Individuals who have paid Medicare taxes during their working years are eligible for Medicare at age 65. You should enroll in Medicare Part A at age 65, whether you are retiring or not. Part A is hospital insurance, which helps cover hospital stays and post-hospital care; usually, there is no premium. You can enroll at ssa.gov up to three months before your 65th birthday.
Not retiring? Enroll in Medicare Part A; defer Part B. And review Medicare Secondary Payer Rule, below.
Retiring? Choose between Original Medicare (Parts A and B) and Medicare Advantage (Part C). And Review Planning To Retire, below.
Medicare Secondary Payer Rule
If you do not plan to retire and your employer has fewer than 20 employees, your employer should apply for an exception to the Medicare secondary payer rule. Under the rule, the Medical Plan is automatically the primary payer on costs that fall under Medicare Part A coverage. But small employers may qualify for an exception, making Medicare the primary payer — and potentially saving the Medical Plan significant costs. (Employer dues and employee coverage are not affected by the exception.)
To apply for the exception, the employer should complete the Small Employer Exception (SEE) Package form, available on pensions.org, under Available Resources, in the Forms section, before the employee turns 65 and mail it to
Attn.: Plan Operations
The Board of Pensions of the Presbyterian Church (U.S.A.)
2000 Market Street
Philadelphia, PA 19103-3298
Planning To Retire
If you are planning to retire, you may want to refer to Medicare’s Medicare & You handbook, available on medicare.gov, and the Board’s Choosing Healthcare Coverage at Retirement booklet, found on pensions.org.
If you have opted out of Social Security, visit ssa.gov or call the Social Security Administration at 800-772-1213 (TTY 800-325-0778) for information.
Medicare comprises Parts A, B, and D as well as Medicare Advantage, which is also referred to as Part C. Parts A and B make up Original Medicare, often referred to as traditional Medicare.
Usually, you do not pay a premium for Part A, coverage for hospital stays and post-hospital care. If you paid Medicare taxes while working, you usually do not pay a premium.
- If you will be getting Social Security benefits, you will be automatically enrolled in Part A starting the first day of the month of your 65th birthday.
- If you will not be getting Social Security benefits, you should enroll in Part A, at ssa.gov, up to three months before your 65th birthday.
Medicare Part B provides coverage for doctor and preventive care services and outpatient medical care. There is a monthly premium for this optional coverage.
- If you will be getting Social Security benefits, you will be automatically enrolled in Part B starting the first day of the month of your 65th birthday. If you want to defer Part B coverage, contact Social Security before the effective date of your Medicare coverage.
- If you will not be getting Social Security benefits, contact the Social Security Administration at 800-772-1213 (TTY 800-325-0778).
Medicare Part D (outpatient prescription drugs)
Social Security charges a monthly premium for the optional coverage for outpatient prescription drugs, or Part D. You can enroll for Part D when enrolling for other Medicare plans.
You should not enroll for Part D if you are enrolled in a Medicare Advantage plan with outpatient prescription drug coverage, or if you will be participating in the Medicare Supplement Plan, through the Board of Pensions, which includes this coverage.
Medicare Advantage Plans
Medicare Advantage plans, or Medicare Part C, are offered through Medicare-approved private insurers. Part C provides coverage for doctor and hospital services and usually includes outpatient prescription drug coverage. It can include such additional benefits as vision, hearing, and dental.
The providers available to you are determined by the Medicare Advantage private insurer you select. You usually pay a monthly premium to the private insurer in addition to your Part B premium. Medicare Advantage plans can charge different monthly premiums and feature different out-of-pocket costs.
You can enroll in a Medicare Advantage plan when first eligible for Medicare.
Medigap plans supplement Original Medicare. They are issued by private insurance companies and HMOs. Medigap plan premiums vary by insurance company, region, and plan type. See medicare.gov for information.
You are eligible for a Medigap policy if you have coverage under Medicare Parts A and B. You have six months in which to enroll in a Medigap policy from the first month you are 65 or older and enroll in Medicare Part B.
Medicare Supplement Plan
The Medicare Supplement Plan, available through the Board, is similar to a Medigap plan. It is available only to eligible retired members and their eligible family members. For more information, see the Medicare Supplement Plan page on pensions.org, and the Choosing Healthcare Coverage at Retirement booklet and Benefits Overview: Medicare Supplement for Retiring Members, both available on pensions.org.