Working past 70: Americans can’t seem to retire.

Happy Birthday, You Qualify For Medicare. Now What?

Should You Enroll in Medicare If You Are Still Working?

The size of your employer is a key factor in determining the answer.

You’re turning 65 but still working and covered by your employer’s health insurance plan. Should you enroll in Medicare? The answer to that question is not as simple as it may appear.

The size of your employer could determine in part whether you enroll in Medicare Part B, which covers outpatient services. If your employer has 20 or more employees, your employer’s insurance will be your primary coverage. As long as you’re still working, neither you nor your spouse — if your spouse is older than 65 and covered by your plan — need to enroll in Part B. When you leave your job, you and your spouse can enroll in Part B during a special enrollment period, which lasts for eight months after you stop working.
You can always drop your employer coverage while you’re still working and enroll in Part B. (Stick with your employer plan if your spouse is not eligible for Medicare.) You should compare benefits and costs of your employer coverage and Medicare. If you’re considering traditional Medicare, consider costs for Part B, a Part D prescription-drug plan and a Medigap supplemental insurance plan.
If your employer has fewer than 20 employees, you should enroll in Medicare as soon as you are eligible because it becomes the primary payer. As secondary payer, your employer’s plan will not pay for any expenses covered by Medicare. If your spouse is on your employer plan, she or he can continue on your employer plan until age 65 as long as you keep the plan for yourself as secondary coverage. Here are other questions to consider.

If my employer is the primary payer, should I enroll in Part B anyway? It usually doesn’t make sense to pay premiums for both plans, unless your spouse needs coverage. Because of a complex formula that Medicare uses to determine how much it will pay for services when it’s a secondary payer, the program will not necessarily fill in all the gaps between what a provider charges and what your employer pays.

Should I keep my employer coverage if I work for a small company? Ask the employer’s insurance company what kind of gap coverage it offers as a secondary payer to Medicare. Smaller plans often limit the choice of providers. Unless your spouse needs coverage, you’re better off buying a private Medigap plan.

If I leave my job after 65 with retiree health benefits until I turn 70, do I need to enroll in Part B? Corporate retiree health benefits are always secondary to Medicare — even if you have not enrolled in Medicare. Retiree health plans differ on the amount of gap coverage they provide, so it’s a good idea to check with the benefits administrator. You may be better off with a Medigap plan. If your spouse is younger than 65 and on your employer plan, find out whether the retiree health plan will continue to provide full coverage.

Medicare Open Enrollment.

You only have one chance a year to make changes to your Medicare coverage. The annual Medicare open enrollment period is that chance.

Whether this is your first Medicare open enrollment or you’ve been doing it for years, it pays to take time each autumn and study your options. The number and types of plans available in your area change each year, bringing new options and eliminating previous options.

The benefits and costs associated with a plan you’ve had for years can change. This is your chance to do something about it.

When Is Medicare Open Enrollment?

Medicare open enrollment starts October 15 and ends December 7, Pearl Harbor Day. The changes you make during open enrollment take effect January 1 the following year.

You don’t have to wait until October 15 to start planning for open enrollment. You can start doing research on plan options when you get each year’s “Medicare & You” booklet in the U.S. mail or by email. The booklet alerts you to changes in Medicare that might impact your coverage or plan choices.

You’ll likely get information from you current Medicare Advantage and Medicare Part D drug plans as well as Social Security in the mail around that same time.

What You Can Do During Open Enrollment

  • Switch back and forth between Original Medicare and a Medicare Advantage Plan.
  • Switch from one Medicare Advantage plan to another.
  • Enroll in a Medicare Part D drug plan.
  • Switch from one Medicare Part D drug plan to another
  • Drop your Medicare Part D drug plan completely, perhaps because you switched to a Medicare Advantage plan that includes drug coverage.

What if You Miss Open Enrollment?

If you miss open enrollment, you won’t be allowed to make changes to your Medicare coverage until next year’s open enrollment. Your current Medicare coverage choices will roll over to next year.

There are a few exceptions that will allow you to make coverage changes outside of open enrollment. Some things, such as moving outside of your Medicare Advantage plan’s service area, trigger a special enrollment period allowing you a brief period to make changes even though it’s not open enrollment.

