If you are eligible for Medicare but instead deferred Medicare coverage and opted to be covered by an employer group health plan, and you are now losing the group health coverage, you can sign up for Part A and/or Part B during a special enrollment period. The enrollment period is available to you if:
- You or your spouse (or family member if you’re disabled) is working.
- You’re covered by a group health plan through the employer or union based on that work.
You have an 8-month period to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
- The month after the employment ends
- The month after group health plan insurance based on current employment ends
For 2021, Medicare Part B has a standard monthly premium of $148.50 (but may be adjusted upward for higher incomes). If you are not enrolled in Social Security, your Part B premium bill is typically billed for 3 months at a time. If you are enrolled in Social Security, the Part B premium will be deducted from your Social Security check each month.
ENROLL IN PART B ONLY
- If you are already enrolled in Medicare Part A and you want to enroll in Part B, complete the form CMS-40B, Application for Enrollment in Medicare – Part B (medical insurance).
In section #12 under Remarks, you must specify:
Make Part B effective <insert date>.
The effective date is always the 1st day of the month, and the effective date must be after your group coverage ends. For example, if your group coverage ends in June of 2021, specify your Part B effective date as 7/1/2021.
- As you are applying for Medicare Part B due to a loss of group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
Fill out Section A, and ask your employer to complete and sign Section B.
- If your employer is unavailable to complete Section B, you can instead fill it out for them and send evidence of employment and health coverage, like health insurance cards with policy effective dates and pay stubs showing health insurance premium deductions.
- Section B, #4 “Date the Coverage Ended” must be provided (e.g., 6/30/2021) and is typically the last day of the month, NOT the 1st.
- You have three options to submit your enrollment request under the Special Enrollment Period. You can do one of the following:
- FAX your forms to 1-833-914-2016
- MAIL the forms to your local Social Security office
- Go to “Apply Online for Medicare Part B During a Special Enrollment Period” and complete CMS-40B and CMS-L564 online. Then upload your evidence of Group Health Plan or Large Group Health Plan.
- Be sure to make copies of any forms you mail and if you fax the forms, keep the fax confirmation sheet.
ENROLL IN PART A AND PART B
You will need to call Social Security at 1-800-772-1213 to apply for Part A, and you will also need to complete and provide the above-mentioned forms to apply for Part B.
Once you have received your Medicare card information with your Medicare Beneficiary Identifier and Part A and Part B effective dates, you can enroll in a Medicare plan such as a Supplement (Medigap) plan, or Medicare Advantage plan.
Enrolling in Medicare and selecting a plan doesn’t need to be confusing. We are here to help!
Reach out to us at 1-937-401-0260 or firstname.lastname@example.org to make your Medicare journey stress-free.
Suzanne Werts is the Principal Broker with Heartland Insurance Group, specializing in Medicare Planning and Enrollment.
We Help You Get the Benefits You Deserve!