If you're 65 or older — or turning 65 soon — and you get your health insurance through a small employer (fewer than 20 employees), there are important things you need to know about Medicare. We know Medicare can feel confusing, especially when you already have coverage through work – but we’re here to make it simple and help you avoid any surprises.
What Is Medicare, and Why Does It Matter?
Medicare is a government health insurance program for people 65 and older, and for some younger people with certain health conditions. Even if you're already on a Sana plan, Medicare will need to become your primary insurance.
When we say Medicare becomes your primary insurance, we mean:
- Medicare will pay your medical bills first
- Your Sana plan will help cover what Medicare doesn’t (this is called being a secondary payer)
What This Means for You: If you don't sign up for Medicare when you're supposed to, your Sana plan might not be able to pay for services that Medicare would have covered. That could leave you stuck with big medical bills – and we don’t want that!
Do I Have to Enroll in Medicare?
Yes, it’s important to enroll in Medicare Part A and Part B when you first become eligible, if:
- You’re 65 (or older)
- Your employer has fewer than 20 employees
The only exception is if you have End-Stage Renal Disease (ESRD) — a special case where different rules apply. (If that's you, log into your Sana portal to reach out to Sana Care or to our Support team — we’ll guide you through it!)
For more information about Medicare enrollment requirements, please refer to your Summary Plan Description (SPD), located in the “Documents” section under “Resources” in your member portal here. See page 80 for details related to Medicare.
What Are Medicare Part A and Part B?
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Part A covers hospital stays, skilled nursing facilities, and some home health care. Most people get Part A for free if they’ve worked and paid taxes long enough.
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Medicare covers skilled nursing facilities but does not cover long-term or custodial care in a nursing homes
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- Part B covers doctor visits, outpatient care, preventive services, and some medical equipment. You usually pay a monthly premium for Part B.
What This Means for You: To stay fully covered, you’ll typically need both Part A and Part B – even if you’re already enrolled in a Sana plan. We’re here to make it easy.
When Should I Enroll?
Timing your enrollment in Medicare depends on your situation. Let’s break that down:
If You're Turning 65
You have a 7-month window called your Initial Enrollment Period (IEP):
- Starts 3 months before the month you turn 65
- Includes your birthday month
- Ends 3 months after your birthday month
Example: If you turn 65 in June, your IEP starts on March 1 and ends on September 30. We found this IEP Calculator Tool to find your exact enrollment window!
If You're Already 65
If you're already 65 and still working at a company with fewer than 20 employees, you should enroll in Medicare now. Waiting could lead to losing coverage and paying permanent late fees.
If you missed your first chance to sign up, you can still enroll during Medicare’s General Enrollment Period (January 1–March 31 each year).
What Happens If I Don't Enroll?
- You might have coverage gaps, where Sana can’t pay claims that Medicare would have handled
- You could get stuck with permanent late penalties:
- For Part B, you’ll pay 10% more for every 12 months you were supposed to be enrolled but weren’t
- Penalties stay with you for life — they don’t go away later
How Do I Enroll in Medicare?
You can enroll:
- Online: ssa.gov/medicare
- Phone: Call 1-800-772-1213
- In Person: Visit your local Social Security office (appointments recommended)
Are you already enrolled in Medicare?
Let us know by filling out this quick questionnaire!
Still have questions?
We’re here to help make this simple:
- Chat with us using the chatbot on any Sana page
- Call us at (833) 726-2123 (Monday–Friday, 7 AM–7 PM Central)
- Email us at hello@sanabenefits.com
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Visit our Help Center: help.sanabenefits.com
You can also visit Medicare.gov for more in-depth information.