FACT SHEET:
Centers for Medicare & Medicaid Services Page 1
How will this Fact Sheet help me?
As you make your plans to retire, you need to make several important decisions about
your Medicare coverage. This fact sheet will help you:
1
Decide whether to enroll in Medicare Part A and Part B when you retire
(if you haven’t already)
2
Decide whether you need additional coverage (Medicare Advantage, Medigap)
3
Decide whether you need Medicare prescription drug coverage (Part D)
When do I need to decide?
Even if you will have other coverage available to you after you retire, you will still need
to make some Medicare enrollment decisions before you stop working. There can be
penalties if you do not enroll on time, so it is best to make these decisions before
you stop working.
Medicare Decisions for Those Over 65 and Planning to
Retire in the Next 6 Months
Centers for Medicare & Medicaid Services Page 2
FACT SHEET: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
1
Decide Whether to Enroll in Part A and Part B
When You Retire
What are Medicare Part A and Part B?
Medicare Part A is sometimes called “Hospital Insurance.” It helps cover inpatient
hospital care, skilled nursing facility care, hospice care, and home health care.
Medicare Part B is sometimes called “Medical Insurance.” It helps cover services
from
doctors and other health care providers, outpatient care, home health care,
durable
medical equipment, and some preventive services, including certain
vaccines and
cancer screenings.
Should I enroll in Part A and Part B?
You should decide whether to enroll in Part A and Part B before you retire or lose your
current employer coverage.
If you have already enrolled in BOTH Part A and Part B —
SKIP to Decision 2 on page 5.
If you don’t have BOTH Part A and Part B — Select the situation that will
apply to you after you retire:
After I retire, I will have HEALTH COVERAGE FROM A SPOUSE who
is still working and his/her employer has 20 or more employees.
If you will have health coverage through a spouse who is still working, you will still
have coverage based on “current employment.”
What do I need to do before I stop working?
• If you are not sure about the size of the employer, check with your spouse’s
employer or union benets manager.
• If your spouse’s employer has more than 20 employees, check with your spouse’s
employer or union benets manager about whether you have group health plan
coverage (as dened by the IRS). People with group health coverage based on
current employment may be able to delay Part A and Part B and won’t have to
pay a lifetime late enrollment penalty if they enroll later.
• If you qualify for premium-free Part A, in most cases you should enroll in Part A.
However, people who have a high deductible health plan and a health savings
account (HSA) may want to delay Part A to avoid a tax penalty. If you have an
HSA, contact your employer benets manager to learn whether you should
enroll in Part A.
NOTE: If you are eligible for premium-free Part A, your coverage starts
retroactively 6 months back, so it’s important to stop contributing to an HSA
6 months before applying for Medicare or Social Security benets.
Group Health Coverage
Contact your employer and ask
if you have group health plan
coverage, then check which
applies to you:
I have group health plan
coverage and do not need
to enroll in Part B
I do not have group health
plan coverage and need
to enroll in both Part A
and Part B
Centers for Medicare & Medicaid Services Page 3
FACT SHEET: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
What do I need to do when my spouse stops working or I lose my coverage
from my spouse’s employer?
• Enroll in Part A and Part B (even if you sign up for COBRA or retiree health
coverage). You have 8 months to enroll in Medicare once you stop working OR
your employer coverage ends (whichever happens rst). But you’ll want to plan
ahead and contact Social Security before your employer coverage ends, so you
don’t have a gap in coverage.
!
WARNING: If you do not enroll in Part B within 8 months of losing your coverage
based on current employment, you may have to pay a lifetime late enrollment
penalty. In addition, you will only be able to enroll in Part B during the Medicare General
Enrollment Period (from January 1 to March 31 each year) and your coverage won’t
start until July. This may cause a gap in your coverage.
Once you have enrolled in both Part A and Part B, go to Decision 2 on page 5.
After I retire, I will have HEALTH COVERAGE FROM A SPOUSE who is still
working AND his/her employer has fewer than 20 employees.
If you will have health coverage through a spouse and his/her employer or union
has fewer than 20 employees, you should enroll in both Part A and Part B. In this
case, Medicare pays before the employer insurance. This means that Medicare is
the primary payer for your health coverage.
What do I need to do before I stop working?
