Enrollment Guide

How To Enroll In Medicare

Medicare can be overwhelming when you are not familiar with the program. If you will be turning 65 soon and don’t know where to begin, follow our guide to help you learn how to prepare for Medicare enrollment.

Medicare Enrollment Guide

Medicare Eligibility

Enrollment in Medicare will differ depending on your circumstances. The first step is to determine if you are eligible. If you can answer yes to one of the following questions then you should meet the eligibility requirements.

  • Are you Age 65 or older?
  • Are you under 65 with certain disabilities?
  • Do you have End-Stage Renal Disease (kidney failure that requires transplant or dialysis)?

When To Sign Up?

If you currently get Social Security or Railroad Retirement payments:

  • You will automatically be enrolled in Medicare Part A & B on the first day of the month of your 65th birthday. For example, if you turn 65 on June 15, you will be enrolled on June 1. Your Medicare card should come in the mail three months prior to your 65th birthday. If you do not receive your card, contact the Social Security Administration.

If you do not draw Social Security or Railroad Retirement payments:

  • You must sign up to get Medicare benefits. To sign up, contact the Social Security Administration. In addition, you can apply in person at your local Social Security office.

What Does Medicare Cost?

If you qualify for Social Security benefits, you don’t pay a premium for Medicare Part A coverage. Therefore, you should definitely sign up for Medicare Part A.

Everyone pays a monthly premium for Medicare Part B, which is usually taken out of your Social Security check. Most people will pay the standard premium amount. However, if your modified adjusted gross income, as reported on your IRS tax return from two years ago, is above a certain amount, you may pay more. Social Security will notify you if you have to pay more than the standard premium. See Part B Premium Table.

Your Part B premium may be higher if you didn’t sign up for Part B when you first became eligible. The 2012 Part B premium is $99.90. You may choose not to participate in Medicare Part B insurance, which covers doctor visits and other outpatient medical services.

If you are still working and you are covered under your union or employer’s health insurance — or if you are covered under your spouse’s employee health insurance — Medicare Part B is not necessary. However, if you have retiree health insurance, you will need Medicare Part B. If you do not want Part B, you must opt out.

If you opt out of Part B when you are enrolled, you may pay higher premiums if you decide you want it later. The premium goes up 10% every year that you could have had Part B.

There are some exceptions. You will not pay more for signing up later:

  • If you are covered by another group health plan when you turn 65.
  • If you sign up for Part B within eight months after the group health plan no longer covers you.

If you decline Part B at first, and do not sign up within eight months after your other health coverage ends, you can only sign up during Medicare’s “general enrollment” period: January 1 to March 31 of each year, and your coverage will not begin until July of that year.

Before opting out of Medicare Part B, it would be a good idea to talk to the group benefits administrator with your other health insurance plan. In some cases, Medicare Part B would be your main insurance even if you have other coverage.

Coverage for Prescription Drugs

In 2006 Medicare launched its prescription drug plan called Medicare Part D. It provides some insurance coverage for brand name and generic prescription drugs. Coverage is offered through private insurers, not the federal government, and a number of different plans are available.

To obtain drug coverage, you have quite a few options. You can:

  • Buy a plan that offers the drug benefit alone through a private insurance company.
  • Choose a Medicare Advantage plan that has prescription drug benefits.
  • Keep the prescription drug benefits you get from your employer or other health plan (instead of getting drug benefits from Medicare).

To join Medicare Part D, you need to pay a premium each month. Most people will pay the standard premium amount. However, as a result of the Patient Protection & Affordability Care Act, if your modified adjusted gross income is above a certain amount, you will pay more. See Part D Premium Table. Prices vary depending on the plan, and you will also have to pay a deductible and — depending on how much you spend — other drug costs. People with limited incomes may qualify for financial assistance.

Learn more about Medicare Part D Plans.

Supplemental Coverage

If you are on a retiree health insurance plan, it may pay for some of the deductibles or co-payments that you have to pay with Original Medicare coverage. If you don’t have retiree health benefits, you can decide to participate in two specially designed health insurance plans which help cover the “gaps” in Medicare coverage. They are: Medicare Supplement Plans or Medicare Advantage Plans.

Medicare Supplement (Medigap) Plans

Medigap plans are sold by private companies to seniors on Medicare. These plans are meant to fill in the “gaps” in Medicare. They help pay for things that Medicare does not cover.

If you are going to buy a Medigap plan, you should do so within six months of taking Medicare Part B. During this six-month window, insurers:

  • Can’t deny you coverage.
  • Can’t delay the start of your coverage.
  • Can’t charge you more based on pre-existing health conditions.

If you try to buy a Medigap policy after your six-month enrollment period has ended, there is no guarantee that you will be given coverage.

Note: As of June 2010, the types of Medigap Plans that you can buy changed. Medigap offered two new plans — M and N — and eliminated Plans E, H, I and J. However, if you already bought Plan E, H, I, or J before June 1, 2010, you can keep that plan.

Learn more about Medicare Supplement Plans

Medicare Advantage Plans (also known as Part C)

These are managed care plans sold by private insurers as alternatives to the traditional Medicare Plan. To join, you must already have Medicare Part A and Part B. Your Medicare Advantage plan may also require a monthly fee for some of the plan’s extra benefits.

If you are in a Medicare Advantage Plan, you don’t need a Medigap policy. Medicare Advantage plans usually cover the same benefits that a Medigap plan offers.

Medicare has imposed a number of restrictions on when you can join or leave a Medicare Advantage plan. In general, you must join within three months of your 65th birthday. If you already have Medicare, you need to join a Medicare Advantage plan by either May 15 or June 30, depending on the specifics of your current coverage. If you miss that date, you will have to wait until October 15.

Once you join a plan, you are typically locked in for the calendar year. You will be allowed to switch plans between October 15 and Dec. 31 each year.

Learn more about Medicare Advantage Plans.

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