Transitioning into the Medicare System

The how-to stage

Unfortunately, this is going to be all over the map. Why is that? Because Medicare enrollment depends on a number of pieces of information. It’s like setting up a conditional logic piece in Zapier. If this, then that.

The way that someone enrolls into Medicare depends on a number of different situations.

Collecting Social Security benefits prior to age 65

Let’s say that you began collecting your Social Security benefits at age 63. In this case, when you turn 65 years old, you will automatically be enrolled into both Medicare part A and B.

Well, that was easy, right?

It would be easy if you do need to be enrolled into Medicare. If you are collecting Social Security benefits and you definitely need Medicare to be your health insurance when you turn 65, then your red, white and blue Medicare card will show up in your mailbox a few months before you turn 65, and you are then good to go. You’re enrolled!

What if you are collecting Social Security benefits but you have your health insurance through your spouse’s employment because he/she is still working? If that employer has more than 20 employees, then you can remain on the employer plan and defer your enrollment into Medicare’s part B. Part B is the medical insurance portion that has a premium; instead of paying a premium to the government and a premium through the workplace insurance, you’ll typically want to defer part B in this situation.

I’m not mentioning part A deferment. You cannot defer enrollment into part A of Medicare. Well, you can, but you’d have to pay back all the cash benefits that you’ve received to that point, so that probably isn’t such a good idea. Revert back to the CMS document mentioned before and see page 12. There’s a green box talking about paying back benefits.

If you do decide to delay part B enrollment, you’ll have to be sure that when your Medicare card arrives in the mail, you follow the instructions in the packet to sign the card and return it to the Social Security Administration and tell them that you are deferring part B until you need it down the road.

Be sure to do that part.

Don’t just tuck the card into a drawer or a file because the government will start charging you a monthly premium (and many people don’t realize they are now paying for part B premiums) and you’ll be enrolled in part B when you don't need to be.

If you become enrolled in parts A and B this way, don’t forget that if you need to purchase a Medicare product, you’ll want to spend some time looking for good insurance agent help in this space.

Not collecting Social Security benefits and turning 65

Let’s say that Jim Smith isn’t collecting Social Security benefits at age 65, so he’s got a decision to make. He did retire a few years back, but his wife is going to work for two more years in a large hospital system, so he has his insurance coverage through his wife’s employer plan.

Jim is rather healthy, takes a few minor medications, and the hospital pays 80% of the premium each month for him and his wife. He prefers to not have to enroll into Medicare.

He doesn’t have to. Since the employer has more than 20 employees and the premium is rather low and he’s not struggling with any problems related to the insurance, I’d recommend that he stay with that group plan until he no longer has access to it when his wife finally decides to retire.

I’d also ask him if he and his wife are contributing to a health savings account (HSA). If they are both contributing, I would suggest he not enroll into premium-free part A at this time as he can no longer contribute to the HSA if he enrolls into any part of Medicare. I would say, “Don’t enroll in Part A” if Jim is contributing the $1,000 catch up provision into his own HSA. If he is not contributing that $1,000, I’d suggest that he go ahead and enroll in premium-free part A and then his wife could still continue funding her HSA. She can contribute the full family amount even though Jim is enrolled in part A. Seeking additional guidance from your HSA Administrator related to that account is highly suggested, as well.

Again, see page 4 of the really helpful document from CMS. It’s one of the few government documents that I find easy to understand.

But let’s say that they only have a flexible spending account at her workplace, then I’d again suggest enrolling into part A of Medicare. He’ll be able to take advantage of some secondary hospital coverage, it will cost him nothing and it will coordinate with her employer plan.

Now, the real “how to”

Let’s go with Jim Smith and pretend he needs to enroll into parts A and B at age 65 when he’s eligible since he’s not married. He was retired and buying his own coverage through the Marketplace, so he needs to enroll into Medicare.

Again, this is the panic “where do I start?” part.

I suggest enrolling online. It’s far easier than possibly spending hours on hold with the Social Security Administration.

The steps to take:

• Go to the SSA website, Scroll down until you see the bright blue button of "apply for Medicare only"

• Follow the prompts.