• If you are not sure about the size of the employer, check with your spouse’s
employer or union benets manager.
• If the employer has fewer than 20 employees, enroll in both Part A and Part B.
You’ll want to plan ahead and contact Social Security before your employer
coverage ends, so you don’t have a gap in coverage.
!
WARNING: If you do not enroll in Part B within 8 months of losing your coverage
based on current employment, you may have to pay a lifetime late enrollment
penalty. In addition, you will only be able to enroll in Part B during the Medicare General
Enrollment Period (from January 1 to March 31 each year) and your coverage won’t
start until July. This may cause a gap in your coverage.
Once you have enrolled in both Part A and Part B, go to Decision 2 on page 5.
Centers for Medicare & Medicaid Services Page 4
FACT SHEET: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
After I retire, I will be eligible for RETIREE COVERAGE from my former
employer (or from my spouse’s former employer).
If you are planning to take retiree coverage from a former employer, you should
enroll in both Part A and B. Most retiree insurance requires you to have both
Part A and Part B to get coverage.
What do I need to do before I stop working?
• Before you stop working, check with your employer or union benets manager
to nd out how your retiree coverage works with Medicare.
• You should enroll in Part A and B as soon as you stop working or lose your
current employer coverage (even if you sign up for COBRA or retiree health
coverage from your employer). You have 8 months to enroll in Medicare once
you stop working OR your employer coverage ends (whichever happens rst).
But you’ll want to plan ahead and contact Social Security before your employer
coverage ends, so you don’t have a gap in coverage.
!
WARNING: If you do not enroll in Part B within 8 months of losing your coverage
based on current employment, you may have to pay a lifetime late enrollment
penalty, and you will only be able to enroll in Part B during the Medicare General
Enrollment Period (from January 1 to March 31 each year). Your coverage won’t start
until July. This may cause a gap in your coverage.
Once you have enrolled in both Part A and Part B, go to Decision 2 on page 5.
After I retire, I will NOT HAVE HEALTH COVERAGE from any current or
former employer.
If you will not have health coverage from a current or former employer, you should
enroll in both Part A and Part B.
What do I need to do before I stop working?
• Enroll in both Part A and Part B (even if you sign up for COBRA coverage from
your employer). You have 8 months to enroll in Medicare once you stop working
OR your employer coverage ends (whichever happens rst). But you’ll want to
plan ahead and contact Social Security before your employer coverage ends, so
you don’t have a gap in coverage.
Once you have enrolled in both Part A and Part B, go to Decision 2 on page 5.
Centers for Medicare & Medicaid Services Page 5
FACT SHEET: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
2
Decide Whether You Need Additional Coverage
(Medicare Advantage, Medigap)
Once your Part A and Part B starts, you will have health coverage under “Original
Medicare.” Because Original Medicare does not cover all of your health care expenses,
you should consider whether you need additional coverage.
Select the situation that will apply to you after you retire:
After I retire, I will be eligible for RETIREE COVERAGE from my (or my
spouse’s) employer.
If you are eligible for retiree coverage, you should talk to the employer about how
your coverage works with Medicare. If you decide not to take your retiree coverage,
you can purchase other coverage such as Medicare supplement insurance (also
called Medigap) or a Medicare Advantage Plan. You can nd an introduction to
these types of coverage below.
!
WARNING: If you decline employer retiree coverage or enroll in other coverage,
you may not be able to change your mind and enroll in your retiree coverage later.
It is important to talk to the employer before making a decision.
You have completed Decision 2. Go to Decision 3 on page 7.
After I retire, I will NOT have retiree coverage from my (or my spouse’s)
employer.
If you don’t have other coverage available to you, you should consider purchasing
additional coverage. Many people with Medicare choose to purchase either
Medicare supplement insurance (Medigap) or a Medicare Advantage Plan.
You can nd an introduction to these types of coverage below.
Review the introduction to Medigap and Medicare Advantage below.
Introduction to Medicare supplement insurance (Medigap) and
Medicare Advantage
Medicare supplement insurance (also called Medigap) and Medicare Advantage
Plans are two types of insurance available to people who have both Medicare Part A
and Part B.
What is Medigap?
