A Review of Required Medicare Enrollment & Eligibility

One of the most common questions we receive from members is regarding enrollment in Medicare. In most cases, Medicare enrollment is triggered upon turning age 65 – hence the term commonly used for this process “Turning 65”.

As you may or may not know, Massachusetts public retirement law requires Medicare eligible retirees to enroll in Medicare once eligible for the federal health insurance plan. This requirement applies to all state and local retirees, as a condition of your eligibility to maintain your GIC or local health insurance coverage. The mandatory Medicare requirement also applies to your spouse or survivor, if they are enrolled in the public retiree health insurance plan.

Once enrolled in Medicare, your GIC or local health insurance plan becomes your supplemental plan (often referred to as a Medicare supplement plan). To be clear, after enrolling in Medicare A & B, you will still be enrolled in the GIC or with your local insurance plan. However, Medicare is the primary insurance, and your Medicare Supplement plan (or Medicare Advantage plan offered through the GIC or your local insurance carrier) becomes the secondary insurance.

Before going any further, we need to acknowledge the fact that not all public retirees qualify for Medicare, either on their own or through a spouse. This is because Massachusetts public employees do not participate in Social Security. While public employees hired on or after April 1, 1986 participate in Medicare, those hired prior to April 1, 1986 do not participate in Medicare. Therefore, many career public employees never earned the minimum 40 quarters to be eligible for Medicare and remain enrolled in the non-Medicare health plans.

A growing number of municipalities have opted into the Medicare Buy-In, whereby the local government pays the added fees and penalties in order to enroll all local retirees, 65 or over, in Medicare. Mass Retirees continues to advocate for the state GIC to implement Medicare Buy-in for the 10,000 or so retirees insured under the state plan who are not Medicare eligible.


Before summarizing eligibility, let’s first review the basic components of Medicare. Medicare contains various parts, commonly referred to as Parts A, B, C, and D.

  • Part A (Hospital Insurance): Helps to cover: inpatient care in hospitals, limited skilled nursing facility care, hospice care, and home health care.  Part A is free to those who qualify for Medicare.
  • Part B (Medical Insurance): Helps cover services from doctors and other health care providers. There is a monthly premium for Part B, with six levels of contribution based on your taxable income from two years prior. In 2023, the federal government looks to your 2021 taxable income. The Part B premium is deducted from your Social Security benefit (if the retiree receives a benefit) or is billed directly each quarter.
  • Part C (Medicare Advantage): Unless offered through the GIC or your local community, retirees should not enroll in private Medicare Advantage plans.
  • Part D (Drug Coverage): CVS SilverScript is an example of a drug plan that utilizes Part D. Like Part B, Part D also has a monthly premium that is set on an income-based sliding scale.


To keep it simple, let’s break down the following explanation into three scenarios: Applying for Medicare on your own work history; Applying for Medicare through a spouse who is older than you; and Applying for Medicare through a spouse who is younger than you.

Before walking through the scenarios, we should remind you that Medicare eligibility starts at age 65. However, if you are 65, still working full time and enrolled in your employer’s non-Medicare health insurance plan, then you do not have to enroll in Medicare. However, once you stop working full time, you must enroll in Medicare or incur potential penalties.

We should also point out that there is a partial temporary exemption to the state requirement that public retirees must join Medicare if you are eligible. The law allows Medicare eligible retirees, enrolled in a family health insurance plan (3 or more subscribers enrolled in the plan), to remain in the non-Medicare plan until such time as a family plan is no longer required. This usually occurs when dependents age out of  the plan at 26 or otherwise become enrolled in their own insurance plan. However, retirees who choose not to enroll in Medicare when first eligible may be subjected to the late enrollment penalty.

SCENARIO 1: Retiree qualifies for Medicare on their own.

The most straight forward way to qualify for Medicare is through your own work history. In order to qualify for Medicare on your own, you need at least 40 quarters (10 years) of contributions into the system. This can either be in conjunction with Social Security or specific to Medicare only.

If you qualify for Social Security, then you automatically qualify for Medicare at age 65. However, as we reported earlier, all Massachusetts public employees hired on or after April 1, 1986 contribute to Medicare (but not Social Security). This means that if you were hired on or after that date you paid a FICA tax to Medicare only throughout your public service career and earned eligibility for Medicare.

Once age 65, a retiree with 40 or more quarters must enroll in Medicare. We advise that members begin this process 5-6 months prior to your 65th birthday (or from the date in which you wish to enroll). Contact Medicare to enroll in Part A & B, then contact the GIC or your local health insurance provider to enroll in a Medicare supplement plan.