From January 1 through February 14, you can change your mind about your Medicare Advantage plan and switch back to Original Medicare. You can’t switch to another Medicare Advantage plan or join an Advantage plan you don’t already belong to, though.

How To Prepare for Open Enrollment

  1. Gather information about your current coverage so you’ll be able to compare and contrast the new offerings with what you have now. You’ll need information on the premiums, deductibles, copay or coinsurance amounts, which of your drugs are on your plan’s drug formulary and how much they cost.
  2. Go to the Plan Finder tool at to get information about which plans will be offered in your area next year, what they’ll cost and how their quality scores stack up.
  3. Compare what you have now with what you’d have next year if you kept the same coverage. Are your premiums or cost-sharing going up? Are your drugs all still covered at the same level on the plan’s drug formulary? Are your doctor and hospital still in-network if you have a Medicare Advantage plan?
  4. Look at the other Medicare coverage options in your community. Check the drug formulary of each plan you’re interested in. Do any of them have better coverage for your particular drugs? Can you find a plan with a lower premium but similar coverage? Can you find a plan with a similar premium but better coverage? Do the plans you’re considering have good quality scores? Make sure to check out Medicare Advantage and Medicare Part D provider networks to make sure you’ll be satisfied with the doctor, hospital and pharmacy choices.

How To Make Changes During Open Enrollment

If you decide to change your Medicare coverage during open enrollment, you have several options for how to do that.

You can sign up for most plans on the website.

You can sign up with the plan directly by:

  • Visiting its website
  • Telephone
  • Filling out a paper application and mailing or faxing it to the health plan
  • Attending a community meeting put on by the health plan to educate Medicare recipients—and to market the health plan to them. Often, these plans will allow you to enroll in the plan during the meeting. Not all plans hold community meetings, and some communities don’t have any meetings.

How to Get Help

If you’re having difficulty understanding the rules of Medicare open enrollment, how to accomplish your Medicare open enrollment goals, or comparing plans, you have several resources for help. Learn more in “Get Help With Medicare Problems & Medicare questions.”

If you’re having trouble understanding how Medicare Advantage plan types differ, learn more in “HMO, PPO, EPO & POS—What’s the Difference & Which Is Best?

If you need clarification about what a particular plan does or doesn’t offer, contact the health plan.

Yes, you need to signup for Medicare benefits.

It happened 50 years ago, today. On July 30, 1965, President Lyndon Johnson signed legislation to establish Medicare.

You probably know that your benefits start at age 65, but you need to sign up for them – and a lot of people don’t know that.

The Centers for Medicare and Medicaid Services want you to apply for your Medicare benefits three months before your 65th birthday, even if you’re not ready to retire yet.

If you don’t sign up at age 65, and you decide to enroll later, you may pay a lifetime late enrollment penalty and you may have a gap in medical insurance coverage.

You can sign up for Medicare online in less than 10 minutes. That’s a lot more convenient than going to the Social Security Office.

At that time, you’ll be asked if you also want Medicare Part B. This coverage helps pay for doctors’ services and many other medical services and supplies that hospital insurance doesn’t cover.

There are no forms to sign and in most cases, no documentation is required. Your Medicare card will arrive by mail.

The 5 Most Common Medicare Mistakes You Can Avoid.


Millions of Americans are currently enrolled in Medicare – and more than 10,000 new members sign up every day. Unfortunately, many of them fall into costly – and sometimes irreversible – pitfalls when they enroll.

The good news is the most common Medicare mistakes are easy to avoid if you know what to look for…That’s why we compiled this short list of the most common Medicare mistakes to avoid. Take a look…

List of 5 Common Medicare Mistakes

Common Medicare Mistake No. 1: Not opting for “Extra Help.”

There are billions of dollars devoted to programs to help retirees pay for their prescriptions, health insurance premiums, deductibles, and coinsurance. If your retirement income is thin, find out if you qualify for assistance.

According to the official Social Security website, “Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be about $4,000 per year.”

Bottom Line: A little research into the “Extra Help” qualification could save some serious cash.

Common Medicare Mistake No. 2: Signing up at the wrong time.          

