Are you about to turn 65 or are you currently 65 or older and considering applying for Medicare? HealthPocket can assist you. The following is information regarding when and the steps you should take to apply depending on the coverage you need and your personal circumstances.
Most U.S. citizens or permanent residents who are 65 or older qualify for free Medicare Part A which covers hospital insurance. You are eligible for free Medicare Part A if you or your spouse receive or are eligible for Social Security benefits (or railroad retirement benefits) or if you or your spouse worked for 10 or more years as a “qualified wage earner” and paid Medicare taxes during your employment. You can qualify for Original Medicare based on your spouse’s work record if he or she is at least 62 years old.
Additionally, you are eligible for free Medicare Part A if you are the dependent parent of a fully insured deceased child. You can still obtain Medicare Part A coverage if you don’t meet these aforementioned requirements by paying a monthly premium. This premium is reduced if you have 30-39 work credits but if you have less than 30 work credits you must pay the full premium. If you elect to continue working until you reach 40 work credits you no longer have to pay Part A premiums. If you pay for Part A you must also enroll in part B. However, you can enroll in Part B without buying Part A. Certain individuals can also sign up for Original Medicare before the age of 65 if they meet disability requirements, are on dialysis or need a kidney transplant due to permanent kidney failure, or have Lou Gehrig’s disease.
If you are eligible for Medicare Part A you are also eligible for Part B which covers medical insurance by paying a monthly premium. You may pay a higher premium if your income is high relative to other beneficiaries. If you are a dual eligible and you qualify for both Medicare and Medicaid you may be able to receive “extra help” from your state to help pay for your Part A and Part B premiums and other medical costs.
If you are currently receiving Social Security retirement or disability benefits you will be contacted before you become eligible for Medicare and provided information. You will be automatically enrolled if you live in:
However, if you live in Puerto Rico or a foreign country you must elect Part B, you will not receive Part B automatically.
If you are not currently receiving retirement benefits you should contact the social security administration via their toll free number: 1-800-772-1213 three months before you turn 65 to sign up for Original Medicare Parts A & B. If you are deaf or hard of hearing you can call 1-800-325-0778. A Social Security representative is available on both of those lines from 7 AM to 7 PM EST Monday through Friday and their automated telephone services are available 24 hours a day. You can sign up for Original Medicare even if you do not plan to retire, but if you are presently covered by your employer-sponsored group health plan or your spouse’s employer-sponsored group health plan, then you should first contact your HR department or insurer before you sign up for Medicare to see if your current plan works with Medicare. Alternatively you can apply for Medicare Part A & B online, which may be a more convenient option since you can save an unfinished application and make corrections to your application before you submit it. After you submit your application electronically, you are able to check on the status of your application online as well. For your Original Medicare Application you will need the following information: your date and place of birth, your current health insurance information including employment start and end dates for you or your spouse and start and end dates for your employer-sponsored health insurance. If you are enrolled in Medicaid you will also need your Medicaid number and start and end dates.
Initial enrollment period for Part B: Once you become eligible for Medicare Part A you have a seven-month initial enrollment period to apply for Medicare Part B. The initial enrollment period spans from three months before to three months after your 65th birthday. Refer to the following table to determine when your Part B coverage starts depending on when you enroll:
|When You Enroll During Initial Enrollment Period||When Part B Coverage Starts|
|1-3 months before age 65||Your 65th birthday month|
|Your 65th birthday month||1 month after your 65th birthday month|
|1 month after your 65th birthday month||2 months after month of enrollment|
|2-3 months after your 65th birthday month||3 months after month of enrollment|
If you wait to enroll and you do not sign up for Part B during the initial enrollment period you can still sign up during the annual enrollment period from January 1st to March 31st and your coverage begins July 1st. However it is important to note that your monthly premium increases 10% for every year which you were eligible but did not enroll in Part B. If you are covered under an employer-sponsored group health plan you qualify for a special enrollment period and the 10% premium increase does not apply to you. You are also able to enroll in Part B at any point while you are enrolled under the employer-sponsored group health plan. Once your job-based health coverage ends you can enroll in Part B during an eight-month period after the month your job-based coverage ends. Visit our special enrollment period page for further information.
Medicare Advantage (MA) plans are offered by private insurance companies that have been approved by Medicare. You may enroll in a Medicare Advantage plan if you already have Medicare Parts A & B and many Medicare Advantage plans include prescription drug coverage (MAPDs). Because Medicare Advantage plans usually cover many of the same benefits as Medicare supplement plans also known as Medigap plans, you cannot enroll in a Medigap plan if you are already enrolled in a Medicare Advantage plan. A recent HealthPocket study found that Medicare Advantage is the more cost effective insurance option for the typical new Medicare enrollee. Furthermore, in another study, we found that nearly all Medicare Advantage plans include at least one vision, dental, or hearing benefit that is not included with Original Medicare Parts A & B:
Any Medicare beneficiary enrolled in either Part A or Part B or enrolled in a Medicare Advantage plan is eligible for Part D, also called PDP plans. Similar to Medicare Advantage plans, PDP plans are sold by private insurance companies and joining a Part D plan is voluntary. If you have other prescription drug coverage you can wait to enroll in Part D but you will have to pay a penalty, so it is best to sign up for a PDP plan during your initial enrollment period if you anticipate needing the plan. After the initial enrollment period is over, the period to change your plan provider is from October 15th to December 7th. Special enrollment periods also apply for certain individuals experiencing qualifying situations.
Our Medicare plan comparison tool can help you compare Medicare Advantage & PDP offerings from various insurers in your area or you can call.
“Do you Qualify for Medicare?” (January 21, 2014) http://www.aarp.org/health/medicare-insurance/info-04-2011/medicare-eligibility.html