A Medigap policy is supplemental insurance that is sold by private companies to help
pay for some of the health care costs that aren’t covered by Medicare like copayments
and deductibles. If you have a Medigap policy, you will still have “Original Medicare.”
This means that Medicare will pay its share of your covered health care costs and then
your Medigap policy will pay its share. For example, Medicare will pay 80% for covered
services from your doctor and the Medigap policy would cover the remaining 20%.
If you have a Medigap policy, you can see any doctor who accepts Medicare.
Centers for Medicare & Medicaid Services Page 6
FACT SHEET: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
You must have both Part A and Part B to purchase (and keep) a Medigap policy.
Other important things to know:
• Medigap policies do not cover prescription drugs. If you purchase a Medigap policy,
you will need to join a separate prescription drug plan to get your Medicare drug
coverage (Part D).
• If you have a Medigap policy, you do not need a Medicare Advantage Plan (like an
HMO or PPO).
• The best time to buy a Medigap policy is during your 6-month Medigap open
enrollment period. During this time you can buy any Medigap policy sold in your
state, even if you have health problems. If you are 65 or older, this period
automatically starts the rst month you are enrolled in Medicare Part B.
To nd out which companies sell Medigap policies in your area, visit the Medicare Plan
Finder at Medicare.gov/nd-a-plan/questions/Medigap-home.aspx. Or call your State
Insurance Department.
!
WARNING: If you apply for Medigap coverage after your Medigap open enrollment
period ends, the insurance company is allowed to deny you or charge you a higher
premium based on your health.
What is a Medicare Advantage Plan?
Medicare Advantage Plans, sometimes called “Part C,” are oered by private
companies approved by Medicare. Medicare Advantage Plans include HMOs, PPOs,
and Private Fee-for-Service plans. If you join a Medicare Advantage Plan, you still have
Medicare, but you will get your coverage through the Medicare Advantage Plan and
not from “Original Medicare.”
You must have both Part A and Part B to enroll in (and keep) a Medicare Advantage Plan.
Other important things to know:
• All Medicare Advantage Plans must cover all of the benets available under
Medicare Part A and Part B. However, plans can charge dierent costs and have
dierent rules for how you get services (like whether you need a referral to see a
specialist or if you have to go to certain doctors or hospitals).
• You must continue to pay your Part B premium while in a Medicare Advantage Plan.
• Many Medicare Advantage Plans include Medicare prescription drug coverage
(Part D) and other benets that Original Medicare doesn’t cover.
• If you have a Medicare Advantage Plan, you do not need a Medigap policy.
• You can enroll in a Medicare Advantage Plan during a two-month “Special Enrollment
Period” that begins the month that you no longer have employer-sponsored health
coverage. You can also enroll each year during the fall open enrollment period,
which runs from October 15 to December 7.
To nd out which Medicare Advantage Plans are available in your area, visit the
Medicare Plan Finder at Medicare.gov/nd-a-plan. Or call 1-800-MEDICARE
(1-800-633-4227). TTY users should call 1-877-486-2048.
You have completed Decision 2. Go to Decision 3 on the next page.
My Medigap Open
Enrollment Period
Look on your Medicare card to
nd out the eective date for
your Part B coverage:
My Part B coverage is
eective on
/ /
Your Medigap open enrollment
period will end 6 months after
your Part B eective date:
My Medigap open enrollment
period will end on
/ /
My Medicare Advantage
Special Enrollment Period
My employer-sponsored health
coverage will end on
/ /
Your Special Enrollment Period
to buy a Medicare Advantage
Plan will end 2 months after
your health coverage ends:
My Special Enrollment
Period to enroll in a Medicare
Advantage Plan will end on
/ /
3
Decide Whether You Need Medicare Prescription Drug
Coverage (Part D)
Because Part A and Part B do not cover outpatient prescription drugs, you should
consider whether to add Medicare prescription drug coverage (Part D). Part D is
available to anyone who is enrolled in Part A or Part B (or both).
Select the situation that will apply to you after you retire:
After I retire, I WILL be eligible for prescription drug coverage from my
(or my spouse’s) employer.
If you are considering prescription drug coverage from a former employer,
contact the employer to determine if you have “creditable” coverage. (“Creditable”
coverage means that your coverage is expected to pay, on average, as much as
the standard Medicare prescription drug coverage.) If you’re not sure, ask your
employer or union benets manager if the employer’s prescription drug coverage
is “creditable.” They are required to provide that information in writing if you ask.
