MEDICARE PART A
Medicare Part A helps cover inpatient hospitalization, hospice, and home health care costs. To avoid late enrollment penalties, enroll in Medicare Part A (and Part B) during your Initial Enrollment Period when you first become eligible at 65 or, if you are still working after age 65 and have employer-provided coverage, during your Special Enrollment Period.
If you fail to enroll in Medicare Part A within three months of your 65th birthday (unless you qualify for a Special Enrollment Period), you will be liable for uncovered medical costs, and you will also pay a 10% penalty in additional premium payments for every 12-month period that you fail to enroll. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but weren’t enrolled in the program.
If you’re already getting benefits from Social Security, you’ll automatically get Medicare Part A (and Part B) starting the first day of the month you turn 65. (If your birthday is on the first day of the month, Part A (and Part B) will start the first day of the prior month.) You can also request that the Part B premium be paid automatically from your Social Security check.
If you are not receiving Social Security benefits when you turn 65, to avoid late enrollment penalties, you must enroll in Medicare Part A during the 7-month initial enrollment period, which begins three months preceding the month in which your 65th birthday falls, includes the month in which you turn 65, and ends the three months after, unless a Special Enrollment Period applies.
You can apply online if you meet certain requirements.
You can find answers to questions about the online application here.
MEDICARE PART B
This helps cover doctors’ services – and many other medical services and supplies that are not covered by Medicare Part A such as lab tests, ambulance transportation, second opinions, durable medical equipment like CPAPs, and some preventive services.
If you enroll in Part B late, you will also be liable for uncovered medical costs, and may have to pay a late enrollment penalty for as long as you have Part B coverage. For each 12-month period you delay enrollment in Part B, you will have to pay an extra 10% of the Part B premium, unless you qualify for a Special Enrollment Period.
Make sure you pay your Medicare Part B premium. Simply signing up does not grant coverage.
IF YOU ARE WORKING AT A JOB THAT PROVIDES HEALTH COVERAGE then you do not need to enroll in Part B during your Initial Enrollment Period to avoid late penalties and can wait, if you wish, until your employer-supplied health coverage runs out. You have eight months that begin the month after your employment ends or your employer-supplied health coverage ends (whichever happens first) to enroll in Medicare Part B. (See this chart for more details)
IF YOU ARE NOT WORKING AT A JOB THAT PROVIDES HEALTH INSURANCE COVERAGE then to avoid late penalties you need to enroll in Medicare Part B (as well as Medicare Part A) in the 7-month Initial Enrollment Period, which begins three months preceding the month in which your 65th birthday falls, includes the month in which you turn 65, and ends in the three months after.
If you fail to enroll in Medicare Part A in the initial enrollment period (unless you qualify for a Special Enrollment Period), you will be liable for uncovered medical costs, and you will also pay a 10% penalty in additional premium payments for every 12-month period that you fail to enroll. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t enroll. If you enroll in Part B late, you will also be liable for uncovered medical costs, and may have to pay a late enrollment penalty for as long as you have Part B coverage. For each 12-month period you delay enrollment in Part B, you will have to pay an extra 10% of the Part B premium, unless you qualify for a Special Enrollment Period. (Please note: Make sure you pay your Part B premium. Merely signing up does not activate coverage.)
Appendix D lays out the monthly premium cost for Part B as of November 2015.
MEDICARE PART C
Technically, this is called Medicare Advantage, but it is almost universally referred to as Medicare Part C. It works like this: Private companies offer healthcare plans that Medicare approves. If you join a Medicare Advantage Plan, you still have Medicare, but you’ll get your Medicare Part A and Medicare Part B coverage through the Medicare Advantage Plan, not Original Medicare.
Medicare Advantage might place you in an HMO like Kaiser, or in an open-access or gatekeeper plan such as are typically offered by large health carriers like Blue Cross. If the cost-certainty of such a situation appeals to you despite the other restrictions you are likely to encounter, then this might be an option you would select.
MEDICARE PART D
Medicare Part D provides prescription drug coverage through Medicare-approved plans. All Medicare eligible individuals and Certified Retirees over 65 years of age will be automatically enrolled into the EGWP, which stands for the “Employer Group Waiver Plan”. This is a prescription drug program administered by Express Scripts (ESI) for participants covered by Medicare. EGWP is a Medicare Part D plan and you can only be enrolled in one Medicare Part D plan at a time. This enrollment will automatically cancel your enrollment in a different Medicare Prescription Drug (Part D) plan or a Medicare Advantage plan.
The Fund’s prescription drug coverage is considered creditable coverage, meaning it is expected to be at least as valuable as standard Medicare Part D coverage. As a result, Certified Retirees do not need to purchase a separate Medicare Part D plan.
You aren’t required to be enrolled in this plan. You can also decide to join a different Medicare drug plan on your own or arrange for other prescription drug coverage.
However, if you choose to opt out or decline enrollment in this EGWP plan:
- You have 21 days from the date you notify the Fund that you are retiring to opt out.
- You will not be enrolled in the Fund’s prescription drug coverage, and you will not be able to enroll in the Fund’s prescription drug coverage until your next special or open enrollment period.
- If you do not have other “creditable” prescription drug coverage (coverage that is at least as good as Medicare’s standard Part D benefit), you may have to pay a permanent Part D Late Enrollment Penalty (LEP) if you later join an individual Medicare drug plan on your own.
You can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, for help learning how. TTY users should call 1-877-486-2048.
Note: Most Medicare-eligible Certified Retirees receive prescription drug coverage through the Fund’s EGWP arrangement and generally do not need to enroll in a standalone Medicare Part D plan. Always contact the Fund before enrolling in any individual Medicare prescription drug plan.
If you are not a Certified Retiree and are not enrolled in the Fund’s Medicare-sponsored coverage, you may wish to consider Medicare Part D or another prescription drug option to help cover your medication expenses.
How to opt out
If you understand these consequences and still wish to decline this plan, you must notify us no later than retirement date and complete, sign, and return the Opt-Out Election Form within 21 days from the date you notify the Fund that you are retiring.