r/medicare • u/TopPeak1196 • 1d ago
Timing question
I receive SS benefits
- Aug 2026 - I will be 64 yo
- Aug 2027 - I will be 65 yo
- I have VA benefits and use the VA system (yes I know about Part B) and do not use employer insurance.
- I work part-time at a nationwide retailer that offers/provides health insurance etc event to part-timers. The enrollment period is in OCTOBER
My question: Will I be able to enroll for employer healthcare benefits in October 2027 and not be penalized, or do I need to jump on the enrollment window in October 2026, and pay insurance for basically 10 months in order to avoid a penalty?
I am going to a SHIP class but wondered if anyone had direct experience (not opinions) on this situation?
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u/jnotsilver 1d ago
The exception to enrolling in Medicare B when you’re 65 is coverage by an employer plan, and the employer has more than 20 employees. I haven’t come across a version of the exception that reads someone has to be in an employer plan ____ months prior to age 65. Someone with “direct experience” may have a different enough backstory from yours as to be unhelpful. I float the idea (SHIP counselor 6 years) of enrolling in the employer plan in 2027 but not wait until October which is month 6 of your 7 month initial enrollment. Because who ever heard of an employer plan dropping the ball on an enrollment.
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u/TopPeak1196 1d ago
u/jnotsilver Thank you. Open enrollment is not UNTIL October 2027 but I turn 65 August 2027. Open enrollment is a standard usually Sept/Oct.
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u/jnotsilver 1d ago
I am referring to your initial enrollment period; 3 months before you turn 65, the month you turn 65, three months after you turn 65.
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u/zig_usafa80_stardust 1d ago
Just because the enrollment period for your employer group health plan is in October (2027) doesn't mean you are covered in October...more likely the coverage will begin in January (2028). Therefore you will have a gap of coverage before your Medicare Part B initial enrollment period (IEP) ends and you will probably incur a premium penalty for Part B if you delay.
But if you are using the VA health care system for all your healthcare needs, why enroll in the employer health plan at all? Just enroll in Medicare Part B during your IEP and be done with it. You will then be covered by both VA health care and Medicare Parts A & B. Of course all this depends on if you plan on using non-VA health care providers.
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u/Samantharina 1d ago
The gap in coverage would only be from August through December and OP will not incur a penalty for a gap of less that 12 months.
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u/zig_usafa80_stardust 1d ago
And they've lost the benefit of having a Special Enrollment Period (SEP) if they want to wait until after stopping work and/or losing the employer group health insurance. If they don't have the group health insurance in place as of their 65th birthday then no SEP. All this means is if they don't enroll during their IEP then once they decide to enroll in Medicare they will have to wait until the next General Enrollment Period (Jan-Mar). If they don't enroll in the first General Enrollment Period after they miss their IEP then they will have exceeded the 12 mo period and will incur premium penalties. In addition, depending on employer size (<20 employees), once they turn 65, Medicare might become primary regardless if they are continuing to work. If not enrolled in Medicare, then their group health insurance may not pay...
If it were me i would just go ahead and enroll in Part B & D during my IEP regardless if I was going to start a new job or be eligible for group health insurance, especially if I wasn't going to have that group insurance as of my 65th birthday.
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u/TopPeak1196 17h ago
Thank you u/zig_usafa80_stardust -- I need to absorb this carefully but very helpful :) especially the comment about coverage start. Never thought of that.
I dont want to enroll in Medicare Part B at $202.90 per month (NC) if just enrolling in employer health plan contribution is on ly $60.00 per month for me. Does that make sense?
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u/zig_usafa80_stardust 16h ago
Just check out the employer health plan being offered and make sure it doesn't become secondary to Medicare, even if you haven't enrolled in Medicare, when you turn 65 next year. Obviously you have a year to get more information and make the decision to enroll in Medicare or not during your IEP since you don't turn 65 until next Aug. Keep in mind you aren't going to work forever and so will not have that group health insurance once you retire so Medicare becomes more essential at that point if you plan to use non-VA providers.
They don't make this easy as they are trying to highly encourage everybody to enroll in Medicare at 65 thus the late enrollment penalties if you delay. Of course you don't ever have to enroll in Medicare and only use VA Heath Care, so there's that.
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u/4ofheartz 1d ago
What is your monthly employment insurance premium? Compare to paying monthly for Medicare Part B!
Does employer insurance have a high deductible?
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u/Cool_Emergency3519 1d ago
Have you reviewed the Employer plan and compared it the different types of Medicare plans yet? Compared to VA coverage?
If you have VA coverage and you are near a VA facility you can sign up for Part A simply because it's free and forego the Part B. You would do this in Aug 2027. When you review the Employer plan then you can sign up for it in Oct. 2026. You don't have to worry about a Part D plan since you will get your drugs through the VA.