Frequently Asked Questions About Becoming Medicare Eligible:

• Plan on evaluating your Medicare options 3-6 months in advance.
• If your spouse continues to work, and they have group insurance offered through their employer you should evaluate the benefits and cost of their group plan in comparison to Medicare plans offered for yourself.

Personalized Coverage Options

• If your spouse does not work:
  • If both of you are turning age 65, both of you need to move to Medicare.
  • If your spouse is younger than 65 you need to determine which option is best to bridge them to age 65.
    • If you terminate when Medicare is made effective your spouse is eligible for 36 months of COBRA. Please verify this with your HR department.
    • Individual health plans are available and depending on the Modified Adjusted Gross Income your spouse may be eligible for a Premium Tax Credit that can make the health insurance more affordable.

• If you have dependent children, you will need to cover them on one of the following options:
  • COBRA
  • Individual Health Plan
  • Short Term Medical Plan

Personalized Coverage Options

• Call: 713-322-0040
• E-mail: [email protected]

• If you are turning age 65 and continuing to work, you need to know the following:
  • Do not worry about incurring penalties if you continue to be covered by your employer’s creditable group health plan.
  • If you are continuing to work, you need to determine if you should enroll in Medicare Part A.
    • If you are making or receiving contributions to a Health Savings Account, you should not enroll in Medicare Part A.
    • If you are not making or receiving contributions to a Health Savings Account, you should enroll in Medicare Part A.
      • Benefits of enrolling in Medicare Part A while working are the following:
        • There is not a premium for Medicare Part A if you have worked in the United States for 40 quarters or more.
        • Part A will pay secondary to your group coverage so it can pay some of your unpaid hospital claims.
        • Should you need to elect Part B quickly it makes applying for Part B easier.
      • Do not enroll in Medicare Part B. There is no reason to enroll in Medicare Part B as it has a premium, and you will not receive a penalty for not being enrolled if you have creditable group health insurance coverage.
      • You will have an open enrollment event when leaving group coverage and you will be able to enroll in Medicare Part B.

Feel free to contact Individual Insurance Solutions, LLC with questions at:

• Call: 713-322-0040
• E-mail: [email protected]

• First, determine your retirement date and start visiting with Individual Insurance Solutions, LLC 3-6 months in advance.
• You will need to follow the following steps to have seamless coverage and not incur any penalties:
  • Once you are within 3 months of your retirement date you need to apply for Medicare Part A and B if you have not already.
  • If you have Medicare Part A and B you need to have a representative help you with determining if a Medicare Supplement or Medicare Advantage plan is best for you. In addition, you will need to have your prescriptions priced to determine which Prescription Drug Plan is best for your situation.
  • If you only have Medicare Part A you need to apply for Medicare Part B timely. You need to complete Form 40B (Part B application) and note the date that Part B needs to be effective (refer to the Forms drop down for Form 40B along with instructions).  You will also need to have your HR department complete Form L564 that will indicate you have had creditable coverage since turning age 65.  If you have had other employers since turning age 65 you will need to get a form L564 from them as well.  Once both forms are completed our recommendation is for you to personally deliver these to your local Social Security office.
  • If you do not have either Medicare Part A or Medicare Part B you will need to follow the instructions above for Part B and when you deliver your Part B forms to your local Social Security office, you will need to let them know that you also need Medicare Part A.

Personalized Coverage Options

• Call: 713-322-0040
• E-mail: [email protected]

If you or your spouse are turning age 65 or are age 65+ and leaving employment, please note that you do not want to elect COBRA.  By electing COBRA, you would be incurring penalties, and you would be negatively affected for your election periods when enrolling in Medicare Supplement, Medicare Advantage or Prescription Drug Plan coverage.

• COBRA is not recognized as creditable coverage.
  • If you elect COBRA instead of Medicare Part B you will only be able to enroll in Medicare Part B during the General Election Period which is between January 1^st through March 31^st, and Part B will be effective the following month.
  • For every 12 months that you are not enrolled in Medicare Part B you will be incurring a penalty of 10% and the penalty stays with you for life.
  • If you elect COBRA vs. enrolling in a Medicare Supplement when leaving employment, you will bypass your open enrollment period. If you wish to enroll in a Medicare Supplement later, you will have to answer medical questions and you could be declined or be charged additional premiums.
  • By enrolling in COBRA, you will bypass your open enrollment period for Medicare Advantage and Prescription Drug Plan coverage. You will only be able to enroll during the Annual Election Period which is between October 15^th and December 7^th for a January 1^st effective date. 
  • If you do take COBRA, it will only be secondary to Medicare and if you do not have COBRA, it will pay as if you have COBRA. This is called a Medicare Assumption.

* It is best to not enroll in COBRA if you are eligible for Medicare, and you can incur penalties and negatively affect your open enrollment window.

Feel free to contact Individual Insurance Solutions, LLC with questions at:

• Call: 713-322-0040
• E-mail: [email protected]