TalkingMedicare

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Why choose A and/or B

Your individual circumstances play a significant role in deciding whether or not to enroll in Part A and/or Part B Medicare.

Why choose A and/or B?

Your individual circumstances play a significant role in deciding whether or not to enroll in Part A and/or Part B Medicare. I'll try and illustrate some common items or circumstances that you might consider.


I, or my spouse, is currently working and I have coverage through my or my spouse's employer.

The size of the employer determines whether you may be able to delay Part A and Part B without having to pay a penalty if you enroll later.

The employer has fewer than 20 employees.

You should sign up for Part A and Part B when you're first eligible. In this case, Medicare pays before your other coverage.

The employer has 20 or more employees.

Ask your benefits manager whether you have group health plan coverage (as defined 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 want to delay both Part A and Part B coverage, you don’t need to do anything when you turn 65.

If you’re eligible for premium-free Part A, you can enroll in Part A at any time after you’re first eligible for Medicare. Your Part A coverage will go back (retroactively) 6 months from when you sign up (but no earlier than the first month you’re eligible for Medicare). If you aren't eligible for premium-free Part A, and you don't buy it when you're first eligible, you may have to pay a penalty.

Once employment (or the employer/union coverage) ends, 3 things happen:
  1. You may be able to get COBRA coverage, which continues your health insurance through the employer's plan (in most cases for only 18 months) and probably at a higher cost to you.
  2. You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA. To sign up for Part B while you're employed or during the 8 months after employment ends, complete an Application for Enrollment in Part B (CMS-40B) and a Request for Employment Information (CMS-L564). If you choose COBRA, don't wait until your COBRA ends to enroll in Part B. If you don't enroll in Part B during the 8 months after the employment ends, you may have to pay a penalty for as long as you have Part B.

    • You won't be able to enroll until January 1–March 31, and
    • you'll have to wait until July 1 of that year before your coverage begins. This may cause a gap in health care coverage.
  3. If you already have COBRA coverage when you enroll in Medicare, your COBRA will probably end. If you become eligible for COBRA coverage after you're already enrolled in Medicare, you must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have End-Stage Renal Disease (ESRD)).

I have retiree coverage (from my former employer or my spouse’s former employer) or COBRA coverage.

You should sign up for Part A and Part B when you're first eligible. In this case, Medicare pays before your other coverage.


I have TRICARE, and I'm a retired service member.

If you’re eligible for Part A and TRICARE, you must get Part B to keep your TRICARE coverage


I have TRICARE, and I'm an active-duty service member.

If you're an active-duty service member, or the spouse or dependent child of an active-duty service member:

  • You don't have to enroll in Part B to keep your TRICARE coverage while the service member is on active duty.
  • Before the active-duty service member retires, you must enroll in Part B to keep TRICARE without a break in coverage.
  • You can get Part B during a special enrollment period if you have Medicare because you're 65 or older, or you're disabled.
  • If you have End-Stage Renal Disease (ESRD), you should enroll in Part A and Part B when you're first eligible.

I have Veterans' benefits.

If you have only Veterans' benefits, you should enroll in Part A and Part B when you're first eligible. Also pay attention to see if you are covered by one of the other situations listed above.


I have CHAMPVA.

If you're eligible for Part A and CHAMPVA, you must get Part B to keep your CHAMPVA coverage.


I have End-Stage Renal Disease (ESRD).

If you qualify for Part A, you can also get Part B. Enrolling in Part B is your choice. But, you’ll need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services.

You can enroll in Part B without paying a late enrollment penalty if you apply for Medicare and are approved based on End-Stage Renal Disease (ESRD)


I have Marketplace or other private insurance.

If you’re eligible for premium-free Part A, you should enroll in Part A and Part B when you're first eligible. If you have a Marketplace plan for individuals or families, you should drop it so it stops when your Medicare coverage starts. Remember Medicare coverage is for you only and you may have to make other arrangements for other members that were originally covered by your Marketplace coverage.

If you have Marketplace coverage and you’re getting the reduced premium or tax credit, it will stop once your Part A starts. You won’t need this coverage once Medicare begins. If you get tax credits to help pay your Marketplace plan premium after your Part A starts, you might have to pay back the credits when you file your taxes.

If you aren’t eligible for premium-free Part A, you can choose to stay in the Individual Health Insurance Marketplace to get your coverage. That coverage may cost less.


What if I don't want Part B?

If you want to drop Part B, here's how to do it:

Your Medicare hasn't started yet

If your Medicare hasn’t started yet, there are 2 ways to drop Part B:

  • If you were automatically enrolled in both Part A and Part B and sent a Medicare card, follow the instructions that come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.
  • If you signed up for Medicare through Social Security, contact Social Security.
Your Medicare has already started

If your Medicare has started and you want to drop Part B, contact Social Security for instructions on how to submit a signed request. Your coverage will end the first day of the month after Social Security gets your request.


Isn't all of this easy and crystal clear?