• You'll see that the system will ask if you have a “My Social Security account”:

• If you do – have your username and password handy to begin your Medicare Parts A and/or B application.

• If you do not:

• Register yourself for a “My Social Security Account”. *This is best to do prior to even applying online for Medicare when possible.

• If you can’t create a “My Social Security Account” or get locked out, then you may need to call Social Security at 1-800-772-1213 or try calling your local SSA office, which can be found by using this link.

• We created a video that walks people through this stage.

• You’ll get email confirmations of the enrollment and when your red, white and blue card arrives, Jim is now ready to add his Medicare products for himself.

Adding Part B when you are over age 65

We’re staying with Jim but in this case, he is married and he is enrolled for his medical coverage through his wife’s employment. But,, she’s decided to retire and Jim is now 67. He did enroll into part A when he turned 65 since it made sense to do so.

Jim needs to approach his enrollment in a different manner.

We created a video when COVID began, as that’s when the Social Security Administration changed its practices for enrollments.

Here are the steps that these folks should take:

• You'll need a working email address along with a completed employer verification form. Why? This form will verify that you have been covered by employer coverage, thus you may eliminate any penalty as you enroll into Medicare Part B.

• Here's that form. Have it filled out before you go to the next steps.

• Employer verification form HERE

• if you had more than one employer since turning 65, you'll need a form completed from each of them. Also, there cannot be more than an eight-month consecutive gap in employment after age 65.

Have the form completed?

Start here:

• Use this LINK HERE to get to the Social Security website page that will allow you to enroll into Part B;
• The application for Medicare's Part B form will open up and you'll begin filling it out;
• Enter your Medicare ID number. *Enter the numbers without using the hyphens;
• Do you wish to enroll into Part B – Answer is yes;
• In Section 7, enter the date that you want your part B to begin;
• On page 4, upload the completed L564 form from your employer(s);
• Provide your email address after your signature has been entered.

Jim is done. He’ll now wait for the official word that his part B has been activated with the government.

If a person is computer challenged, they can take the form 40B, the application for Medicare’s part B coverage along with the form L564, the employer verification form, and fax it to their local Social Security office. I always suggest following that up with a phone call to be sure it was received.

Finally, applying for A and B when you are older

The final situation is for those that did nothing at age 65 in terms of enrollments for Medicare and now, at age 70 perhaps, it is time to enroll in both parts A and B.

Call your local Social Security office (locate that here) and tell them that you need to enroll in part A and Part B and ask them what process you should follow (every office will have a different answer it seems!) But – in general, tell them that you'll be filing online and ask them how to handle the L564 form.

You’ll then go online (like the first situation) and start your application. Answer the questions that they ask about your current insurance. Answer all questions until you get to the end remarks box.

In the remarks section: Write this in "I will provide the CMS-L564 form upon request"

The easiest way to show you what to do is by following our video here.

You’re done

Those are the four situations:

1. You are either automatically enrolled;

2. You are enrolling in A/B proactively at age 65;

3. You are enrolling in Part A only at age 65; then applying for Part B later; or

4. You are enrolling into no parts of Medicare at age 65 and delaying both Part A and Part B until a later date.

You can see that the “how to enroll when you finally need to” changes for each situation.

I can’t stress enough the importance of the step that comes before you enroll.

The over-the-top-in-importance step is “get qualified help to assist you in finding out IF YOU NEED TO ENROLL.” I hate all caps, but in that case, it’s important to yell it.

There is a method to the madness of Medicare. You just need to know what to do and when to do it.

The hard part is learning what to do and when to do it as a consumer.

Help them, your clients. They’ll love you for it. Bring Medicare up in your planning conversations. It’ll go a long way for both you and them.

Joanne Giardini-Russell is a Medicare Nerd & the owner of Giardini Medicare, helping people throughout Michigan and AZ, CA, FL, IA, IL, IN, MI, MD, NC, OH, PA, SC, TX transition to Medicare successfully. Contact the team at [email protected] or by calling 248-871-7756.

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