Medicare Enrollment and Eligibility

About Medicare

Medicare is a federal insurance program. The coverage of each plan differs from patient to patient. As each one of them has different health requirements, therefore they opt for a plan that suits them the most. Medicare offers many choices in coverage to best meet the needs of everyone. Individuals interested in enrolling in Medicare should take the time to compare their healthcare needs with the plans that are available in their area. The government offers it to people who are at least 65 years old or above and also to individuals who have qualified for social security disability for 24 months. Once you become admitted into it, then you can choose from plenty of coverage options that go well with your needs.

Medicare ‌cover health concerns, and some other out-of-the-pocket expenditures for those who are eligible. One thing to keep in mind is that the coverage of the Medicare plan may vary from individual to individual according to the plan they choose and their Medicaid and health condition. Because of this reason, Medicare offers different plans, and it’s up to your choice to choose the plan that best meets your needs. Patients that are interested in acquiring enrolled in Medicare, should do their research and compare the pros and cons of different plans before choosing the right one for their medical and health needs that is available in their residential location.

Medicare Enrollment and Eligibility

You can apply for Medicare if you’re 65 years old or above and also if you have any disability, but there are some requirements that you need to fulfill to gain maximum Medicare benefits at ‌65 or above. Some of the main requirements include the following points:

• 65 years or older (or younger individuals when qualifying disabilities apply).
• Citizen or permanent resident of the U.S.
• If you are already receiving benefits from Social Security or the Railroad Retirement Board then you will receive a letter by mail notifying you of your Medicare eligibility, as well as informational materials about Medicare.

Important things to know about this notification:

• It will arrive roughly 3 months prior to your 65th birthday.
• The information material will explain the choices available to you and how to act on them.
• You may decide to accept this Medicare enrollment or postpone it. If you are still employed and covered by employer insurance, you may decide that postponing until retirement is the right decision for you.

If you are not receiving Social Security or Railroad Retirement Board benefits, then you won’t receive notification about your Medicare eligibility. In case, if you’re not part of receiving Social Security or Railroad Retirement benefits, then you cannot receive a notification related to your Medicare Eligibility.

Medicare Supplement Plan Eligibility

One thing to keep in mind is that one patient cannot enroll for Medicare advantage or Medicare supplement (also known as Medigap) at the same time. With the help of the Medicare supplement plan, it will ‌cover your out-of-the-pocket expenses that are gaps in Medicare parts private insurance companies. Medicare beneficiaries will ‌cover your deductibles, coinsurances, and copayments from the original Medicare.

Some of the requirements that you need to qualify for Medigap coverage are mentioned below:

•  The patient must be 65 years old or above.
•   The patient has been diagnosed with Lou Gehrig’s disease.
•  The patient has been entitled to Social security and Railroad retirement benefits for more than 24 months.

The patient needs a kidney transplant or dialysis.

Medicare Choices & Coverage

For choosing a Medicare coverage plan for yourself, you might feel overwhelmed because plenty of options are available. Each option covers different health needs, and they vary according to location as well. Once you are eligible for Medicare, you can choose your enrollment choices per your medical and health needs. Patients who are receiving Social security benefits become automatically enrolled. If not so, then they can sign up online easily on Social Security Administration (SSA).

An interesting fact to know is that you can apply for Medicare even if you’re not retiring yet mentioned by cms.gov. It will give you a safe spot for your future but one thing to keep in mind is that you can get yourself signed up only at specific months of the year. If you’re not entitled to Social Security benefits, then you can also pay monthly premiums to acquire into that plan. The cost-sharing chart below will provide details on premiums for parts A. Therefore, it is important for you as a patient to understand the rules and regulations for enrollment in Medicare to avoid mistakes.

The federal government provides Original Medicare to patients including parts A and B. There is a facility that if you or your spouse has worked and paid for Medicare taxes for a minimum of 10 years, then you are eligible for the coverage of Part A that is premium permitted. For Part B, you have a choice whether to enroll right away or postpone it and it also comes with the cost of the monthly premium.

Moreover, there are 2 options available from private insurance companies for your additional coverage. You can choose wisely from both of the routes that are discussed below:

Option 1: Keep Original Medicare and Add Supplement Insurance

Original Medicare allows you to combine Parts (A, B, D) and Plans (i.e., F, G, N) to achieve the level of coverage you desire. For example, you could add Part D drug coverage or a Medicare Supplement (i.e., F, G, N), or add both to Parts A and B.

Option 2: Enroll in a Medicare Advantage Plan

Medicare Advantage (Part C) offers some additional benefits that Medicare does not provide, however, they are managed private network plans, and the insurance carrier approves claims as opposed to Medicare.

Is My Spouse Covered Under Medicare?

Some assume that Medicare automatically covers their spouse once they qualify themselves. However, there is no family coverage provided under Medicare. The minimum age of eligibility for Medicare is 65. Your spouse will have to meet this requirement regardless of your qualification. If a person retires and enrolls in Medicare, the spouse will need to find other health insurance until they are eligible by age.

