Medicare is a federal health insurance program for people age 65 or older, people under 65 with certain disabilities and people of any age with End-Stage Renal Disease (ESRD). Every paycheck you earned in your working life had money taken out of it so you could have Medicare – you paid a lot of money for these benefits!
If you are a Certified Retiree and enroll in Medicare Parts A and B, Medicare becomes your primary health carrier (i.e., pays first). The Health Fund coordinates with Medicare so that you receive comparable benefits to when the Health Fund alone was providing coverage. The Health Fund will continue as the sole plan for your prescription drugs unless you opt to pay for Medicare drug coverage.
Federal law places Medicare in a secondary position (i.e., pays second) if you are still working and receiving health coverage through your current employer (or your spouse’s), and the employer has 20 or more employees.
If you are not a Certified Retiree, you will want to enroll in Medicare Part A and Part B when you first become eligible at 65. If you are still working after age 65 – and have employer-provided coverage – you will enroll when you are no longer receiving employer-provided coverage, during your Special Enrollment Period (explained in more detail later in this guide). You may want to consider a Medicare Advantage program, commonly referred to as Medicare Part C; Medicare Part D, which covers prescriptions, may also be of interest to you. There will be more information about this later.
In addition to reading this guide, you can get government-provided information,including the official U.S. government Medicare Handbook, Medicare & You (2016), from: www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
THERE ARE FOUR PARTS TO MEDICARE
MEDICARE PART A Covers hospitalization, hospice, and home health care (more about this in Section III). If you are a Certified Retiree, optimize your coverage and reimbursements for hospital and doctor bills by enrolling in Medicare.
MEDICARE PART B Covers outpatient services like doctor visits (more about this in Section III).
MEDICARE PART C Medicare Advantage Plans (commonly called Medicare Part C) are Medicare approved Plans available through private companies (more about this in Section III).
MEDICARE PART D Covers prescription drugs (more about this in Section III).
HOW MEDICARE PARTS A THROUGH D APPLY TO YOU AS A WRITER
As you approach age 65, Medicare Parts A, B, C, and D are each relevant, depending on your individual circumstances. As a writer, you most likely will fall into one of the following categories and should consider carefully the actions you need to take:
EARNED COVERAGE If you (or your spouse) have healthcare coverage as a result of being currently employed, you may want to apply only for Medicare Part A coverage.
The earliest possible time to apply for Medicare Part A is three months before the month of your 65th birthday.
Because your healthcare needs may be covered by your primary carrier as long as you or your spouse continues to receive health coverage from employment, it might be to your advantage to delay Part B (and Parts C and/or D) enrollment.
If you are still working when you reach age 65 and do not enroll in Part A and/or Part B when first eligible because you have employment-based coverage (your own, your spouse’s, or, if disabled, a family member), you can enroll in Part A and/or Part B without paying a penalty any time you are still covered by that group health plan. If you do enroll at that time, you will have to pay premiums for both your employer-provided coverage and any Medicare Part B coverage (Part A is free).
If you don’t enroll in Medicare Part A and/or Medicare Part B while you have employment-based coverage, once that coverage ends, you will need to enroll during the 8-month period that begins the month after the employment ends or the coverage (not including COBRA coverage) ends, whichever happens first, in order to avoid penalties and increased costs. This is referred to under Medicare as a Special Enrollment Period. If you are not a Certified Retiree who qualifies for health benefits, you may want to examine Medicare Part C and Medicare Part D. (There will be more about this later.)
EXTENDED COVERAGE PROGRAM If you are receiving health coverage because you are using Extended Coverage points, you may want to opt solely for Medicare Part A until your Extended Coverage points are exhausted. The reason for this is that while you are receiving health insurance via Extended Coverage you may not have need for Medicare Parts B, C, or D.
Once your health coverage from employment (or Extended Coverage points) ends, Medicare becomes the primary carrier. It is critical to keep this in mind, and to make plans to enroll in Medicare Part A and Part B, and to pay your Part B premium as soon as possible in the Special Enrollment Period at the conclusion of employment-based coverage in order to avoid penalties and increased costs. (For further explanation, see chart in Section IV)
CERTIFIED RETIREE If you and/or your spouse are a Certified Retiree* under the Health Fund and you (or your spouse) are not covered by employer-provided health insurance, it is necessary to enroll in Medicare Part A and Medicare Part B in a timely manner in order to avoid paying late enrollment penalties and increased costs. You may not want to enroll in Medicare Parts C or Part D if your health care needs that would be covered by Medicare Parts C and D are already be covered by the Health Fund. (See item #5 in the FAQ section of this document for more information)
* A Certified Retiree is a Plan participant who has retired under the Pension Plan and at the time of retirement has a minimum of 68 qualified quarters (for those retiring on or after January 1, 1997) of Health Fund coverage. Certified Retiree Health Fund coverage does not become effective until the Certified Retiree is at least 60 years of age
RETIREMENT BEFORE REACHING CERTIFIED RETIREE STATUS It is important that you carefully consider your options before retiring with the PWGA Pension Plan. If you file for retirement with the PWGA, and you have not accumulated enough qualified quarters to become a Certified Retiree (68 quarters), you will not receive Certified Retiree health coverage from the Health Fund even if you earn 68 quarters at a later date.
the consequences of electing to retire if you fall into one of these categories.
If you elect to retire before you acquire 68 qualified quarters, you should apply in a timely manner for both Medicare Part A and Part B in order to avoid paying late enrollment penalties. You may also want to consider a
Medicare Advantage program and/or Medicare Part D as soon as you turn 65.
WORKING BUT NOT YET A CERTIFIED RETIREE If you are still working and have Earned Coverage you may opt not to retire. In this circumstance, when you are first eligible you may want to enroll in Medicare Part A only. Medicare Parts B, C, and/or D may not be necessary because your healthcare needs may be covered by your primary carrier as long as you or your spouse continues to receive health coverage from employment.
If you decide to retire anyway (which would make you a Non-Certified Retiree), you may still want to opt for Medicare Part A only when you are first eligible, and then file for Medicare Part B in a timely manner when you are no longer receiving Earned Coverage in order to avoid increased penalties.
SOCIAL SECURITY If you are collecting Social Security benefits (even if you are still working), you will automatically be enrolled in Medicare Part A and Part B starting the first day of your birthday month. (If your birthday is on the first day of the month, then Part A and Part B will start the first day of the prior month.) If you are automatically enrolled, you should receive your Medicare ID card in the mail 3 months before your 65th birthday. If you are going to wait to enroll in Part B, then follow the instructions that come with the Medicare ID card and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.
If you are receiving health coverage through the Health Fund as a Certified Retiree, you should enroll in Medicare Part A and Part B when first eligible in order to avoid penalties and increased costs. Once you enroll, at your request, the Part B premium will be deducted from your Social Security check