer whose insurance covers you. This form is critical during the SEP process because it proves you had creditable coverage while delaying Medicare. If you don’t provide this form, you could be hit with a late enrollment penalty.
Once you have those completed, you can upload them online to the SSA website, deliver them in person, or fax or mail them to a local office.
As you might imagine, getting Medicare as soon as possible is critical to avoid any gaps in coverage. On the CMS form 40B, you can request an effective date in the remarks section. Generally, Social Security is pretty good about honoring that effective date as long you apply before the date you are asking for.
However, if you don’t request an effective date, they should give you an effective date of the 1st of the month after you submit the forms. But they may give you an effective date of two months after. It depends on who is processing the documents and when they receive them. Trust me, I wish this process was more consistent too.
Also, prepare to not to have an approval for several weeks due to the long processing times. And when I say several weeks, I’m talking about at least two months which I know is not ideal, but that’s why I recommend getting these forms taken care of as quickly as possible. They will likely approve the effective date you request, but you may not receive the confirmation until it’s already past that date.
It’s shocking to many that small employer insurance is not creditable coverage for Medicare. Suppose there are less than 20 employees where you or your spouse worked. In that case, you will not qualify for a SEP for Medicare. This means you will need to wait until the GEP from January 1st to March 31st to enroll in Medicare, which can be very inconvenient if you lose your coverage in, let’s say, April. This would be several months without coverage, and you’ll be hit with a late enrollment penalty.
When you apply during the GEP, your Medicare benefits will be effective on the 1st of the following month after you apply.
You can complete the application online through the SSA website, or you can call or go in person to a local SSA office.
Once you have completed all the necessary steps to get Medicare Part A and B in place, you can move on to the Medicare plans you need. You’re one step closer to the finish line!
If you’re considering a Medigap plan to be secondary to your Original Medicare, you can enroll in a plan within 6 months of your Part B effective date. This window is your one-time golden ticket to enroll in a Medigap plan with no health questions asked, so you will want to think about this carefully and consider all options. Another viable option is Impact Health Sharing for Seniors, it is a very affordable plan and it covers the gap for you. Get More Details Here
Many people will enroll in a Medigap plan and have it start at the same time as Part B so they can immediately have fuller coverage.
When it comes to Advantage and Part D plans, you only have a 2-month window from the day you lose coverage to apply for a plan. You will need your Medicare number handy for these applications, so, again, you will want to complete your Medicare application as soon as possible. Missing this 2-month window can result in a lifelong penalty and force you to wait until the Annual Election Period (from October 15th to December 7th) to enroll in one of these plans.
