Many employees approaching age 65 have questions about whether they must enroll in Medicare, whether they should stay on Lehigh's medical plan, or how to decide what's best for their situation. This page provides general guidance and points you toward resources that can help you make an informed choice.
This overview is for informational purposes only and should not be considered legal, tax or financial advice. Employees should consult official Medicare resources or a qualified advisor for guidance on their individual circumstances.
Not necessarily.
Because Lehigh's medical plans provide creditable coverage under Medicare rules, most employees who continue working at Lehigh can delay enrolling in Medicare without any late-enrollment penalties.
Whether you should enroll depends on your specific situation, including your medical needs, costs, retirement planning, spouse coverage needs, and HSA implications (if applicable). If you would like to connect with someone to review your options and compare your plan against what Medicare offers, reach out to Health Advocate (registration code EFL8M2S).
Eligibility
Most individuals become eligible for Medicare at age 65 if you (or your spouse) have the required work credits. Eligibility alone does not require you to enroll.
There are some instances when your enrollment in Medicare is automatic:
- You are already receiving Social Security benefits at least 4 months before you turn 65, or
- You begin receiving Social Security benefits, or
- You have been receiving Social Security Disability Income (SSDI) benefits for at least 24 months.
If you are not receiving Social Security benefits, automatic enrollment does not occur.
The Parts of Medicare
- Part A (Hospital Insurance)
- Covers: inpatient hospital care, skilled nursing facility care (following a hospital stay), hospice care, certain home health services
- Cost: most people pay no premium. Deductibles and daily coinsurance amounts apply for hospital stays.
- Note: Part A is the portion of Medicare that many people are automatically enrolled in if they begin collecting Social Security.
- Part B (Medical Insurance)
- Covers: doctor visits, outpatient care and surgeries, diagnostic tests, preventive services, durable medical equipment
- Cost: monthly premium set annually by the federal government. There is also an annual deductible plus 20% coinsurance for most services.
- Note: enrollment is optional but important. If you delay enrollment without creditable coverage, you may face permanent late-enrollment penalties.
- Part D (Prescription Drug Coverage)
- Covers: prescription medications
- Cost: monthly premium plus copays/coinsurance for medications
- Note: you must have Part A or Part B to enroll in Part D. Delaying Part D without creditable coverage (such as Lehigh's plan) may result in a penalty.
- Part C (Medicare Advantage Plans)
- What it is: an alternative to Original Medicare (Part A + Part B) and is offered by private insurance companies approved by Medicare
- Covers: provides at least the same coverages as Parts A and B, and often includes Part D. May include additional benefits like vision, hearing or dental
- Cost: Part B premium + any additional premium set by the private insurance company you purchase the coverage through
- Note: Advantage plans typically have provider networks (like a PPO or HMO), and costs vary by plan and location
- Medicare Supplement (Medigap)
- What it is: insurance policy that helps pay some of the out-of-pocket costs of Original Medicare (A + B), such as deductibles and coinsurance
- Note: only works with Original Medicare, not Medicare Advantage. Requires a separate monthly premium, and policies are standardized by plan type
Many employees choose to remain on Lehigh's medical plan when they turn 65. Because Lehigh's coverage is creditable:
- You may delay enrollment in Part A and Part B without penalty
- Your coverage through Lehigh remains your primary insurance while actively working
- You can remain covered on Lehigh's plan for yourself and eligible dependents
When your employment with Lehigh concludes, that will open a Special Enrollment Period (SEP) which will give you the opportunity to enroll in Medicare at that time.
If you enroll in Medicare while still working, you can either drop your Lehigh coverage as a qualifying life event (now being eligible for and enrolled in Medicare).
Cost-effectiveness will vary from person to person is very individualized. Health Advocate (registration code EFL8M2S) can assist you with your questions as you determine if you would prefer to defer your Medicare enrollment, or enroll while still working.
For more information directly from Medicare, see here.
If you (the employee) are turning 65:
- If you stay on Lehigh's plan, your spouse can stay covered as well
- If you enroll in Medicare and drop Lehigh's plan, your spouse's coverage through Lehigh will also terminate and they may need to consider Marketplace coverage, COBRA, or Medicare (if eligible)
If your spouse is turning 65:
- They do not need to enroll in Medicare immediately. Because Lehigh's coverage is creditable, they can defer their enrollment without incurring a late-enrollment penalty.
- If your spouse chooses to enroll in Medicare, you can remove them from your Lehigh plan as a qualifying life event.
Choosing between Lehigh's plans and Medicare is a personal decision. Consider the following:
- Lehigh premiums vs. Medicare premiums
- Out-of-pocket costs on both plan options
- Prescription drug needs
- Total family coverage needs
- Frequency of doctor visits and specialist needs
- Expected medical procedures
- Retirement timeline
- When you expect to claim Social Security
- If you currently have an HSA
Navigating the Medicare landscape can quickly become overwhelming. The good news is, free help is available. Reach out to Health Advocate (registration code EFL8M2S) to connect with a representative that can assist you with understanding which option may be best for you and your family. See the following section for various Medicare Resources as well.
Medicare also provides additional guidance here.
The following resources have come recommended to us by Lehigh retirees who found their services beneficial while navigating Medicare enrollment. These resources are not affiliated with the university, with the exception of Health Advocate (the university's EAP and Health Advocacy vendor).
| Organization | Services | Contact |
|---|---|---|
| AARP | Supplement plan options, general resources |
888-867-2277 aarp.org |
| Capital Blue Cross Medicare | Supplement plan options |
888-234-5707 capitalbluemedicare.com |
| Health Advocate | Medicare plan guidance, Lehigh's EAP and Health Advocacy Vendor |
866-799-2728 members.healthadvocate.com (code EFL8M2S) |
| HTA Insurance | Supplement plan options, Medicare application/enrollment assistance, free seminars |
610-430-6650 hta-insurance.com |
| Silvercrest Insurance | Supplement plan options, Medicare application/enrollment assistance |
610-868-5801 silvercrestins.com |
| Social Security Office (Bethlehem) | Medicare application/enrollment, social security income assistance |
866-783-7458 ssa.gov |