Signing up for your Medicare plan too soon or too late can result in serious penalties. According to, during your initial Medicare enrollment – the first time you sign up for the program – you can sign up for parts A, B,C, and D:

  • During the three months before your 65th birthday;
  • The month of your birthday; and
  • The three months following your 65th birthday.

There can be long-term, irreversible effects of not signing up properly. The penalty rates vary. For example, the penalty for Part D late enrollment is equivalent to 1% of the cost of a standard Medicare drug plan premium for every month the enrollee delays enrollment. A May 5, 2013, Forbes article outlines how that penalty can play out…

Say a standard Medicare drug plan premium costs $46.00. One percent of that is $0.35. If a new enrollee forgot to sign up for coverage until his or her 66th birthday, that comes out to $4.20 in accrued penalty fees ($0.35 x 12 = $4.20).

The amount is tacked onto the enrollee’s monthly premium for life once he or she finally does sign up.

Bottom Line: Know your enrollment window ahead of time and don’t miss it.

Common Medicare Mistake No. 3: “Guessing” at what is the right plan.          

Comparing every single plan available for you and your spouse can be very difficult and time-consuming. Sometimes the specifics of each plan are hard to understand. To the end, people grow frustrated and impatient and end up selecting a plan without thorough comparison.

But this isn’t something you should leave to guesswork. According to a June 10, 2015, article posted on the National Council of Aging’s website, someone about to select his or her plan should, at a minimum, answer the following four questions:

  • Do I have health insurance from another source?
  • Do I have any chronic conditions?
  • Which doctors and hospitals do I use?
  • Which prescriptions do I need and what pharmacies do I get them from?

Your answers will help you more quickly and accurately narrow down which Medicare plan is right for you.

Bottom Line: Don’t guess when it comes to choosing your plan.

Common Medicare Mistake No. 4:  Ignoring Part D because you don’t take any prescription drugs.

Many people think, “Why pay Part D premiums if I don’t take prescription medicine?” The answer to this question is simple: Chances are you’re not psychic, so you don’t know what the future holds.

You may fall ill or get injured. And when you do, Part D provides coverage, but only the coverage you signed up for during the enrollment period. That means if you don’t have prescription coverage, you’ll have to wait until the next open enrollment (up to a year later) to make any adjustments. A March 7, 2014, AARP article advises readers to pick a plan according to the specific medications they’re currently on. And if you aren’t on any current medications, choose a plan that meets your current needs, as well as those you think may be in your foreseeable future.

Bottom line: Always have prescription coverage.

Common Medicare Mistake No. 5: Choosing Medicare plans solely based on premium amounts.

When comparing plans, investigate and learn about all out-of-pocket costs, not just the premium amount. Such costs include deductibles, co-payments, and more.

You see, while zero or low-premium plans seem attractive, expenses can show up elsewhere come time to pay the bill – and they prove ultimately more costly than a higher-premium plan.

Bottom Line: Study the components of each plan carefully, then decide what’s right for you

3 Medicare Enrollment Myths.

Medicare can be deeply confusing, and there are a lot of myths out there about how it works and what works best for a particular situation. Here are three myths that you need to watch out for to ensure that you don’t lose out on important coverage or get hit with big penalties.

Myth #1: I’m automatically enrolled
Unless you’re already getting Social Security or Railroad Retirement Board benefits when you turn 65, you will not be automatically enrolled in Medicare. You need to apply directly with Social Security to get on the books.

You can enroll anytime from three months before your 65th birthday month to three months after, meaning that you have a seven month period in which to choose the right plan for you. Part A is free, so it makes sense to sign up right away.

Of course, if you’re still working you might think that you don’t need Medicare Part B (which isn’t free), so there’s no point in enrolling. That brings us to myth number two:

Myth #2: I can wait to enroll
One thing you don’t want to do when it comes to Medicare is wait. Part A is free, so, again, no matter what your situation it makes sense to enroll right away.

When it comes to Part B, it generally makes sense to enroll as soon as you’re eligible, as making a mistake can be quite costly. Missing your enrollment can mean a permanent 10% annual increase in your Part B premium and a 1% monthly increase in your Part D premiums, which is probably not something you want to deal with.