NOTE: Keep any letters from your employer about whether their coverage is
“creditable.” You may need it later if you decide to enroll in Medicare prescription
drug coverage.
You should consider purchasing Medicare prescription drug coverage (Part D):
• If your employer does not have “creditable” prescription drug coverage
• Or, if you decide not to take prescription drug coverage from the employer
You can nd an introduction to this coverage on the next page.
!
WARNING: If you decline employer retiree coverage or enroll in other coverage,
you may not be able to change your mind and enroll in your retiree coverage later.
It is important to talk to the employer before making a decision.
!
WARNING: If you don’t have other “creditable” prescription coverage AND
you don’t sign up for Medicare Part D drug coverage, you may have to pay a late
enrollment penalty if you enroll in Part D later. This lifetime penalty increases for each
month you go without Part D or other coverage. And, you can only enroll during certain
times of the year, which may cause a gap in your coverage.
You have completed the fact sheet. But more help is available. Contact
the resources on page 9 if you have questions or want more information
about Medicare.
Centers for Medicare & Medicaid Services Page 7
FACT SHEET: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
Creditable Prescription
Drug Coverage
Contact your employer and
ask if you have “creditable”
prescription drug coverage then
check which applies to you:
I have creditable coverage
and do not need Part D
I do not have creditable
coverage and need to enroll
in Part D
FACT SHEET: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
After I retire, I will NOT be eligible for prescription drug coverage from my
(or my spouse’s) employer.
If you do not have other drug coverage, you should consider purchasing
Medicare prescription drug coverage (Part D). You can nd an introduction to
this coverage below.
!
WARNING: If you don’t have other “creditable” prescription coverage AND
you don’t sign up for Medicare Part D drug coverage, you may have to pay a late
enrollment penalty if you enroll in Part D later. This lifetime penalty increases for each
month you go without Part D or other coverage. And, you can only enroll during
certain times of the year, which may cause a gap in your coverage.
Review the introduction to Medicare prescription drug coverage below.
Introduction to Medicare Prescription Drug Coverage (Part D)
There are two ways to get Medicare prescription drug coverage:
• If you join a Medicare Advantage Plan (like an HMO or PPO), you usually must get
your Medicare drug coverage through that plan.
• If you don’t have a Medicare Advantage Plan or if you have a certain type of other
Medicare health plan (some Medicare Cost Plans, some Medicare Private Fee-for-
Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans), you can
join a separate, stand-alone prescription drug plan.
You can enroll in Medicare prescription drug coverage during a two-month
“Special Enrollment Period” that begins the month that you no longer have
employer-sponsored prescription drug coverage. You can also enroll in drug
coverage each year during the fall open enrollment period, which runs from
October 15 to December 7.
To nd out which Medicare drug plans are available in your area, visit the Medicare
Plan Finder at Medicare.gov/nd-a-plan. Or call 1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048.
You have completed the fact sheet. But more help is available. Contact the
resources on the next page if you have questions or want more information
about Medicare.
My Part D Special
Enrollment Period
My employer-sponsored
prescription drug coverage
will end on
/ /
Your Special Enrollment Period
to buy Medicare Part D drug
coverage will end 2 months
after your coverage ends:
My Special Enrollment
Period to enroll in Part D
coverage will end on
/ /
Centers for Medicare & Medicaid Services Page 8
FACT SHEET: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
Where can I get more information or help?
For more information, you can:
•
Contact your local State Health Insurance Assistance Program (SHIP) to get free
personalized help making decisions about your health coverage. To get the number
for your local SHIP, call 1-800-MEDICARE.
•
Get information from Medicare:
•
Contact 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
•
Visit the Medicare web site at Medicare.gov.
•
Look at the most recent “Medicare & You” handbook. If you don’t have the most
recent Handbook, you can download it on Medicare.gov or request a copy by
calling 1-800-MEDICARE.
•
Call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
You can also visit SocialSecurity.gov.
•
Contact your employer or union benets manager.
My Employer or
Union Benets Manager
-
I can reach my employer or union
benets manager by calling
.
Page 9
FACT SHEET: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
CMS Product No. 11963
