Medicare enrollment can be complicated, especially for people who hadn’t given much thought to their options because they had coverage through their employer or their spouse’s employer.
Medicare is a federal health insurance program. It was initially intended to cover the costs of hospital stays and doctor’s office visits of seniors. Eventually, the program expanded to include preventative care, prescription medications, and people under the age of 65 who have disabilities or are suffering from long-term medical conditions.
If you’re planning to sign up for Medicare, here are the top four things that you need to know:
- Eligibility Requirements
To qualify for Medicare, you need to meet the following requirements:
- Citizenship or residence: You need to be either an American citizen or a permanent resident to be eligible for the benefits.
- Age: You should be at least 65 years old.
- Disability: If you’re under the age of 65, you should have received Social Security or Railroad Retirement Board disability payments for 24 months consecutively.
- Health condition: If you’re under the age of 65, you must be diagnosed with Lou Gehrig’s disease, amyotrophic lateral sclerosis (ALS), or end-stage renal disease (ESRD)
If you have questions about eligibility, you can contact the counselors at your state’s health insurance assistance program. You can also check out the resources from licensed and accredited insurance agencies like Boomer Benefits – We Speak Medicare.
- Four Parts
Medicare isn’t a one-stop policy—its benefits are offered in parts. Part A and Part B are also known as Original Medicare. Part C is often referred to as Medicare Advantage. Part D covers prescription drugs. Check out their differences below:
- Part A: This covers the usual hospital expenses you’d incur if you get ill or had to get surgery. Some examples include stays in a semi-private hospital room, stay at a nursing facility, hospice or home care, meals, blood transfusions up to three pints, and any other medical services you get while you’re hospitalized.
- Part B: This offers benefits for outpatient healthcare services and procedures. Some examples include doctor and therapy (occupational or physical) visits, diagnostic and lab testing, certain treatments like chemotherapy, preventative care like mammograms or flu shots.
- Part C: This is a policy offered by private companies authorized by Medicare. It provides the benefits of Parts A and B, plus coverage for medical services such as dental, hearing, or vision, which aren’t usually included in the previous two parts. You can choose either Original Medicare or Medicare Advantage—you can’t have both.
- Part D: This covers expenses for prescription drugs. If you have Original Medicare, you’ll need to apply for Part D separately to obtain drug coverage. If you have Medicare Advantage, drug coverage may or may not be part of your plan—you’ll need to check with your specific insurance provider.
The premiums you need to pay also depend on the plan you’re getting. Part A is free for those who have paid for Medicare while working, have received disability benefits, or were diagnosed with certain medical conditions. Most people pay an annual deductible and a standard monthly premium for Part B. The premiums, deductibles, and co-pays for Part C depend on the specific provider. Part D’s premiums depend on the plan’s coverage.
- Enrollment Options
Enrollment into the Original Medicare program may be done automatically or by voluntarily signing up. If you want to know which option applies to your case, check out the information below:
- Automatic enrollment: Those living in the U.S. and its territories (excluding Puerto Rico) are automatically enrolled into Parts A and B if they’re already collecting Social Security benefits of retirement or disability. They can decline Part B, but not Part A, unless they pull out their Social Security application and pay back all the cash benefits they’ve received so far.
- Voluntary sign-ups: Those not eligible for automatic enrollment will need to contact Social Security to sign up.
If you’re approaching 65, check whether you’re automatically enrolled to Medicare by visiting or contacting your local Social Security office.
- Enrollment Deadlines
You only have seven months to sign up for Medicare—this timeline starts three months before your 65th birthday. If you’re eligible for automatic enrollment, you’ll receive your Medicare card in the mail on the 25th month after you’ve started receiving Social Security disability benefits or three months before you turn 65.
If you’re not eligible for automatic enrollment, make sure to enroll before the deadline passes. Otherwise, you’ll have to pay the penalty for late enrollment—which will recur every month you’re covered by Medicare.
Medicare enrollment can be complicated, especially for people who hadn’t given much thought to their options because they had coverage through their employer or their spouse’s employer. However, your health insurance needs change with age. You may need to make ongoing choices depending on your healthcare providers, medications, income, and location to ensure you’re getting the right Medicare combination.