This is the most complicated election for timing your Medicare start dates, yet it is very common. I’ll walk you through each step to thoroughly cover exactly what you need to do to get Medicare started on time, without penalties, and without any hassles. I’ll assume a few things as we go through this step by step so you can put yourself in this scenario even if your situation is slightly different. 

This Medicare enrollment scenario assumes you are working past the age of 65, delaying your Social Security benefit, and covered through your employer sponsored plan with more than 20 employees or you are older than 65 and covered through your spouse’s employer sponsored plan with more that 20 employees. 

Note: Im very specific with the employer plan being more than 20 employees because if you or your spouse’s employer plan is more than 20 employees, then the employer group plan is primary to Medicare the month you turn 65 and after the age of 65 while you are working. This means that even though you are over the age of 65, you were able to skip enrollment into Part B (and technically Part A) of Medicare since it is not primary coverage (employer plan remains primary). Therefore, enrollment into Part B can be delayed in this scenario without penalty until transitioning to full Medicare A & B the 1st of the month following retirement/leaving the employer group plan. Part A may have been activated at 65 if you enrolled online for “Part A Only” and delayed Part B. Technically whether you enrolled in “Part A Only” or not with more than 20 employees in your group plan, “Part A Only” is just “sitting on the sidelines” until you elect to start Part B (they then both become primary once activated via your SEP).  

If your employer group plans is less than 20 employees, Medicare will be primary and the employer group plan would then act as the supplemental coverage to Medicare. If under 20 employees, you’ll be best off not delaying your Part B of Medicare. You’ll need to proactively enroll in Part B 3 months before turning 65 using IEP even though you are working. I recommend you try to negotiate with your employer to pay your Part B premium as well as the group plan coverage acting as your supplemental in this scenario. Many times the company may offer to pay for the Part B premium, the Medicare Supplement and your Part D plan while working. It is much cheaper for the employer if you to go off their group plan, so many times, they are happy to reimburse the Medicare Part B premium and Medicare insurance products for you each month.  

If you have more questions, call my office so I can go through this with you. It’s tricky, but I’m very familiar with timing these scenarios for my clients.  

Back to the scenario…. you are over 65, working, delaying Social Security, and wishing to enroll at some future date for Medicare to begin the day you leave your or your spouse’s employer group plan that is larger than 20 employees. Let’s assume, you’re 68 years old and wishing to retire in the month of September for a seamless transition to Medicare for October, 1 2022. In this scenario, your birthday is irrelevant when it comes to enrolling in Medicare with Social Security. Since you are outside the Initial Enrollment Period (IEP) (the 7 months surrounding your 65th birthday), you’ll need a different election tool to activate your Medicare properly. You’ll be using whats called, a Special Election Period or SEP. Since you have been covered on an employer group plan prior to the month leading to your 65th birthday, you’ve had what is called “credible coverage”. This credible coverage is going to allow you to enroll into Medicare on any retirement date in the future if you remain covered under that employer group plan while employed with the company. For this example, we are using 10/01/2022 as the preferred Medicare start date after retiring in September so I can be specific with dates for this illustration. 

In this specific scenario you would need to print forms on SSA.gov or print from the Resources Tab under Helpful Medicare Forms and Documents on this site. These forms are SSA form L564 and form 40B. 

40B is a form that you’ll use to “say” that you want to elect to start your Medicare Part B on “X” date. In this example, we are targeting 10/01/2022 for the start date. Print and fill out form 40B indicating your intended Part B start date of 10/01/2022. 

Now, to SSA form L564. This form is what activates the use of form 40B. L564 is a form that your employer administrator will fill out showing you’ve had credible coverage under their group plan from date “X” to date “Y” — signed by the benefits administrator in your company. You can get this form signed up to 8 months prior to your intended Medicare start date- 10/01/2022. 3-4 months prior to your start date is sufficient in my opinion. 

To continue the example, let’s say you filled out the 40B in June/July and had your employer sign off on your credible coverage on the L564 and returned the form to you. You can submit both forms to the Social Security office in person for your 10/01/2022 start date. If you’re working with me on this, I’ll be happy to guide you and fax the documents to the local Social Security office with your permission to get a hard copy receipt of SEP enrollment for 10/01/2022.  

Let’s assume for ease of the this example that you are still delaying your Social Security benefit. You’re Medicare is set for 10/01/2022. You’ll now receive a quarterly Part B billing statement for the Part B premium. Remember, Part A is “premium free” since you paid into the system for more than 10 years. If Part A was activated as “Part A Only” at 65 online it is still “sitting on the sidelines”. Once L564 and 40B go through both Part A and Part B will be activated to be primary on 10/01/2022, once the group employer ends the last day of September. No penalties!

Medicare is now primary and you can work with John to get quotes, pricing, and enroll yourself in the plan of your choice. You will have exactly the same guarantee issue rights as someone who went through the process when turning 65 (no health questions asked). You are not subject to late enrollment penalties for Part B or Part D because of the credible coverage you had through the employer group plan or your spouse’s employer plan. L564 took care of the proof for the Part B penalty, but you may need to show proof of “credible coverage” to the FIRST enrollment into a Part D plan you enroll into whether it be a standalone Part D or Part D included in a Medicare Advantage plan. After this initial Part D enrollment, you should not need to resubmit proof.

If you enroll in Medicare insurance products with my office, we will help you get this organized and submit it with your application before they even ask- avoiding any confusion as to whether you had credible coverage or not. Best to give them the proof ahead of time than deal with it at a later time. 

Once you elect to start your Social Security benefit at a later time (ie. 68-70 in this example), the Part B premium will then be withdrawn automatically each month prior to the monthly draft (your monthly Social Security benefit amount minus the Part B premium = monthly Social Security benefit draft into your account). The standard Part B premium for 2022 is again, $170.10 (more if subject to IRMAA).  

This is one example- please call if you want me to review your specific enrollment scenario so we can pin point the exact months you needs to complete each step to get it all coordinated correctly without penalties.