CDISNM Blog
Still Working After 65? Here’s What to Know About Delaying Medicare
If you or your spouse have job-based insurance, you might delay Medicare — but it’s not without risk.
If you’re still working at 65 with employer insurance, you may not need Medicare right away. But delaying Medicare enrollment incorrectly can cause costly penalties or gaps.
When You Can Delay
You can delay enrolling in Medicare Part B (and sometimes Part A) if:
• You (or your spouse) are still working.
• You have active, creditable employer coverage.
• Your employer has 20+ employees.
This lets you keep employer insurance, skip Part B’s monthly premium, and sign up during an 8-month Special Enrollment Period (SEP) later. You might even enroll in Part A (often free) unless you have an HSA.
When You Shouldn’t Delay
• No job-based insurance — COBRA, retiree, and Marketplace plans don’t count.
• Employers with under 20 employees.
• If you rely on VA coverage, Medicare suggests still enrolling in Parts A & B.
If you delay Part B without proper coverage, you’ll face a 10% lifetime penalty for each year you wait. That’s why it’s critical to understand the rules if you plan to delay Part B enrollment while working, so you can avoid costly Medicare delayed enrollment penalties down the line.
HSA Users, Be Careful
Enrolling in any part of Medicare stops your ability to contribute to an HSA. If you want to keep contributing, don’t sign up for even free Part A. Stop contributions at least 6 months before enrolling to avoid IRS issues.
What to Do Next
1. Ask HR if your plan counts as creditable.
2. Get written proof.
3. Plan ahead for SEP.
4. Don’t assume you’ll be auto-enrolled — take action.
We’re Here to Help
Call us today at 1-855-890-2583 to talk with an Education Specialist about delaying Medicare Part B or to learn how to delay Medicare while working without penalties.
CDISNM Blog
How to Qualify for a Medicare Dual-Eligible Special Needs Plan (D-SNP)
These plans with extra benefits are for people who qualify for both Medicare and Medicaid.
A D-SNP Medicare plan is a type of Medicare Advantage (MA) plan made for those eligible for both Medicare and Medicaid. These dual special needs plans combine standard Medicare benefits with your state Medicaid program, adding extra support—often at no cost. If your income is limited, you may qualify. Enrollment is open year-round.
Step 1: Qualify for Medicare
• Be 65+, or under 65 with a qualifying disability (SSDI for 24+ months, ALS, ESRD).
• Must be enrolled in Part A and Part B.
Step 2: Qualify for Medicaid
• Eligibility usually depends on income and assets (not your home).
• If you qualify, you may fall into: QMB, SLMB, QI, or FBDE.
• These programs can pay Part A and B premiums, copays, deductibles, and offer extra services.
How to Confirm Eligibility
• Apply for Medicaid through your state.
• Visit Medicare.gov or talk to a licensed agent.
• Be ready to prove both Medicare and Medicaid coverage.
Why This Matters
If you qualify for a dual eligible special needs plan, you could access lower costs and extra support through a D-SNP Medicare option. These Medicare D-SNP plans are sometimes called a dual special needs plan Medicare approach because they combine your Medicare and Medicaid benefits in one. Even if you already have Medicare, adding Medicaid might open the door to Medicare dual plans like a D-SNP, giving you more coverage without extra cost.
We’re Here to Help
Call us today at 1-855-890-2583 to see if you qualify for a Medicare D-SNP plan today!
CDISNM Blog
What CAN You Do During Medicare AEP?
Each fall, Medicare beneficiaries have an opportunity to review and adjust their coverage. Knowing your options during the Annual Enrollment Period (AEP) can help you save money and avoid surprises.
When is Medicare AEP?
The Medicare Annual Enrollment Period (also called Medicare Open Enrollment) runs every year from October 15 through December 7. Any changes you make take effect on January 1 of the following year.
What You CAN Do During AEP
• Switch from Original Medicare to Medicare Advantage (Part C): If you currently have Parts A & B, you can move into a Medicare Advantage plan, which may include extra benefits.
• Switch from Medicare Advantage back to Original Medicare: You may disenroll from your MA plan and return to Original Medicare. This may also allow you to apply for a Medigap policy, though acceptance isn’t always guaranteed outside certain periods.
• Change from one Medicare Advantage plan to another: If your current plan’s coverage, costs, or provider network no longer fit your needs, AEP is your chance to find a better option.
• Enroll in, change, or drop a Medicare Part D plan: If your drug costs have increased or your prescriptions are no longer covered, you can review and update your plan. Even if satisfied, it’s smart to check annually — formularies often change.
