Medicare Enrollment & Eligibility
Medicare is a federal insurance program that assists over 60 million Americans, covering both older individuals and those with qualifying disabilities. The insurance coverage it provides helps individuals save on their health care costs.
Medicare coverage may look different for different people based on their health care needs. 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 health care needs with the plans that are available in their area.
Eligibility for Medicare
Generally, individuals are eligible for Medicare if they meet the following criteria:
- 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 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 this case, you must contact a Social Security office to enroll in Original Medicare. You will want to make sure to do so before turning 65, in order to avoid any gaps in coverage.
Medicare Choices & Coverage
There are multiple parts to Medicare coverage that cover different health care needs. If you are eligible for Medicare, then you can choose which parts you would like to enroll in.
Original Medicare (Parts A and B) is insurance provided by the federal government. If you or a spouse worked and paid Medicare taxes for at least 10 years, you are eligible for premium-free Part A coverage. You can enroll in Part B at this same time or delay enrollment. Part B comes with a monthly premium.
If you feel that you need or would like additional coverage, there are more choices available to you, which are offered by private insurance providers. To add additional benefits, there are two routes of coverage to choose from:
Option 1: Keep Original Medicare and Add Supplement Insurance
Original Medicare allows you to combine parts and plans to achieve the level of coverage you desire. For example, you could add Part D drug coverage or a Medicare Supplement to Parts A and B. You could also add both.
Option 2: Enroll in a Medicare Advantage Plan
Medicare Advantage (Part C) combines coverage from Part A and Part B into one plan. These plans come with or without drug coverage. Plans without drug coverage allow you to add a standalone Part D plan.
A licensed agent can help guide you through the enrollment process. Connect directly with one of our agents to learn more with no obligation.
Is My Spouse Covered Under Medicare?
Some assume that their spouse is automatically covered by Medicare 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 own qualification. In the event that a person retires and enrolls in Medicare, the spouse will need to find other health insurance until they are eligible by age. There are exceptions in the case of disability.
When to Enroll in Medicare
Original Medicare Parts A and B:
As soon as you become eligible for Medicare at age 65, you can enroll in Original Medicare Part A and Medicare Part B. If you are waiting to retire until a later date, you may want to consider postponing enrollment in Part B due to its monthly premium. If you are already receiving 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.
Once you have turned 65 and have enrolled in Original Medicare, you can purchase a Medicare supplement at any time. Supplement plans are also provided by private insurance companies with their own enrollment processes.
Enrollment Periods for Medicare
There are specific periods during the year for when a person can enroll in Medicare, whether enrolling for the first time or switching plans.
Initial Enrollment Period:
This refers to a seven-month period when a person first becomes eligible to enroll. It includes the three months prior to 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 Open Enrollment Period:
This 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:
This period is for those who chose not to enroll during their initial enrollment period. If the person meets certain 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 during 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:
This 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 an additional 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.
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 a Medicare health plan. In addition, you may choose to enroll in supplement plans or Medicare Advantage Plans. In the event that your employer offers health insurance to retirees, it is important to review the company’s plan. In some cases, the plan may require you to enroll in Original Medicare.
Continuing to Work After 65:
If you are continuing to work after turning 65, you have the option to enroll in Medicare or postpone it. Many choose to enroll in at least Part A, as there is no monthly premium. Some choose to enroll in Parts A and B, however Part B comes with a monthly premium. The individual’s income determines the Part B premium cost, so this is a factor to take into consideration.
Retiring After 65:
If you have decided to work past 65, you are eligible for a Special Enrollment Period once you choose to retire. The Special Enrollment Period will give you 63 days from the time your employer insurance coverage ends to enroll in a Medicare policy. Signing up for a plan before retiring will ensure there are no gaps in coverage and will help you avoid penalty.
If you would like 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 choices that are right for them. Prefer to speak by phone? Give us a call today!