The next most asked question is-

When to Enroll?

Here are the options with brief details:

Original Medicare Parts A and B

When you become eligible for Medicare at age 65, you can enroll in Original Medicare Part A and Medicare Part B. You can also postpone enrollment in Part B due to its monthly premium if you have creditable coverage. If you receive Social Security benefits or Railroad Retirement Board benefits, then you are automatically enrolled. If not, then you must contact a Social Security office or visit Medicare.gov.

Medicare Part C and Part D

Once you are eligible for Original Medicare, you are also eligible for Medicare Parts C and D. Part C is Medicare Advantage. Part D is prescription drug coverage. Private insurance companies provide these plans and have their own enrollment processes apart from your Original Medicare enrollment.

Medicare Supplements

Once you have turned 65 and have enrolled in Original Medicare, you can purchase a Medicare supplement at any time. Private insurance companies also provide supplement plans with their own enrollment processes.

Enrollment Periods for Medicare:

There are specific periods during the year when a person can enroll in Medicare, whether registering for the first time or switching plans.

Initial Enrollment Period

The Initial Enrollment period refers to a seven-month period when a person first becomes eligible to enroll. It includes the three months before the person’s 65th birthday, the month of their birthday, and the three months after. The timing is different in the case of disability.

Medicare Annual Election Period

The Annual Enrollment period refers to the yearly period of October 15 – December 7. Any Medicare recipient can enroll at this time or change Medicare plans. Coverage begins on January 1 of the following year.

Special Enrollment Period

The Special Election period is for those who chose not to enroll during their initial enrollment period. If the person meets the requirements, they are allowed to enroll in Medicare without penalty.

General Enrollment Period

For those who did not enroll during their initial enrollment period or a special enrollment period, there is another chance to enroll between January 1 – March 31. Late penalties apply in some cases.

Medicare Supplement Open Enrollment Period

The Medicare Supplement Open Enrollment period refers to the six-month period in which a person can buy Medicare Supplement Insurance. The period begins in the month of the person’s 65th birthday (and once enrolled in Part B) and extends for five months. During this period, the person can buy any available plan regardless of their health status. If the person misses this period, they can still purchase supplemental coverage, but higher premiums may apply or possibly coverage denial.

A person can also switch plans if they qualify for a Guaranteed Issued policy. States such as MA, CT, CA, OR, and WA allow Medicare recipients to change plans without answering health questions outside their initial Open Enrollment period. They don’t allow you to switch in all situations, but they enable more cases to switch plans. For example, California’s birthday rule permits changing plans up to 60 days from the day of your birthday.

Retirement & Medicare Choices:

Retiring Before 65

Individuals are only eligible for Medicare once they have turned 65, or in the event they have a qualifying disability. So, if you retire before 65 and no longer receive employer insurance coverage, you will need to find another insurance plan until you are eligible for Medicare.

Retiring at 65

At age 65, you are eligible to enroll in Medicare. In addition, you may choose to enroll in supplement plans or Medicare Advantage Plans. If your employer offers health insurance to retirees, it is important to review the company’s plan. Your employer may not offer health insurance once Medicare is eligible.

Continuing to Work After 65

If you continue to work after turning 65, you can enroll in Medicare or postpone it. Many choose to enroll in at least Part A, as there is no monthly premium for those that paid into social security for ten years. Some choose to enroll in Parts A and B; however, Part B comes with a monthly premium and can be taxed. The individual’s income determines the Part B premium cost, so this is a factor to consider.

Retiring After 65

If you have decided to work past 65 and have creditable coverage through your employer, you are eligible for a Special Enrollment Period once you choose to retire. The Special Enrollment Period will give you two months when your employer insurance coverage ends to enroll in a Medicare Advantage or Supplement plan. Signing up for a plan before retiring will ensure no coverage gaps and help you avoid penalties.

The most asked question related to retirement and Medicare choices is-

Which part should I choose?

As you have so many options available, you need to sort out your choices to prevent yourself from choosing the wrong option. We advise you first to clarify your health concerns, finalize a budget and then select the best sign-up option available for the plan. Many patients opt for plans A, B, and D, adding Medigap coverage. Some of them go with the Medicare advantage plan. Therefore, it is necessary to check the cost of the plan first, especially if you’re retired as you have a minimum option available to enroll in Part A and Part B. ‌In case you decide to work after your retirement while having eligibility for group health plan coverage, then you can Medicare options differently. The best way to clear up this confusion is by communicating with your current employer’s human resource department. They will help you ‌choose options that are not overlapping.

Conclusion

If you want to learn more about your Medicare eligibility, connect directly with one of our trusted agents. We love assisting with your Medicare needs and ensuring our clients make the right choices for them. Prefer to speak by phone? Give us a call today!

Prefer to chat by phone? Give us a call at 1-888-559-0103.

Sources:

Top 5 things you need to know about Medicare Enrollment, cms. gov,8/15/2022

Who is eligible for Medicare? hhs.gov, 8/15/2022