What if you or your spouse are still working and have health insurance? In this case, check with your current provider to see how they work with Medicare. It might make sense to postpone — but don’t forget about signing up when you do retire. You’ll have eight months to do so.

Also, as a rule of thumb, if you work for a company with fewer than 20 people, it makes sense to sign up when you’re first eligible. That’s because smaller plans are allowed to drop you once you’re eligible for Medicare, and they might even refuse to pay Medicare-eligible claims.

If you’re retired and have health coverage, sign up anyway. This applies even if you have COBRA, a retiree health insurance plan, or veteran’s benefits. All of these plans become secondary plans once you’re signed up — and none of them exempt you from the late-enrollment penalties.

Myth #3: Once I’ve signed up, I’m done
While Parts A and B cover a fair amount, neither has out-of-pocket limits. That means that the 20% of costs you’re responsible for under A and B could add up to a lot of money should you need extensive treatment. This is the main argument for getting Medigap’s supplemental coverage or signing up for an Advantage plan.

But even here, it’s important to keep an eye out for gaps in coverage.

The Part D donut-hole is a great example. Part D provides for prescription drug coverage, but once you and the insurance company have collectively paid a certain amount on prescription drugs ($2,960 in 2015), you become responsible for significantly more of the cost — 45% of brand name drugs and 65% of generics. Once your out-of-pocket spending reaches $4,700, the donut-hole closes and you’ll pay a small amount on drugs for the rest of the year.

In other words, take the time to do your homework. Don’t just stop at Parts A and B, and remember to note the deductibles, premiums, and coverage limits in the plans you’re reviewing. Taking the time now can save you a lot of stress down the line.

What Medicare Does and Does Not Cover.


  • Introduction

    Medicare pays for many of your health-care needs and expenses—but not everything. Knowing what’s covered and what isn’t can help you plan for unexpected costs and budget for your annual health-care expenses.

  • What Does Medicare Not Cover?

    Medicare coverage doesn’t provide:

    • long-term care (also called custodial care), such as nursing home stays or stays in an assisted-living center
    • routine dental or eye care
    • dentures
    • cosmetic surgery
    • acupuncture
    • hearing aids and exams for fitting them

    What Does Part A Cover?

    Medicare Part A covers your inpatient hospital stays.

    • You pay a deductible and no co-payment for days one to 60 each benefit period.
    • You pay a co-payment for days 61 to 90 each benefit period.
    • You pay a co-payment per “lifetime reserve day” after day 90 each benefit period (up to 60 days over your lifetime).
    • You pay all costs for each day after the lifetime reserve days.

    Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.

    What Does Part A Cover? Continued

    Medicare Part A will cover an inpatient stay in a skilled nursing facility—after you have stayed a minimum of three days in the hospital.

    • You pay nothing for the first 20 days each benefit period.
    • You pay a co-insurance per day for days 21 to 100 each benefit period.
    • You pay all costs for each day after day 100 in a benefit period.

    Hospice care facilities

    • You pay nothing for hospice care.
    • You pay a co-payment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
    • •    You pay five percent of the Medicare-approved amount for inpatient respite care.

    Home health-care services

    • You pay nothing for covered home health-care services.
    • Blood transfusions
    • You pay for the first three pints of blood if the hospital treating you had to buy the blood. It’s free if the blood was donated to the hospital or to pay 20% of the Medicare-approved amount for durable medical equipment.

    What Does Part B Cover?

    • Doctor’s appointments, including specialists. You pay 20 percent co-insurance.
    • Outpatient care, including outpatient hospital, medical, urgent care, tests, therapies, outpatient mental health, emergency, and ambulance services. You pay 20 percent co-insurance.
    • Home health services. This is limited to medically necessary part-time care. You pay 20 to 25 percent co-insurance.
    • Durable medical equipment. You pay a 20 percent co-insurance for items like oxygen, wheelchairs, and walkers.
      Preventive and screening services. You pay 25 percent co-insurance for some screenings.

