The N.C. Cooperative Extension Service and N.C. State University offer advice for those nearing retirement:

Gathering information

It is important for everyone nearing his or her 65th birthday to get accurate information about health insurance to prevent serious, costly problems.

• You need information from Social Security. (Are you eligible for Medicare or can you purchase coverage?)
• If you will be eligible for Medicare at age 65, you need to take specific actions to be sure that Medicare has accurate information about your situation. If you fail to do so, you could suffer some costly consequences.
• You need information about insurance to supplement your Medicare coverage: an employer group health plan (EGHP), a privately purchased Medigap policy or a Medicare Managed Care plan.

Your work situation

Think about what your work situation will be when you reach 65, as this will influence the health insurance decisions and actions you should take.

You may be eligible for Medicare through your spouse, or you may have questions about when to enroll for Medicare due to differences in ages between spouses and when working partners want to retire. Counselors from Seniors’ Health Insurance Information Program (SHIIP) of the N.C. Department of Insurance can help you find answers. Call 1-800-443-9354.

Deadline for action

Whether you plan to enroll in Medicare at age 65 or to delay a few years, it is important that you take the actions in countdown tips I or II within a seven-month window — the three months before your 65th birthday, plus the month of your birthday, plus the three months after your birthday.

• Countdown tips I — for persons already retired or retiring at 65:

Nine months before your 65th birthday: Call 1-800-772-1213 and get a copy of the Social Security form for requesting an official report of your work record: SSA-7004 — Request for Earnings & Benefit Estimate Statement. Or request the form from the SSA Web site. Mail in the form and study the report you receive for the number of “credits earned” (maximum four per year). If you earned 40 or more credits in the Social Security System, you are eligible for premium-free Medicare Part A at age 65.

Talk to your employer’s benefits officer and ask for information about any company health insurance options at age 65. If there is an employer group health plan for retired employees, study the benefits booklet to find out about the plan’s costs and benefits.

Get The Medicare Handbook from Social Security or SHIIP and study it so that you understand what Medicare covers and the costs you will be responsible for.

Six months before your 65th birthday: If you do not have access to a good employer group health plan, begin shopping for an individual Medicare Supplement (Medigap) policy. Call SHIIP and arrange to meet with a volunteer to learn about the 10 standardized Medigap plan options and the companies offering policies for each plan in North Carolina.

Three months before your 65th birthday: Go to the nearest Social Security office to confirm you are enrolled for Medicare Part A-Hospital Insurance and enroll for Medicare Part B-Medical Insurance. If you are already retired, and your Medicare card arrives in the mail, confirm that you are enrolled for both Part A and Part B.

Make final arrangements to purchase a Medigap policy (and find a doctor who accepts Medicare patients) or enroll in a Medicare Managed Care plan if you will not have an EGHP or the EGHP that is offered is inadequate.

• Countdown Chart II - for persons who will continue working after 65:

Nine months before your 65th birthday: Call 1-800-772-1213 and get a copy of the Social Security form for requesting an official report of your work record: SSA-7004 — Request for Earnings and Benefit Estimate Statement. Or request the form from the Social Security Web site.

Mail in the form and study the report you receive for the number of “credits earned” (maximum of four per year). If you earned 40 or more credits in the Social Security system, you are eligible for premium-free Medicare Part A at age 65. If you’re not sure about whether you will be eligible for Medicare, call SHIIP at 1-800-443-9354 and ask for help.

Talk to your employer’s benefits officer and ask about any company health insurance options for persons who continue to work past their 65th birthday. If you will have an employer group health plan, ask specifically how many hours you must work to keep it and whether it will be your “primary” or “secondary” coverage (in relation to Medicare).

Get “The Medicare Handbook” from Social Security or SHIIP and study it so that you understand what Medicare does and does not cover, and the costs you will be responsible for.

Six months before your 65th birthday: If you will not have access to a good employer group health plan (EGHP), begin shopping for an individual Medicare Supplement (Medigap) policy. Call SHIIP and arrange to meet with a volunteer to learn about the 10 standardized Medigap plan options and the companies offering policies in North Carolina. Also ask SHIIP if there are any Medicare Managed Care plans offered in your area.

Three months before your 65th birthday: Give your company written notice of your intention to continue working.

Decide whether an EGHP or Medicare will be primary. If an EGHP will be primary, ask your company to write a letter to Medicare verifying that you will continue working and are covered by an EGHP.

If you elect Medicare as primary, ask your company to write to Medicare stating that you are continuing to work after age 65 and will not be covered under an EGHP.

If you elect Medicare as primary, make final arrangements to buy a Medicare HMO plan or Medigap policy (and find a doctor who accepts Medicare patients).

Information

• Social Security — 1-800-772-1213 to request SSA-7004 — Request for Earnings & Benefit Estimate Statement.
• Local Social Security Administration to apply for Medicare or Supplemental Security Income.
• SHIIP (Seniors’ Health Insurance Information Program): Call 1-800-443-9354 to get information and publications about Medicare, EGHP, Medigap, Medicare Managed Care Plans and long-term care insurance, also access to local trained volunteer counselors.
• Employer benefits representative for information about EGHP.
• N.C. Cooperative Extension Service (704-797-0571) for educational fact sheets on elder care decisions, Medicaid eligibility, legal authority to act for another, and video program/handouts on Medicare.