Part B enrollment special election rules
You are not required to take Medicare Part B during your Initial Enrollment Period (IEP) (the first of the month you turn age 65) if you are have insurance through work and either you and/or your spouse is still working. You should usually only delay Part B if the employer insurance (called group health insurance) is the primary payer on your health care expenses (meaning Medicare would pay secondary to your group/employer plan paying). It is usually a good idea to talk with the employer or the employers HR department to see which is the primary payer. Usually the employer must have more than 20 employees in order for the employer plan to be considered the primary insurance . If you are eligible for Medicare because you get Social Security Disability Insurance, the employer must have more than 100 employees to be the primary payer.
If there are fewer than 20 employees at the company where you get your insurance, that means Medicare is likely your primary coverage. If this is the case, you should not delay your part B enrollment, doing so can leave you without any insurance coverage at all.
In either case, if you have insurance from a current employer, you remain eligible for a Special Enrollment Period (SEP). During this time, you can enroll in Part B without penalty at any time while you or your spouse is still working and for up to eight months after you lose employer coverage, switch to retiree coverage, or stop working. However, if you have a lapse in coverage more than eight months at any time after you become 65 and Medicare-eligible, you will lose your SEP. A lapse means any period of time where you were not covered by either Part B or insurance from a current employer.
Part B enrollment special election rules- Cobra and retiree insurance
It is important to remember that COBRA or any retiree insurance are not considered the same as current employer insurance, and you will not have a Special Enrollment Period to enroll in Medicare beyond the eight months you are given after you retired/stopped working. If you have COBRA or retiree insurance and delay enrollment in Part B, you will likely have a Medicare Part B late enrollment penalty when you do sign up for part B
It important to note that if you had already taken Social Security before you turned 65, or if you become eligible for Medicare due to disability, you will be automatically enrolled in both Medicare Part A and Part B. You are allowed not to take Part B, but you will need to send back the Medicare card you received in the mail with the form you received stating that you do not want Part B. You will receive a new Medicare card in the mail that has part A only on it and not part B. You will not need to pay your Medicare Part B premium as a result.
If you are thinking about turning down Part B—or enrolling in only Part A it is advised you call the Social Security Administration at 800-772-1213 and ask if you delaying enrollment will subject you to the Medicare Part B late enrollment penalty. Be sure to explain the type and source of your other insurance and other circumstances in as much detail as possible. When you call Social Security, make sure to write down whom you spoke to, when you spoke to them, and what they said. Remember you generally must be covered under a group health insurance plan which you have access to due to you or your spouse working in order to avoid the part B late enrollment penalty.