Whether you do, or don’t, need to sign up for Medicare if you have other insurance depends. I know that’s not a great answer, but there are a few complications for a variety of reasons.

There have been new rules Congress recently passed which affect anyone turning 65 and changed what you are allowed, and not allowed, to do, along with what is considered “creditable coverage.”

Everything with Medicare is very different now from how it was just one year ago.

Here are some questions and suggestions, that many don’t know, or think to ask, but will help you to make a better, more informed decision...

...and likely, you need to seek out and get some specific advice regarding your unique situation to know for sure.

QUESTION #1: Is your other insurance an individual healthcare plan through the state marketplace exchange (Commonly called Obamacare --- or what I call the "Un"Affordable Care Act)?

ANSWER: This is NOT considered “creditable coverage” and you are NOT even legally allowed to keep this healthcare plan past age 65 anyways, so you would have to sign up for Mediare at age 65, or face paying a permanent penalty for life.

QUESTION #2: Is your other insurance a retiree healthcare plan provided to you by your former Employer because you retired “early” before age 65?

ANSWER: Often times, if you retire pre-65, your Employer may allow you to remain on the Employer Group Healthcare Plan (EGHP) to bridge the gap between your retirement date and when you are eligible to sign up for Medicare.

In this case, like with public school teachers, you can use banked sick days, or unused PTO days, to receive a stipend which will pay for the cost of remaining on the EGHP up until age 65, where you would then have to sign up for Medicare. I am NOT talking about COBRA coverage (more on this later).

QUESTION #3: Is your other insurance from your current Employer because you will keep working past age 65 as an “active” employee? And does your current Employer have at least 20 or more employees, or 19 or less employees?

ANSWER: The employee count of your Employer matters significantly because working somewhere with 19 or less employees is NOT considered “creditable coverage,” and you are required to sign up for both your Federal Medicare Part A&B benefits at age 65, regardless of if your Employer will allow you to remain on the Employer Group Healthcare Plan (EGHP) coverage.

A follow up question in this situation would be: Is your Employer Group Healthcare Plan (EGHP) “good” coverage?

When reviewing and researching on behalf of new clients who call my office in Clarence, anxious and nervous, asking for help, many Employer Group Healthcare Plans have high-deductibles you must meet before insurance will even pay for care, or percentage-based cost sharing exposing you to still have to cover a big chunk of bills.

Whether you work somewhere with 20 or more employees, or 19 or less employes, for most people is most situations, signing up for Medicare at 65 for health insurance is much more financially favorable over and above staying on an Employer Group Healthcare Plan (EGHP), even if you’ll continue to remain working for the income.

QUESTION #4: Is your other insurance from the local Chamber of Commerce, or something similar, because you are self-employed?

ANSWER: While many self-employed persons can be covered by Group Healthcare through member associations and chapter affiliations, more times than not, these are NOT considered “creditable coverage” and you would have to sign up for Mediare at age 65, or face paying a permanent penalty for life.

Even IF the Group Healthcare coverage is considered “creditable,” it is highly likely moving to Medicare at 65 would be a significant cost savings in monthly price while reducing out-of-pocket expenses and offering better benefits.

QUESTION #5: Is your other insurance from a “Cost Sharing” plan, like Medi-Share (Christian), United Refuah Healthcare (Jewish), CrowdHealth, H.S.A. Secure, or something similar?

ANSWER: While these can be thought of as “insurance,” they are not. They are treated as alternatives to traditional insurance, NOT considered “creditable coverage,” and you would have to sign up for Mediare at age 65, or face paying a permanent penalty for life.

QUESTION #6: Is your other insurance from COBRA?

ANSWER: COBRA healthcare coverage is only offered to those who are no longer “active” employees. Everybody who has needed to rely on, or use, COBRA healthcare coverage constantly complains about the high expense.

While your former Employer may allow you to be covered by COBRA healthcare coverage for a specific benefit period, as short as 18 months, or as long as 36 months, COBRA is NOT considered “creditable coverage,” and you would have to sign up for Medicare at age 65, or face paying a permanent penalty for life.

​** NOTE** The good news is, you don’t have to do anything with Medicare on your own. As the one and ONLY approved Certified Starting Medicare Specialist™️ for Erie County, my office does offer the benefit of Medicare SmartApp application services on-site where we are authorized to, not only complete and submit your Federal Medicare applications FOR YOU --- FREE, but we also have the ability to speed up the time it takes for approval, shortcutting the typical 2-3 months down to 2-3 weeks, sometimes as fast as 2-3 days. Let me take away the stress of you trying to tackle anything with Medicare on you own! We are always happy to help in any way we can, you just have to ask…

​Due to our reputation and popularity being voted #1 best Medicare planning service in the area for the last 6 years in a row, appointments are limited and fill up fast. To see if you qualify to use the free, nationally-recognized and 5-star rated, Medicare SmartStart Program™️ I manage, call my local office in Clarence right now at (716) 833-0252. (Really the only people I can't help and the ones who never call).