SCENARIO 2: Retiree qualifies for Medicare through their spouse.

Many career public employees, who did not have the opportunity to earn their own 40 quarters under Medicare, may qualify for Medicare under their spouse’s work history, even in the case of a divorced or deceased spouse. If you have been married for 10 or more years and your spouse qualifies for Medicare or for Social Security then you will as well. Social Security eligibility begins at age 62, regardless of whether or not the benefit is collected at that time.

If your spouse is older than you, then chances are that they will have enrolled in Medicare prior to you. And if your spouse is insured under your public retiree health insurance plan, they are required to enroll in Medicare once they are eligible.

The same process applies as described above, whereby we recommend that you begin the application process 5-6 months prior to your date of eligibility. However, a key difference that might take place is that one spouse will be enrolled in Medicare prior to the other. This means that the Medicare enrolled spouse will have their own Medicare supplement plan, while the non-Medicare enrolled spouse will remain enrolled in the non-Medicare health insurance plan. If you have other non-Medicare eligible dependents enrolled in the plan, then you will likely maintain a family plan. Otherwise, the non-Medicare enrolled spouse will be enrolled in an individual plan until they are themselves eligible for Medicare.

SCENARIO 3: Retiree will qualify for Medicare through their spouse, but their spouse is more than 3 years younger.

This is where things can become pretty complicated and somewhat confusing. If an eligible retiree does not enroll in Medicare upon turning 65, Medicare will assess a 10% penalty for each year the retiree’s enrollment is late. For example, if you were eligible at 65 but did not enroll until 66 a 10% penalty is assessed. Enrolling two years late increases the penalty to 20% of the Medicare premium. And the penalty exists for the remainder of your life!

While harsh, the penalty is easy to follow under normal circumstances where the retiree is eligible on their own or through an older spouse. But what happens if your spouse is younger and not yet eligible for Medicare or Social Security.

As mentioned above, Social Security eligibility begins at age 62. Under this scenario, a retiree aged 65 or older would become eligible for Medicare once their spouse turns 62 and is eligible for Social Security. The retiree can enroll in Medicare Part A at no cost.

However, if your spouse is more than three years younger (under age 62) and not yet eligible for Social Security what are you required to do? While you can put off enrolling in Medicare until your spouse reaches age 62, you would run the risk of the federal government assessing the late enrollment penalty once you finally enroll. Remember, the late enrollment penalty is equal to 10% of the premium per year you are late – for the duration of your Medicare enrollment.

Under this scenario, what is a retiree to do?

Medicare does allow non-eligible retirees to buy into the program. However, the retiree would be forced to pay 100% of the Part A premium out-of-pocket. Again, Part A is free for retirees eligible for Medicare because of the FICA tax you or your spouse paid while working.

If you don’t qualify for a premium-free Part A, you might be able to buy it. In 2023, the premium is either $278 or $506 each month ($278 or $505 in 2024), depending on how long you or your spouse worked and paid Medicare taxes. You also have to sign up for Part B to buy Part A. If you don’t buy Part A when you’re first eligible for Medicare, usually when you turn 65, you’ll pay an extra 10% for your monthly premium. You’ll pay the higher premium amount each month for twice the number of years you could have signed up for Part A but didn’t.

Unfortunately, there is no simple answer as to whether or not a retiree should buy-into Medicare A & B on your own to avoid future penalties or wait until your spouse is eligible for Social Security at age 62 but end up paying late enrollment penalties (which could be quite substantial).

The best advice we can give is that retirees under this scenario should simply do the math. What is the cost of buying into Medicare A & B vs. the cost of late enrollment penalties at a later date? Each case is going to be different based on your age and the age of your spouse.

Mass Retirees strongly disagrees with the late enrollment penalty, which is not at all logical. That said, this federal law has been part of Medicare since the program’s creation in 1965. We do not envision Congress repealing the penalty.

If you are enrolled through the state GIC and have questions regarding Medicare enrollment, they have produced a short video on “Turning 65”. You can also call the GIC with any follow-up questions you may have.

Local retirees, insured through a municipal health insurance plan, can contact their local health insurance administrator with questions on Medicare enrollment.

Regardless of the intricacies of Medicare enrollment, the most important point to remember is that you will continue to have access to excellent health insurance coverage. One great advantage of Medicare is the fact that most out of-pocket costs are far less expensive than non-Medicare plans. This is the reason why we strongly advocate for the Medicare Buy-in program.

And it goes without saying, all Mass Retirees members have the ability to contact any member of our team if you have questions or need help. Our Insurance Coordinator Cheryl Stillman is a great resource for anyone with questions regarding Medicare enrollment.

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