Should I Enroll in Medicare When I Turn 65?

If you are turning 65 soon, you probably have a hundred questions about Medicare. What’s the best plan? How much will it cost? Which doctors can I see? These are all common questions and ones we answer every day. One question we’ve heard a lot lately is, “Should I enroll in Medicare when I turn 65?”

Many people are surprised to learn that they don’t have to enroll in Medicare when they turn 65. You can postpone enrollment as long as you’d like, as long as you meet certain criteria. We’re going to tackle that question today.

Who Can Delay Medicare Enrollment

Many people who are turning 65 think they have to enroll in Medicare right away to avoid being penalized. We’re glad people are aware of this possibility, and it is true in many cases. However, there are ways to postpone Medicare enrollment if you wish to do so.

People who have creditable coverage may delay Medicare enrollment as long as they have that coverage in place. “Creditable” coverage means the plan offers at least as much coverage as Original Medicare (Parts A and B). Even if a plan offers similar benefits, it may not automatically be deemed creditable. The most common form of creditable coverage is through a large employer – one with at least 20 employees.

Whether you are the policyholder or you are on a spouse’s plan, if you have creditable coverage, you may choose not to enroll in Medicare when you turn 65. When you decide to terminate that coverage, you’ll be eligible to enroll in Medicare for the first time. In this case, you do not have to wait for a certain Medicare enrollment period.

If you think you might want to take advantage of delaying Medicare, don’t assume your insurance is creditable. Speak with your benefits administrator or call the carrier directly to make sure your coverage qualifies. As long as you stay on the group plan, the carrier should send you a letter each year with an update about how your benefits compare to Medicare and if they are still considered creditable. Be sure to look at both the medical and prescription benefits, as you’ll also need to prove you have creditable prescription coverage if you want to delay Part D as well.

Prescription coverage is considered creditable if the following conditions are met:

  • The plan pays at least 60% of the prescription cost;
  • The plan covers name-brand and generic medications;
  • The plan extends coverage to a variety of pharmacies; and
  • The plan has no annual benefit limit, or it has a low deductible

VA Healthcare and TRICARE for Life benefits are always considered creditable coverage.

If you decide to delay enrollment, you’ll be required to provide proof of creditable coverage when you decide to make the transition to Medicare. You’ll need to fill out form CMS L564, which also must be signed by your employer. Keep a copy of this for your records, as you may need to provide it to other carriers in the future.

Even if you can put off enrolling in Medicare, you may not want to wait to enroll. It’s important to work with an advisor who can compare coverage and costs of both options so that you get the best benefits at the lowest out-of-pocket costs. 

Person paying a Medicare penalty for their late enrollment

Enroll in Medicare with Carolina Senior Benefits

Enrolling in Medicare isn’t something anyone should do alone. There are too many small details that can easily be missed, leading to a loss in coverage or higher healthcare expenses. The team at Carolina Senior Benefits will make sure you’re well-informed prior to enrollment and every year after. Call today to schedule a consultation with one of our Medicare advisors.