    Preventive and screening services covered by Medicare Part B

    Preventive and screening services covered by Medicare Part B

    • abdominal aortic aneurysm ultrasound
    • bone mass measurement (bone density)
    • mammograms
    • cardiovascular disease behavioral therapy
    • cervical and vaginal cancer screenings
    • colorectal cancer screenings
    • diabetes screening
    • glaucoma tests
    • hearing and balance exams
    • flu shot
    • hepatitis B shots
    • HIV screening
    • obesity screening and counseling
    • prostate cancer screenings
    • tobacco cessation therapy
    • yearly wellness visits

    Emergency Services Covered by Medicare Part B

    Medicare Part B covers ground ambulance transportation when you need to be taken to a hospital or emergency medical center. Medicare may also pay for emergency transportation in an airplane or helicopter if you need immediate and rapid transportation. You may have to pay a co-insurance payment on this service.

    Supplies Covered by Medicare Part B

    • diabetes self-management training
    • diabetes supplies
    • kidney dialysis services and supplies
    • transplants and immunosuppressive therapy




Hospital Industry Raids The Medicare Trust Fund.

Every year, millions of Americans pay federal taxes to support government programs that provide health, wellness, and other benefits to those who need it most. One would assume that safeguards are in place to ensure that our taxpayer dollars are used appropriately and efficiently. However, a recent Government Accountability Office (GAO) report states that rampant waste exists within the Medicare program. In 2014 alone, Medicare overpaid hospitals and other healthcare providers nearly $60 billion for services that were unnecessary or billed improperly. That’s billion—with a “B.”

Would you allow yourself to be overcharged for your groceries and not ask for a refund? Would you go out to dinner and pay for items on your check that you never ordered? The federal government would, and it is wasting your taxpayer dollars while doing so.

The GAO report states that Medicare has the highest level of improper payments government-wide, which should be unacceptable given the program’s important role as the healthcare safety net for the nation’s seniors and other beneficiaries. Pair that with a recent Medicare Trustee report that says Medicare will go bankrupt in the next 15 years (by 2030). Clearly, Medicare waste needs to be made a higher Congressional priority, or we can bid farewell to a program that we hoped would be there for us when we turn 65.

In 2009, Congress launched a program to provide vital oversight to Medicare, the Recovery Audit Contractor (RAC) program, which leverages the expertise of independent contractors to review post payment Medicare claims and determine if they have been billed according to Medicare policy. Since the RAC program began, these contractors have returned more than $9 billion back to the Medicare Trust Fund while reviewing less than 2% of all Medicare claims. This work to recoup dollars that have been inappropriately billed helps prolong the life of this vital healthcare program.

So, what’s the problem? Congress has benched the RACs, the only program looking out for taxpayer dollars, while Medicare hemorrhages billions due to provider complaints that they are “burdened” by Medicare oversight programs.

In fact, in an effort to game a broken system and retain as much money as possible, whether billed correctly or not, hospitals have spent tens of millions of dollars lobbying Congress to shut down the RAC program, one of the most successful oversight programs in U.S. history. Hospitals most passionately fight against review of Medicare Part A claims, which are directly paid for by taxpayer dollars.

Medicare improper billing runs across a wide spectrum—including everything from simple coding mistakes to outright fraud. For example, providers have inappropriately charged Medicare ten times what it costs to administer a single medication, have billed for care provided after a patient’s death, and also have held patients in the hospital longer than necessary in order to recoup a higher reimbursement rate.

Guest post written by Kristin Walter

Ms. Walter is spokesperson for the Council for Medicare Integrity, a non-profit organization.

What Is Medicare?


Medicare is a federal health insurance program that covers millions of Americans. In general, you are eligible for Medicare if you are 65 or older, or you are younger than 65 and meet criteria for certain disabilities, or have End-Stage Renal Disease (ESRD).

The Medicare basics have four main components:

Medicare Part A helps pay for inpatient hospital care, skilled nursing care, some home-health services, and hospice care.

Medicare Part B helps pay for physician services, outpatient hospital care, and other medical services not covered by Part A. Together, Parts A and B are known as Original Medicare.

Medicare Part C, usually known as Medicare Advantage, is offered by private health care organizations.  These plans cover all services under Parts A and B and usually offer additional benefits.

Medicare Part D helps pay for outpatient prescription drugs and is available through private health care organizations such as Kaiser Permanente. Part C plans often include Medicare Part D coverage.

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