If you are nearing age 65 and haven’t already enrolled in Medicare insurance, now is the time. Receiving Medicare coverage isn’t always automatic, and you’ll experience penalties if you wait until after your 65th birthday to enroll. We know navigating all the government rules and instructions can be confusing, and we are here to help. In this article, we explain everything you need to know about how to enroll in Medicare.
What Is Medicare?
Medicare is government-issued health insurance for Americans aged 65 or older. It is also available for anyone with End-Stage Renal Disease (ESRD) and some individuals under 65 who have disabilities.
When Am I First Eligible for Medicare?
The first opportunity you have to enroll in Medicare is three months before your 65th birthday. At this time, you can join Medicare Parts A, B, C, and D.
What Do the Different Medicare Parts Mean?
There are four types of Medicare that cover different medical costs. They label these types Part A, Part B, Part C, and Part D. When signing up for Medicare, you enroll in Part A and Part B coverage.
Part A (Hospital Insurance)
Most people receive free premium Part A coverage. If you qualify, you won’t have to pay a premium each month for your Hospital Insurance. If you don’t meet the requirements for Premium-free Part A, you can buy coverage. Part A Hospital Insurance Medicare covers:
- Inpatient hospital care
- Skilled nursing facility care
- Inpatient care in a nursing facility (non-custodial or long-term)
- Home health care
- Hospice care
Part B (Medical Insurance)
If you sign up for Part A, you are usually required to sign up for Part B Medicare. Some exceptions to this rule apply. For instance, if you are not retired and have insurance through your employer, you may not need to enroll in Part B Medicare before age 65. When in doubt, please contact us for help.
Part B or Medical Insurance covers outpatient services and supplies used for diagnosis, treatment, clinically administered drugs, and preventive health services. Part B covers costs for a variety of medical services, including:
- Ambulance rides
- Diagnostic imaging (CT scan, MRI, X-ray, etc.)
- Doctor’s visits
- Flu shots
- Medical equipment
- Mental health services
The list above isn’t complete. Part B Medicare covers many common and necessary medical needs. You must pay a premium each month for Part B Medicare. Your premium is automatically deducted from any benefit payment you receive from Social Security, Railroad Retirement Board, or the Office of Personnel Management. If you do not draw benefits, you will receive a bill for Part B coverage.
Part B Premiums vary by income. Individuals and couples with higher incomes pay more for their premiums through the Income Related Monthly Adjustment Amount (IRMAA). The most anyone can expect to pay per month is around $450. Deductibles for Part B vary year to year but are low compared to most private plans. After you’ve paid this amount out-of-pocket, you can expect to pay around 20% of the Medicare-approved amount for coinsurance.
Part C (Private Medicare Advantage Plan)
Medicare Part C or Medicare Advantage Plan (HMO, PPO, or similar) are available through private companies and offer Part A and Part B coverage. These private plans often also provide coverage for:
- Wellness packages
Medicare must approve of the private company offering Part C. Medicare pays the company a fixed amount every month for your coverage if you choose this option. However, private companies have different rules for pricing that may shift. Part C coverage isn’t governed by the US government and is separate and private.
Part D (Prescriptions)
Part D Medicare is an optional benefit for prescription drugs. If you don’t enroll in Part D drug coverage when you are first eligible, you will probably have to pay a late enrollment penalty. This penalty stays on your account for as long as you receive Part D drug coverage. You must enroll in Part A or Part C before applying for drug coverage. Your Part D application asks for your Medicare Number, and the date your coverage began.
Am I Automatically Enrolled?
Recipients of Social Security and Railroad Retirement Board Benefits are automatically enrolled for Medicare Part A and Part B. You must receive benefits at least four months before you turn 65 to qualify for automatic enrollment.
Is Everyone Over 65 Automatically Enrolled for Medicare?
No, Medicare enrollment isn’t automatic for everyone. Only those who receive Social Security or Railroad Retirement Board benefits, those who are disabled, or those with certain diseases are automatically enrolled.
If you haven’t received the benefits mentioned above and won’t within four months of your 65th birthday, you will need to enroll for Medicare benefits. You must register for Medicare within the designated enrollment period.
When Is the Enrollment Period for Medicare?
There are three opportunities to enroll in Medicare, as detailed below. It is always best to join as early as possible to avoid paying penalty fees.
Initial Enrollment Period
You have seven months to join Medicare with no penalties. Your Initial Enrollment Period begins three months before your 65th birthday and ends three months after the month of your 65th birthday.
However, the month you sign up dictates when your Part B coverage starts. There are advantages to signing up before your 65th birthday. Part B benefits are available on the first day of your birthday month if you’ve signed up in the three months before that month.
If you sign up during your birthday month, you will receive benefits on the first day of the month after your birthday. If you sign up for Medicare one month after your birthday, you won’t receive benefits until three months after the month you had your birthday. If you register two or three months after your birthday month, you will not receive coverage for five or six months after your birthday month, respectively.
Special Enrollment Period
In some cases, you might be able to delay your enrollment for Medicare Parts A and B and have access to a Special Enrollment Period. This period is available to those who are still covered by an individual or spousal employer or union group health insurance or during the eight months after these sponsored health plans end.
General Enrollment Period
If you didn’t join Medicare in the other two enrollment periods, you have one more opportunity to join. You can sign up for Parts A and B during the General Enrollment Period period of the year you join, and benefits will kick in on January 1 of the following year.
How to Enroll In Medicare
Now that you know the essential information, you are ready to learn how to enroll in Medicare. You have three options for registering: applying online, calling Social Security, or visiting your local Social Security office.
How to Enroll in Medicare Online
Applying for Medicare online is straightforward and takes around 10 minutes. Your signature isn’t required, and usually, you will not need to provide any documentation for your application. Visit the official Social Security Administration website and follow the instructions presented on the screen.
How to Enroll in Medicare by Phone or TTY
To enroll in Medicare by phone, call the Social Security office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. If you are hearing impaired, you can call at TTY 1-800-325-0778.
How to Enroll in Medicare in Person
If you want to enroll in person, make an appointment at your local Social Security office. They take appointments by phone.
What Happens After I Apply for Medicare?
After submitting your application, it will go under review, and someone will contact you if they need more information. Once they process all the necessary documentation, you will receive a letter in the mail that informs you of your Medicare status.
If they approve your application, you will receive a Welcome to Medicare packet. This packet includes your new Medicare card, the Medicare & You handbook, and all the pertinent information about your coverage. If you have been automatically enrolled, you should receive this packet about three months before you turn 65.
Can I Change My Coverage?
There is an Open Enrollment Period, also called the Annual Election Period or Annual Coordinated Enrollment Period, from October 15 through December 7 every year. During this time, you can switch between A and B to C or vice versa, switch Part C providers, or adjust Part D preferences.
Let Us Help You
Although learning how to enroll in basic Parts A and B Medicare is fairly simple, it can be complicated to figure out which coverage is right for you if you want a Part C or Medigap plan. We are experts at identifying your needs and helping you choose the Medicare coverage you need. Contact us today at Senior Solutions Group to get answers to all your Medicare questions.