Is this information for me?
This information is for active employees and their covered family members who are or will soon be eligible for Medicare and have an Individual Coverage Health Reimbursement Arrangement (ICHRA) benefit through an employer.
If you're retiring or don't have an ICHRA benefit, this information doesn't apply to you.
Medicare and ICHRA
If anyone covered by your employer's health plan is becoming eligible for Medicare or is already eligible for Medicare, you may need to take action to prepare for the coverage change.
While your ICHRA can reimburse you for eligible Medicare premiums, it isn't health insurance and doesn't automatically enroll you in Medicare or a Medicare plan.
This guide explains what you need to do, when to enroll, how Medicare works with your ICHRA benefit, and, if applicable, how Medicare enrollment affects your Health Savings Account (HSA).
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Steps To Use Your ICHRA With Medicare
To use your ICHRA benefit with Medicare coverage, complete the following steps:
Step 1: Ensure you have Medicare Parts A and B
You need to have Original Medicare Parts A and B before you can enroll in a Medicare Advantage or Medicare Supplement Insurance (Medigap) plan.
Already enrolled in Medicare?
If you’re already enrolled in Medicare, you don’t need to enroll again. Go to Step 2.
Need to enroll in Medicare?
Medicare has rules about when you can enroll. Make sure you understand the Medicare enrollment deadlines before your current coverage ends. Read the When To Enroll in Original Medicare section below to learn more.
You can sign up for Original Medicare through the Social Security Administration online at ssa.gov, by phone at 1-800-772-1213, or at a local Social Security office.
To learn more about Original Medicare, see Medicare Part A Overview and Medicare Part B Overview.
Note: If you have an HSA, keep in mind that Medicare enrollment affects your ability to contribute to it. Be sure to read the Have an HSA? Read This Before Enrolling section of this article.
Step 2: Get your Medicare information
After enrolling in Medicare, you'll receive your Medicare card. To enroll in a Medicare plan, you’ll need the information from your card, including your Medicare Number and your Part A and Part B effective dates.
Step 3: Choose your Medicare coverage
Medicare plans have rules on when you can apply. To avoid a gap in coverage, enroll as soon as you can after getting your Medicare information. You can:
Shop for and enroll in a plan on the Via Benefits website. For instructions, see Shopping for Medicare Plans Online.
Call us at 1-866-322-2824 (TTY: 711), and we can help you choose coverage that meets your needs.
During this process, you may be asked about your:
Doctors and other healthcare providers
Prescription medications
Healthcare needs
Preferred pharmacies
Travel needs
Premiums and other out-of-pocket costs
To learn about the different types of plans that may be available to you, see Your Medicare Coverage Options.
Step 4: Use your ICHRA benefit
After you're enrolled in eligible Medicare coverage, your ICHRA can reimburse you for eligible premiums, such as those for Medicare Part B, Medigap plans, Part D Prescription Drug plans, and Medicare Advantage plans.
For instructions on requesting reimbursement, see the ICHRA QuickStart Reimbursement Guide.
When to Enroll in Original Medicare
Understanding when to enroll in Medicare can help you avoid coverage gaps and potential late-enrollment penalties. To determine when you should enroll in Medicare, consider when your current employer group health coverage ends, along with the timeframes Medicare allows you to enroll.
You may have three opportunities to enroll:
During your Initial Enrollment Period (IEP)
During a Special Enrollment Period (SEP) if your employer group coverage is ending as part of your transition to an ICHRA
During the General Enrollment Period (GEP)
Your Initial Enrollment Period (IEP)
Your IEP generally lasts seven months:
Three months before the month you turn 65
The month you turn 65
Three months after the month you turn 65
Special Enrollment Period (SEP)
If you chose to delay Medicare enrollment while covered by qualifying employer group coverage through active employment, when that coverage ends, you generally have an SEP to enroll in Medicare (or add Part B to existing Part A coverage) at that time.
So, if your employer group coverage is ending as part of your transition to an ICHRA, you may qualify for an SEP to enroll in Medicare.
General Enrollment Period (GEP)
If you didn't sign up for Part A and/or Part B when you first became eligible, you can enroll during the GEP from January 1 through March 31 each year. You may have to pay a late-enrollment penalty for enrolling after you were first eligible.
Have an HSA? Read This Before Enrolling
The money in your HSA is always yours to keep. You can use it to pay for eligible medical expenses or invest it (following your HSA rules). However, if you’re transitioning from ICHRA coverage to Medicare, you can’t contribute to an HSA, and there are important rules about when you must stop those contributions.
Important: Medicare Part A may be retroactive
If you enroll in Medicare after age 65, your Part A coverage may be retroactive. This can affect HSA contributions you've already made.
What this means for you
If you're contributing to an HSA and preparing to enroll in Medicare:
Find out when your Medicare Part A coverage will become effective.
Stop HSA contributions early enough to avoid making contributions during the timeframe you’ll be covered by Medicare.
You can continue using the money already in your HSA for qualified medical expenses.
If you think you may have contributed too much, consider talking with a tax advisor about your situation.
Because Medicare enrollment can affect the tax treatment of your HSA contributions, consider talking with a tax advisor before your Medicare coverage begins.