More than 44 million Americans are enrolled in Medicare coverage, and if you are nearing the Medicare enrollment age of 65, it is likely that you are looking to sign up for Medicare, too.
However, figuring out when and how to sign up for Medicare can be a bit overwhelming. While the process itself is fairly straightforward, your Initial Enrollment Period and all the other deadlines can add complexity. This guide will help point you in the right direction.
Is It Time for Medicare?
Most people know a little bit about the Medicare program. Medicare has existed for more than 50 years and is the federal government's official healthcare program, available to millions of citizens across the country. Most likely, when you turn 65, you will be eligible for Medicare coverage. Beyond age, the only real requirements that determine eligibility are citizenship (you must be a legal and permanent resident of the United States). To determine your eligibility or calculate your premium, check out this Eligibility and Premium Calculator.
If you are under the age of 65, you may qualify for Medicare due to a disability or permanent condition. Regardless of your age, if you have been receiving Social Security disability benefits for 24 months or more, you qualify for Medicare coverage. Those with End Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS) also qualify for Medicare.
When Do You Sign Up For Medicare?
If are eligible, the next step is figuring out when to apply for Medicare. Generally, Medicare coverage will not start automatically. Most people will have an Initial Enrollment Period, which lasts for seven months in total. This seven month period begins three months before your birthday month and ends three months after your birthday month.
For example, if you are turning 65 in February 2020, your Initial Enrollment Period will begin in November 2019 (three months prior to your birthday month) and end after May 2020 (three months after your birthday month). You can enroll in Medicare anytime during the seven month period through the Social Security office or website. If you qualify for Medicare some other way, the process differs slightly.
Generally, those receiving Social Security benefits will automatically get enrolled in Medicare once they become eligible. For instance, if you qualify for Medicare coverage because of a disability and you are receiving disability benefits, you may get automatically enrolled in Medicare in your 25th month of receiving benefits.
When Does Medicare Start?
If you sign up during the general enrollment period, which is different than your Initial Enrollment Period, your coverage will begin July 1. Otherwise, the day your Medicare coverage begins will depend on when you sign up.
- If you sign up the month you turn 65, your coverage will begin one month after you sign up.
- If you sign up the month after you turn 65, your coverage will begin two months after you sign up.
- If you sign up two months after you turn 65, your coverage will begin three months after you sign up.
- If you sign up three months after you turn 65, your coverage will begin three months after you sign up.
Alternatively, if you sign up within the first three months of your IEP (before your birthday month), your Medicare coverage will officially start the first day of the month you turn 65. In the event that your birthday falls on the first day of the month, your coverage will actually start on the first day of the previous month. So, if your birthday is on July 20, your coverage will begin on July 1. If your birthday is on July 1, your coverage will begin on June 1.
What If I Miss My IEP?
If you miss your Initial Enrollment Period (IEP), you could be penalized for taking Medicare coverage at a later date. This is why it's important to stay on top of the Medicare enrollment deadlines. For those who do not sign up for Medicare Part B when they first become eligible for the program, they may have to pay a late enrollment penalty.
This penalty could make your Part B premium up to 10% higher for each 12-month period where you qualified for, but did not take Medicare Part B coverage. So, if you were three years delayed signing up for Part B, your penalty could be up to 30% higher. You may have to continue paying the higher premium for as long as you have Medicare coverage, so it's important that you stay on top of your IEP.
Still, if you missed your IEP, you can enroll in Medicare during the General Enrollment Period. There are some exceptions that may help you avoid late-enrollment penalties. For instance, one primary exception is that you have health coverage through a health plan, employer or your spouse's employer. In that case, you can delay Part B enrollment without having to pay a penalty.
Keep in mind that retiree benefits or COBRA do not count as employer health coverage for the purposes of determining your late enrollment penalty. You'll want to verify from where your health care coverage currently comes before you decide to delay Part B enrollment.
How Will I Know That I Am Enrolled?
If you are enrolled in Medicare automatically (which occurs if you have received Social Security benefits for at least 24 months) you will receive your red, white and blue Medicare card in the mail. You will receive it either three months before you turn 65 or during your 25th month of receiving disability benefits (depending on which event qualifies you for Medicare enrollment).
If you aren't going to be automatically enrolled in Medicare, you will know that you are enrolled when you complete the online application process. Your red, white and blue Medicare card will be mailed to your address soon thereafter, given that you complete the application process correctly and within your enrollment period.
How to Apply for Medicare
If you are not receiving retirement benefits or do not qualify for retirement benefits, you will likely have to enroll in Medicare manually. In that case, you'll want to follow these steps.
#1 Determine Your Enrollment Period
There are multiple periods in which you may be able to enroll in Medicare. These include your Initial Enrollment Period, as discussed earlier, along with the general enrollment period. The general enrollment period runs from January 1 through March 31 every year.
