If you are over 65 and have coverage through your or employer’s spouse with 20+ employees here is what you need to know.

After pulling the trigger on retirement, you need find your last day of regular employer coverage (not COBRA) and get it in writing from HR. Nearly every decision below hinges off the last date of employer coverage.  Get help with your transition to full Medicare.

Losing group coverage opens a Part B window

Medicare Part B is the medical insurance that covers doctor bills and office visits. If you delayed it while an active employer group plan from a company with 20+ employees that covered you, losing that plan opens a Special Enrollment Period, a window outside the normal enrollment seasons when you’re allowed to sign up. It runs eight months, starting the month after your employment ends or your group coverage ends, whichever comes first.

You don’t want most of those eight months, because Part B doesn’t start the day you apply and until it starts you have no medical coverage. Aim for Part B effective the first day of the month after your group plan ends.

Form CMS-L564 is the employment information form your employer completes to prove you had group coverage while you delayed. Request the L564 early, because it sits in someone else’s inbox.

COBRA is usually the wrong answer

COBRA is the federal right to keep your employer’s plan for a period after you leave, at full cost. Under 65 it’s often a reasonable bridge. At 65 or older it usually isn’t, and the risk is specific.

COBRA is not considered active employer coverage by Medicare. Your eight month Part B window runs from when your active coverage ended, not from when COBRA ends, and electing COBRA doesn’t pause that clock.

If you elect COBRA and run the eight months out, you then pay a lifetime Part B late enrollment penalty that stays on your premium for as long as you have Part B (and the same thing can happen with Part D).

There are narrow cases where COBRA still fits, usually a spouse or children who need the group plan and aren’t Medicare eligible. Ask us before you sign the election form, not after.

Maine gives you 90 days on the Supplement

Maine guarantees Medicare Supplement coverage within 90 days for someone who loses employer group coverage. A Medicare Supplement, often called a Medigap plan, is a private policy that pays much of what Part A and Part B leave for you. Inside that window a carrier issues it with no medical underwriting, whatever your health history.

Most states have nothing like it. Maine’s full set of rules is on Maine’s Medicare Supplement switching rules. The 90 days runs from a date on a letter, so don’t spend it waiting.

A spouse under 65 has a separate clock

Medicare only covers one person, and your spouse doesn’t come along on your card.

If your spouse is under 65 and was on your group plan, losing it is a qualifying life event that opens a 60 day special enrollment period on CoverME.gov, Maine’s state based marketplace. Depending on household income an individual plan may come with a premium tax credit, and it may not. Start at Under 65 Individual & Family Coverage and work their application alongside yours, because 60 days and 90 days are both counting.

The sequence, using a September 30 last day

1. Around July 1, 90 days out. Last day of coverage confirmed in writing. Ask HR for Form CMS-L564 with a deadline.
2. Send us your providers and your prescriptions with doses, plus your spouse’s.
3. August 1, 60 days out. File Form CMS-40B with the completed CMS-L564 at https://www.ssa.gov/benefits/medicare/ so Part B is effective October 1. Apply for Part A too if you never enrolled.
4. Late August. We price a Supplement and a Part D plan against the Medicare Advantage plans in your county, checked against your doctors and your medications.
5. September 1. Paperwork signed so everything starts October 1.
6. By September 30. Your spouse’s CoverME.gov application submitted, inside their 60 day window.
7. October 1. Part B effective, group plan ended the day before, no gap.
8. Through late December. Maine’s 90 day guaranteed issue window is still open, which is your backstop.

Your Part D coverage has its own deadline, generally two months after creditable employer drug coverage ends. Miss that and you could be hit with another lifetime late enrollment penalty. And if this is your first time on Part B, your six month Medigap open enrollment window starts with it.

Three months out is comfortable. Three weeks is less so, because the employment form and Social Security processing are both outside your control.  Get professional guidance for your transition to full Medicare. Bring your last day of coverage and your two lists to a call and we’ll build your dates around them.

BEST PRICE GUARANTEE
Maine Health Insurance Brokers. services are 100% FREE and there is no extra cost or mark-up. Whether you get your Medicare coverage through us, another agent/broker or directly from the insurer, you’ll pay the exact same monthly premium for the same plan.