What Do I Need To Know About Medicare?

Q: I am turning 65 in 2014 and wondering about Medicare. Does it happen automatically? How do I know what to do?

A: First, I want to say, “Good things are coming to you!” I appreciate people paying attention to this event and all the media coverage of Medicare issues.

Medicare coverage eligibility usually begins at age 65; some individuals get Medicare coverage earlier due to a disability. Individuals who have worked 40 quarters – 10 years – are usually eligible for Medicare at age 65.

Medicare coverage always begins at the first of the month and for most individuals that is your birthday month. For those individuals born on the 1st of the month, your coverage actually begins a month early. So if you were born on the 18th, or the 29th or the 2nd of February, your coverage begins on the first of February. If you are born on Feb. 1, your coverage will begin on Jan. 1. So, if you are born on the 1st, you need to start a month early in this process.

Historically, at 65, this was also the time individuals became eligible for Full Social Security Benefits. Many now understand that Social Security Benefits have changed. You can continue to receive early retirement benefits from Social Security at age 62. To receive full benefits you now have to be older than 65. If born in 1943 to 1954 you must be 66 years of age in order to receive full Social Security benefits. Due to this Social Security change, Medicare has had to change its policies. If you are collecting Social Security in some form – widow’s benefits, early retirement benefits, disability or other types – then Medicare will start automatically at age 65. Medicare will send you a packet of information with your Medicare card, about three months before your 65th birthday month. If you accept the benefits, you do not need to act to have your benefits begin. You simply tear off the card, sign it and put it in your wallet. Your coverage will begin automatically the first of your birthday month.

If you do not want to enroll in Medicare Part B – which costs $104.90 monthly in 2014 – you send back the card and have just Medicare Part A. To return the card, you must sign the refusal statement on the back prior to mailing it back to the Social Security Administration. You would only refuse Medicare Part B if you had insurance coverage already from yourself or your spouse from a current employee plan. Please do not refuse Medicare Part B if you are using a small group plan, retiree plan, COBRA type coverage, or similar situation not requiring employment. A Small Group is defined by Medicare as 20 or fewer employees for those of you who are 65. A Small Group for someone with Social Security disability who is getting Medicare coverage is defined as 100 employees.

If you are not collecting Social Security benefits then you must contact the Social Security Administration to begin receiving Medicare benefits at age 65. This is a change for those of you close to age 65. If you do not enroll when originally eligible, you will have some restrictions as to when you can enroll and also may have premium penalties when you enroll.

When you contact Social Security they will review your situation and help you determine whether or not you need Medicare Parts A & B. You may choose to enroll in Part A and not Part B. They also will explain the billing procedure for paying for Medicare Part B. Since you are not collecting Social Security, you can’t have it deducted from that check. They will send you an invoice every three months to pay your Part B premium amount (usually $104.90 x 3).

Another fact to consider is that if you have insurance from another source you may not have to enroll in Medicare at age 65. The other source must be an employer plan of either yourself or your spouse’s full time active employment. Most retiree plans require you to join Medicare at age 65 if you want to continue to receive coverage from their plans.

I cannot stress enough how important this decision is with regard to refusing Medicare or not signing at the correct time. If you have any doubts or are not sure what to do, contact the Social Security Administration (SSA) prior to your 65th birthday and find out what you should do. If you receive the packet automatically, you will probably receive it three months prior to your 65th birthday month. If you don’t receive it, go to the local Social Security Administration office at 321 Hazeltine Ave. in Jamestown, call the local SSA office at 1-877-319-9182 or call 1-800-772-1213 nationally, to clarify your particular situation. You may also use the website at www.ssa.gov.

In some situations if you wait until after your 65th birthday to contact Social Security and you don’t start Medicare at the appropriate time, you may have time without coverage, or penalties to pay.

I will also say that SSA is encouraging many of us to use the Internet and are cutting back on staffing at the local offices. I have found many individuals in recent months unable to set up an appointment for six weeks or more. So putting off contacting Social Security with questions is not a good idea.

I may be a little early, but, “Welcome to Medicare!” The coverage you are getting is useful and affordable.