There are also "special enrollment periods"for which you may qualify. Say that you did not enroll in Medicare Part B coverage when you were first eligible to do so because you had coverage through a union or employer. In that case, if you decide you later want to enroll in Part B coverage, you can sign up at any point as long as you are still covered by the same plan.
You can also sign up during a Special Enrollment Period (SEP). The SEP lasts for eight months and begins either the month that your health coverage ends or the month that your employment ends (whichever happens first). You generally won't have to pay a late enrollment penalty if you sign up for coverage during a special enrollment period.
Remember that COBRA or retiree health coverage will not qualify you for a Special Enrollment Period. Also, the Special Enrollment Period does not apply if you are eligible for Medicare based on End Stage Retinal Disease (ESRD).
#2 Decide If You Want Part D Coverage
Part D is prescription drug coverage, and while it is optional, there may be associated financial penalties if you do not enroll. For new Medicare enrollees, signing up for Part D coverage is one of the first steps to filing in the coverage gaps of Part A and Part B. However, before you enroll, there are a few things to keep in mind.
You may not qualify for Part D coverage if you already have a Medicare supplement insurance policy. If you want Part D coverage, look for a Medigap policy that bundles it into your plan. Meanwhile, if you have a Medicare Advantage plan, your plan may already include Part D coverage. If it can't, you may be able to get a Part D plan separately (like if you have a Medicare Medical Savings Account plan).
In any case, if you are eligible for Part D coverage and you decide that you want to add it, you can sign up for a Part D policy during your Initial Enrollment Period. Anyone with Medicare Part A and/or Part B qualifies so long as they live in an area serviced by a health plan.
Similarly to Part B, you may have to pay a late enrollment fee if you do not take Part D coverage when you are initially eligible for it. This will be the case if you choose to take Part D at a later date after going 63 consecutive days or more without creditable prescription drug coverage.
If you do not sign up for Part D coverage during your IEP, you can still choose to take it during the Annual Election Period, which runs from October 15 through December 7.
#3 Consider a Medigap or Supplement Policy
If you have decided to take Original Medicare (Parts A and B), you may choose to supplement your coverage with a Medigap policy. These plans are offered through private insurance companies, but as with other parts of your Medicare coverage, you'll need to select and enroll in a plan during certain times of the year or you may face a penalty.
Keep in mind that Medicare Supplement Insurance (Medigap) plans are entirely optional, but most beneficiaries choose one because of the additional coverage they provide. The best time to sign up for a Medigap plan is during the Medigap Open Enrollment Period, which is different for each individual (much like your Individual Enrollment Period).
Medigap Open Enrollment Period lasts for six months, starting on the day of the month when you turn 65 and if you have Medicare Part B coverage. So, if your 65th birthday is February 27 and that’s when your Medicare Part B coverage starts, February 27 is when your Medigap Open Enrollment Period begins. If you delay your enrollment in Part B, your Medigap Open Enrollment Period will not begin until after you have signed up for Part B coverage.
Throughout your Medigap Open Enrollment Period, you can buy any Medigap policy available in your state. No one can reject you application because of disabilities or pre-existing health conditions. They are also not allowed to charge you a higher premium based on your health. However, outside of your Medigap Open Enrollment Period, insurance companies may reject your application or require you to pay more for certain conditions.
#4 Consider a Medicare Advantage Plan
A Medicare Advantage Plan, or Medicare Part C, is your other option for receiving Medicare coverage. There are many myths about Part C, but all Medicare Advantage plans provide Medicare Part A and Part B coverage at minimum. Most also bundle in Part D coverage and coverage for hearing, vision and dental care.
Before you are able to enroll in a Medicare Advantage plan, which can be purchased through a private insurance company, you must first sign up for Medicare Part A and Part B. You then have two periods during which you can choose to enroll in a Medicare Advantage Plan, either the Initial Coverage Period or the Annual Election Period.
The Initial Coverage Period takes place at the same time your Initial Enrollment Period does, unless you have delayed Part B enrollment. The Annual Election Period, which runs from October 15 through December 7 each year, also gives you the opportunity to change, add, or drop your Medicare Advantage plan. In the months leading up to your enrollment period, you should carefully compare different providers and shop around for the best plan so that you enter the enrollment period prepared to make a decision.
Get the Most out of Medicare
Medicare can certainly overwhelm anyone who is unfamiliar with the terminology or details, but once you understand how to apply for Medicare, you'll see that it's actually quite simple. With time, the various Medicare enrollment periods and other nuances won't seem so daunting. In fact, you're sure to get the hang of it in no time if you take a little bit of time to understand your options.
To learn more, reach out to us and one of our Patient Enrollment coordinators will be in touch.
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