Medicare Enrollment & Eligibility
Medicare is a federal insurance program. 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, 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, 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.
There are options for additional coverage, which private insurance providers offer. 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 (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. There are exceptions in the case of disability.
When to Enroll in Medicare
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.
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 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 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 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.
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!
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