• Switch from one Part D plan to another: Comparing premiums, deductibles, and pharmacy networks can help reduce out-of-pocket costs.
What You CAN’T Do During AEP
• Guarantee acceptance into a new Medigap plan unless you’re in a qualifying enrollment window.
• Change employer or union retiree coverage — those plans follow separate rules and timelines.
Why AEP Matters
The Medicare Annual Enrollment Period is your main chance to ensure your coverage matches your health and financial needs. Drug prices change, networks adjust, and health needs evolve. Spending just 30 minutes during AEP could save you hundreds in the coming year.
We’re Here to Help
Call 1-855-890-2583 to connect with an Education Specialist who can guide you through your Medicare AEP options and help you choose the right plan for your situation.
CDISNM Blog
What Do Medicare Supplement ‘Plus’ Plans Cover?
These plans help fill Medicare’s coverage gaps — and some offer added perks.
Original Medicare only pays for about 80% of approved costs. A Medicare Supplement insurance policy (Medigap) helps with the rest. Some insurers also offer a “Plus” version, adding benefits you don’t find in standard Medigap plans. For those who value predictability, flexibility, and added value, a Medicare G Plus plan might be worth exploring.
What’s Covered In Standard Medicare Supplement Plans:
• Part A hospital costs & coinsurance: Up to an extra 365 days.
• Part B coinsurance/copayments: Often pays the 20% Medicare doesn’t.
• Blood (first 3 pints): Covers the initial pints needed.
• Skilled nursing facility coinsurance: Up to 100 days.
• Part A deductible & hospice coinsurance: Reduces out-of-pocket costs.
• Part B excess charges: Helps with charges above Medicare’s standard rates.
• Foreign travel emergencies: Often covers 80% up to certain limits.
What “Plus” Plans Add (Example For Select States):
• Dental: Exams, cleanings, fillings, and X-rays.
• Vision: Eye exams and allowances for glasses or contacts.
• Hearing: Hearing exams and discounts on hearing aids.
• Fitness: Programs like SilverSneakers.
• 24/7 nurse line: Speak with a nurse anytime.
Freedom & Flexibility Built In
• No network restrictions: See any doctor or hospital nationwide that takes Medicare.
• Guaranteed renewability: Your coverage won’t be dropped due to health.
• Predictable costs: Manage medical expenses without surprises.
CDISNM Blog
Original Medicare: What’s Covered and What Isn’t
Understanding the limits of Medicare can help you avoid costly surprises down the line.
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). It’s the foundation of most people’s health coverage after 65 — often called Traditional Medicare — but it doesn’t pay for everything. Knowing what Medicare Part A covers, what Original Medicare covers, and what Traditional Medicare is helps you plan ahead and decide if you need additional protection, like a Medigap policy or a Medicare Advantage (MA) plan.
What Medicare DOES Cover
• Part A: Covers inpatient hospital stays, skilled nursing care after a qualifying hospital stay, hospice, and some home health care. Most people don’t pay a premium if they’ve paid Medicare taxes for 10+ years. This is the core of the question, “what does Medicare Part A cover?”
• Part B: Includes doctor visits, preventive services (like flu shots and mammograms), lab work, X-rays, durable medical equipment, mental health, and some home health. You’ll pay a monthly premium for Part B.
• Optional Part D prescription drug plan: Covers many generic and brand-name drugs, depending on the plan’s formulary. Purchased separately through a private insurer.
• Medicare Advantage (Part C, private alternative): These plans must cover everything in Parts A and B, often adding extras like vision, hearing, dental, and drug coverage. Networks and costs vary.
What Medicare DOESN’T Cover
• Long-term care: Custodial stays in a nursing home or assisted living aren’t covered. It’s one of the most common and expensive gaps in Original Medicare coverage.
• Most dental, vision, and hearing: Routine check-ups, glasses, and hearing aids aren’t covered unless tied to a medical procedure.
• Prescriptions (under Original Medicare): You’ll need a separate Part D plan or MA plan for drug coverage.
• Routine foot care and cosmetic procedures: Except when medically necessary, like diabetes-related foot exams.
• Overseas care: Medicare usually doesn’t pay for care outside the U.S., except in rare emergencies.
Why This Matters
If you’re asking, “What is Original Medicare?” or “What is Traditional Medicare?” Well, Traditional Medicare benefits offer a solid base, but major costs can still fall to you. If you rely on daily prescriptions, travel abroad, or want dental and vision included, it’s wise to explore add-ons. It also pays to learn how to sign up for Medicare Part A and B or how to apply for Medicare Part A only, depending on your needs and timing.
