What to Do If You Have a Covered California Plan and Become Eligible for Medicare? (Part 1)

What to Do If You Have a Covered California Plan and Become Eligible for Medicare? (Part 1)

This article is the first in a series to address various scenarios as more people who have a Covered California plan become eligible for Medicare.

People who become eligible for Medicare fall into two groups: entitled to premium-free Part A or eligible for Part A but need to pay the premium. Depending on which group you are in, you have different options. People who have a Covered California plan also fall into different groups: many people qualify for financial help while others do not, and some people qualify for expanded Medi-Cal a.k.a. MAGI Medi-Cal.

This first article provides information for people who have a Covered California plan and are entitled to premium-free Medicare Part A. Other articles in the series will discuss:

  1. What happens to financial help when one becomes eligible for Medicare?
  2. Options for people who have to pay a premium for Medicare Part A
  3. Options for people who have MAGI Medi-Cal and become eligible for Medicare
Are you entitled to premium-free Medicare Part A?
Most people don’t pay a premium for Medicare Part A because they or their spouse paid a tax called FICA (which stands for the Federal Insurance Contributions Act) for at least 10 years. The FICA tax is withheld from paychecks to fund Medicare and Social Security. Thus when they become eligible for Medicare, they are entitled to “free” Medicare Part A. Contrary to some misconceptions, you can be entitled to “free” Medicare Part A even if you have not retired, reached your Full Retirement Age or applied for Social Security retirement benefits.

If you become entitled to premium-free Medicare Part A (see sidebar on who is entitled to premium-free Part A), the advice for most people is to enroll in Medicare and terminate their plan through Covered California.

1. Enroll in Medicare

You need to voluntarily enroll in Medicare if you have not signed up for Social Security benefits. People who applied for Social Security retirement benefits before turning 65 and people who qualify for Social Security Disability Insurance (SSDI) are automatically enrolled in Medicare. The following information is for people becoming eligible for Medicare upon turning 65. If you need to voluntarily enroll in Medicare:

  • Enroll during your 7-month Initial Enrollment Period
    • Your IEP starts 3 months before the month you become eligible for Medicare, continues with the month you turn 65 and 3 months following. Example: You become eligible for Medicare upon turning 65 on April 20. Your Initial Enrollment Period starts January 1 and ends July 31. If you enroll anytime in January, February or March, your Medicare will begin April 1.
    • If you enroll in the month of your 65th birthday, called the month of eligibility, your Medicare will begin the following month. In our example, if you enroll in April, your Medicare will begin May 1.
    • If you enroll during the 3 months after your month of eligibility, (in May, June or July in this example), your Medicare will begin later.
  • Contact Social Security (not Medicare)

2. Terminate the plan

Contact the Covered California plan with information that you are or will be eligible for Medicare and specify a date when you want to terminate the plan. Example: If your Medicare will begin April 1, you would want to terminate the plan on March 31.

Suppose you became entitled to premium-free Medicare Part A in 2015 but did not enroll. Can you enroll now?
If you turned 65 in November 2015 or earlier, the last month of your Initial Enrollment Period was February 2016. Since your Initial Enrollment Period has ended, you may use the General Enrollment Period to enroll. The General Enrollment Period occurs annually between January 1 and March 31. If you turned 65 in December 2015, you may enroll using your Initial Enrollment Period, which ends March 2016.

Example: You turned 65 on April 20, 2015 but did not enroll in Medicare. Instead, you continued with your plan from Covered CA. You may enroll anytime between January 1 and March 31, 2016. Your Medicare Part B will begin July 1, 2016, and your Medicare Part A is retroactive to 6 months prior to the month of enrollment.

Example: You turned 65 on December 20, 2015 but did not enroll in Medicare. Instead, you continued with your plan from Covered CA. You may still enroll through March 31, 2016 because you are still in your 7-month Initial Enrollment Period. If you enroll in March 2016, your Medicare Part B will begin June 1, 2016. Your Medicare Part A is retroactive to December 2015, your month of eligibility.

When you are enrolled in Medicare, you have options. One option is choosing between Original Medicare and a Medicare Advantage plan. If you choose Original Medicare, you may want to consider buying a Medigap. Another option is enrolling in a Medicare prescription drug plan. You may also contact your local Health Insurance Counseling and Advocacy Program (HICAP) for information about what Medicare Advantage plans are available in your county and/or counseling about the different options.

Most people who have a Covered California plan qualified for financial help. In the next article, we will discuss what happens to this financial help when you become eligible for Medicare. In upcoming articles, we will outline options for people who have to pay a premium for Medicare Part A and options for people who have expanded or MAGI Medi-Cal and become eligible for Medicare.


This article is part of an educational series sponsored by SCAN Health Plan.

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Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.