Answers to Basic Medicare Questions

By Stephen J. Silverberg
New York Elder Law Attorney

It’s true – once you reach 65, there’s a whole new world of healthcare to understand. It can be a little overwhelming, but there’s no lack of information and resources to help you navigate Medicare. Here are basics to get you started.

 If you signed up for Social Security before age 65, you’ll automatically be enrolled in Medicare parts A and B and receive your card three months before your 65th birthday. Part A covers hospitalization and is premium-free. Part B covers outpatient care, such as doctors’ visits, x-rays and tests, and costs $134 a month for people who enroll in 2017 (or more for high earners).

Everyone who is not part of the group above, must take action to enroll or face a lifetime late-enrollment penalty (unless you’re still working and have employer coverage). Go to to sign up anytime from three months before until three months after you turn 65, your “initial enrollment period”. This is true, even if you’re waiting to file for Social Security benefits.

If you (or your spouse, if you’re covered by your spouse’s insurance) are still working for a company with 20 or more employees, the employer’s insurance is your primary coverage. Medicare is secondary and can fill any gaps in coverage. You don’t have to sign up for Medicare at 65, and you won’t have a late-enrollment penalty, if you sign up within eight months of leaving your job and losing work-based coverage (or losing coverage under your spouse’s insurance).

If you work for a large employer and like the coverage, you can delay signing up for Part B. However, the rules are different if you work for a company with fewer than 20 employees: Medicare becomes your primary coverage at age 65, and you must sign up for Part A and Part B while you’re still working. You can’t delay signing up for Part A if you’re already receiving Social Security benefits and were automatically enrolled in Medicare, although you’re still working.

You can still contribute to a health savings account after you turn 65, provided you haven’t enrolled in Medicare. If you’re able to delay signing up for Medicare Parts A and B, you can continue contributing to an HSA. Before you do, see about the HSA’s tax breaks, any employer contributions and other benefits that would be more valuable than the premium-free Part A coverage.

At age 65, unless you (or your spouse) are still working and have current employer coverage, sign up for both Medicare Part A and Part B. Retiree coverage can fill gaps in Medicare (which would otherwise require Medicare Supplemental Insurance (commonly called Medigap) and Part D policies or a Medicare Advantage plan), but it’s secondary to Medicare after age 65. Benefits may also not kick in, if you don’t sign up for Medicare. Federal retiree coverage is an exception. It remains your primary coverage if you don’t sign up for Medicare, but you’ll pay a penalty if you sign up for Part B down the road.

The late-enrollment penalty is 10% of the Part B premium for every year you should have had coverage. The penalty applies as long as you receive Medicare benefits.

You may need Medigap insurance to pay deductibles and co-payments. Most people buy a Medigap policy to pay those costs, plus Part D prescription-drug coverage since Medicare rarely covers drugs. Another option is to sign up for a private Medicare Advantage plan, which provides both medical and drug coverage. These policies are sold by private insurers and come in ten standardized versions. You get to go to any doctor or facility covered by Medicare. Private insurers sell part D prescription-drug plans. Medicare Advantage plans combine medical and drug coverage and may also provide coverage that isn’t available through Medicare, like dental and vision care. However, be careful when evaluating a Medicare Advantage plan. Your choice of physicians and facilities are limited to those chosen by the insurance company; traditional Medicare allows you your choice of physician or facility.

If your adjusted gross income plus tax-exempt interest income is more than $85,000 for singles or $170,000 if you’re married and filing jointly, you’ll be subject to the Medicare high-income surcharge and pay extra for Part B. You’ll also have to pay extra monthly for Part D drug coverage.

About the Author
Stephen J. Silverberg is nationally recognized as a leader in the areas of estate planning, estate administration, asset preservation planning, and elder law. He is a past president of the prestigious National Academy of Elder Law Attorneys (NAELA), and a founding member and past president of the New York State chapter of NAELA.