Preparing to Enroll in the Individual Marketplace

When you are ready, there are a few simple steps you can take to get prepared. Of course, Via Benefits is happy to help answer your questions.

Coverage Before You’re 65

The Individual Health Insurance Marketplace has multiple choices, from choosing insurance from a state or federal marketplace or directly from an insurance company. These plans are similar and are required to cover the 10 essential health benefits.

Whether searching for a plan on a public or private marketplace, consider the following:

1. Your health needs, especially if you need a procedure or are living with a chronic condition.

2. The people the plan will cover. This can include spouses and dependents.

1. The doctors, prescriptions, and pharmacies you currently use and want to ensure are in the network.

2. Your household income for the year you’ll retire. 

A licensed benefits advisor can help you narrow down your choices. You can also use the Via Benefits website to review, choose, and enroll in a plan.

Learn How Individual Health Insurance Works

When You Are Medicare-Eligible

Medicare is health insurance for people over 65 (or individuals with particular circumstances). Medicare does not cover families and spouses, only individuals. Via Benefits can help keep everyone in your household covered, whether they are Medicare-eligible or not.

Retiring at 65

When you retire at age 65, you can enroll in Medicare during your Initial Eligibility Period (IEP). IEP lasts for seven months: three months before you turn 65, the month of your birthday, and three months after you turn 65.

Initial Eligibility Period

If you don’t enroll within the seven-month window around your birthday month or your retirement date is after the seven-month window, you can sign up during a Special Enrollment Period (SEP). What To Do if You’re Retiring After 65

Enrolling in Medicare

• Visit the Social Security website to sign up for Medicare Parts A and B and to receive your Medicare card.

• Make a list of your current providers, prescriptions, and pharmacies.

• Talk with a licensed benefit advisor.

• Use the Via Benefits website to review, choose, and enroll in a plan.

To enroll in coverage, you must have your Medicare card with a Medicare Number and the Parts A and B start date.

Important: Late enrollment in Medicare is subject to permanently higher premiums.

Retiring After 65

To avoid a gap in coverage, start the Medicare process a few months before your retirement date. This includes signing up for Medicare Parts A and B, understanding your insurance options, and enrolling in a plan before your current plan ends.

When you retire, you’ll enter a Special Enrollment Period (SEP). This lasts eight months, starting the last day of your current coverage or your last day of employment, whichever comes first. You can sign up for Medicare Part B during the SEP, usually without penalty.

To sign up for Medicare Part B, visit the Social Security website. Once you are signed up for Parts A and B, you can review your Medicare plan options and enroll in new coverage.

What To Do if You're Retiring After 65

Take these steps before your retirement date:

• Visit the Social Security website to sign up for Medicare Parts A and B and to receive your Medicare card.

• Make a list of your current providers, prescriptions, and pharmacies.

• Talk with a licensed benefit advisor and conduct a Medicare assessment.

• Use the Via Benefits website to review, choose, and enroll in a plan.

Creditable Coverage

To avoid penalties that can come with Part B and a Part D Prescription Drug Plan, you may be asked to provide proof of creditable coverage. You can contact your current insurance company or HR department, which will provide you with a document stating you have creditable coverage. 

Note: Even if you don’t take prescriptions at the time you retire, you may be penalized if you do in the future. To avoid this, choose a Medicare Advantage plan that includes prescription drug coverage or make sure you’re enrolled in a standalone Part D prescription drug plan.