There are a number of factors to consider. If you or your spouse is working for a company with 20 or more employees, and you have coverage thru that plan - you do not need to sign up for medicare part B. (You can sign up for zero premium part A - but there are certain other factors to consider if you do - but you do not need to sign up for part A).

If you or spouse are covered by a group health plan thru employer with less than 20 employees you do need to sign up for Medicare part B - even if you continue on that plan.

*check specifics with your employer

You do have the option to come off the group plan at any time and go onto Medicare while you are still employed - if it makes more sense for you - (comparing benefits and costs of a Medicare plan vs. benefits and costs of staying on the group plan.

This is something that we can certainly help you to navigate.

Finally - rest assured - if you stay on your group health plan of 20 or more employees, there will be no “late enrollment penalty” when you come off the group plan and sign up for Medicare part B and part D.

COBRA is considered an “Individual” plan - not a “group” plan and you will still need to sign up for Medicare Part B. For most clients - it does not make sense to keep paying for the COBRA, but rather perhaps purchase a Medicare supplement and prescription plan, or a Medicare Advantage plan.

IRMAA (Income Related Monthly Adjustment Amount) is additional premiums that you might have to pay for part B and part D - based on income. (Bear in mind - if only one spouse has become eligible for medicare - it is still the combined income that is considered when calculating the adjustment amount. The income calculation is generally based on the income reported to the IRS 2 years prior. If you are new to medicare and e.g. just retired, and your income will be significantly reduced in the year that you are going onto Medicare - then you can appeal the adjustment amount. (Please contact us for further details on this).

“Extra Help” or the “Low Income Subsidy” are various levels of “extra help” that are provided through social security that can help lower the cost for medications and part D premiums. Depending on income and asset level, it can also help pay for part B premiums. These various levels of extra help and qualifying income and asset levels get adjusted annually. Please contact us with further details.

The NJ Dept. of Health and Human Services also offers help by way of PAAD (“Pharmacy Assistance for the Aged and Disabled”) and “NJ Senior Gold”. These programs can also help reduce the cost of medications significantly, can pay part or all of the monthly premium for part B - eliminate the “donut hole” - as well as pay any “late enrollment penalty” into part D. And most significantly, these programs are not concerned with the amount of assets - strictly income.

The annual income limit for PAAD is $42,142 (single) and $49,209 (couple)

The annual income limit for NJ Senior Gold - $52,142 (single) and $59,209 (couple).

Please call us if you think you or a loved one might qualify - we are happy to help you get enrolled.

There are a number of factors that weigh into this decision. You can always keep on the group health plan as long as you are eligible (but remember if it is an employer group of less than 20 employees - you still will need to enroll into part B.

Usually if the employee comes off the group plan then the covered spouse will also have to come off the group plan. So in that case - the non-Medicare spouse would need to do one of two things:

If that spouse is working and has a group plan available to her/him thru her own employer - she could look to get enrolled into that group plan go onto an individual plan. The cost of an individual plan can vary wildly and is significantly impacted by household income. If, say, the covered employee will be retiring - usually the non-Medicare spouse will need to find an individual plan - JFH Associates can help navigate the individual marketplace health plans as well as help the Medicare eligible retiree.

However, if e.g. both spouses are eligible for Medicare -

Then regardless of whether either are retiring - it will be worthwhile to compare the difference in costs and benefits between staying on the group health plan compared to going onto Medicare with a Medicare supplement and Rx, or maybe a Medicare Advantage plan.

“Original Medicare” (Part A and Part B) does not provider any coverage outside of the US. However, certain medicare supplement plans (plans F,G,N) cover 80/20% (plan pays 80%, you pay 20%) after a deductible of $250 and with a maximum lifetime benefit of $50,000. Most Medicare Advantage plans have world-wide emergency coverage, most are unlimited benefit amount - and most are structured so that you are responsible for whatever deductibles, copays or coinsurance amounts you would be responsible for if using in-network services.

You are not required to pick up Medicare part D. However, if you do not sign up for Medicare when you become eligible for part A, and do not have other “creditable” drug coverage (“creditable” means “equal to or better than coverage of a Medicare Rx plan’), you will be subject to a late enrollment penalty which will be assessed and added to your monthly premium. (The penalty amounts to about 35 cents per every month you were not covered.) Also, you would have to wait for an eligible election period to enroll (e.g. the annual election period, Oct. 15 - Dec. 7).

You can either keep on your Medicare plan and opt out of the group health plan - or (if it is a group of 20 or more employees) you can cancel your part B (save yourself that monthly cost) and opt onto the group health plan. Again, it would be a matter of examining the costs and benefits of all your options before making a decision.

There are gaps as well as limits to the coverage thru “original” Medicare (part A and B). There are limits to the days covered for an inpatient hospital stay, or stay at a Skilled Nursing Facility. Also, there is no coverage outside of the U.S. on original Medicare. Thus, it is worthwhile to look into other options to help fill in those gaps or expand the limitations through a Medicare supplement plan or Medicare Advantage plan.

There is no “election period” so, technically you can enroll any month. However, in the state of NJ you have a guaranteed enrollment for the 6 months following your enrollment into part B or you turn 65, whichever is later. (This rule can vary from state to state).

Once outside of this guaranteed period and unless you have another special situation which grants you a guaranteed enrollment (e.g. you move out of the service area of your current plan). The supplemental insurer can charge you a higher premium or deny you coverage based on medical underwriting. Once on a supplement plan, however, the insurer cannot charge you more and refuse coverage for any medical reason that might arise.

Conversely, as long as you have Medicare A and B and live in the service area, and you have an “election period available to you, you can switch to any Medicare Advantage plan and have guaranteed enrollment.

No. It is an “either/or”. The supplement cannot coordinate with the advantage plan and vice versa.

If you want to keep or enroll in a Medicare supplement plan, you will need a separate Medicare Rx plan, and it is still possible to go onto a stand alone dental, vision, or hearing plans to help with those costs.