Original Medicare consists of Part A for hospital services and Part B for medical services. Once you have Medicare Part A and Part B you can purchase Part C and/or Part D from private companies. Let’s examine further.
How do I get Medicare Part A?
If you have worked 40 quarters, you will be enrolled into Medicare Part A three months before your 65th birthday or the 25th you are collecting Social Security disability benefits. For more on enrollment into Original Medicare click here.
How do I get Medicare Part B?
You get Medicare Part B automatically 3 months before your 65th birthday if you are collecting your social security benefits. If you aren’t collecting your Social Security or are covered under an employer plan, please contact SSA at 1-800-772-5772. For more information on enrolling in Original Medicare click here.
Medicare Part A and/or Part B Enrollment Periods:
Initial Enrollment Period – this period starts 3 months before your 65th birthday and ends three months after your birthday month. You have a total of 7 months to sign up for Medicare Part A and/or Part B. If you sign up in the 3 months prior to your 65th birthday your coverage will start on the 1st day of your birthday month. If you wait until your birthday month, your coverage will start the next month. If you wait until 3 months after your birthday, your enrollment into Part A and/or B will be delayed.
Special Enrollment Period – If you miss your initial enrollment period, depending on your circumstances, you may still be able to enroll in Part B during a special enrollment period or (Part A if you haven’t worked more than 40 quarters.) Having group, employer, or union health coverage (from yourself or your spouse) is the most common reason to delay enrollment into Medicare. You can sign up anytime while you’re still covered by a group/employer/union plan. After your group/employer/union coverage ends, you will have 8 months to enroll into Medicare. During a special enrollment period, there usually isn’t penalty for enrolling late.
PLEASE NOTE – Very important – taking COBRA will not count as credible coverage and you will be assessed a late enrollment penalty when you do enroll into Part B (and/or Part A if you need to purchase it.) This means you will have to wait until the General Enrollment Period (see below) and your Part B (and/or Part A) premium will cost more money.
General Enrollment Period – If you did sign up for Part B (or Part A if you need to purchase it) when you were first able (during your initial enrollment period and you didn’t have a special enrollment period), there is an annual General enrollment period from January 1 – March 31. Your Medicare coverage will begin July 1. Your Part B (and/or Part A) premium will be assessed a penalty, therefore it will be higher than if you enrolled during your Initial enrollment period.
Part C (Medicare Advantage)
To join a Medicare Advantage, plan you need to live in the plans service area, have Medicare Part and Part B, continue to pay your Part B premium, and do not have End Stage Renal disease. You cannot be turned down for a preexisting condition. You may enroll into a plan during an enrollment period.
Medicare Part D
Medicare Part D is the optional prescription drug coverage available by private companies contracted with Medicare. If you have Original Medicare Part A and/or Part B, live in the service area, you can sign up Part D. Part D is optional, however, if you do not sign up when first eligible, you’ll likely pay a penalty when you enroll in a Part D plan.
Enrollment into a Medicare Advantage Plan and/or Part D plan
There are enrollment periods that you may join, change or leave a Medicare Advantage (MA) Plan.
Initial Coverage Election Period- (ICEP) You may elect to join a MA plan when you are first enrolling into Original Medicare. Your ICEP window is 7 months long around your 65th birthday. You may join 3 months before your 65th birthday, the month of your birthday and 3 months after your birthday. If you are disabled and receiving Social Secuity benefits, you have a 7-month ICEP window around the 25th month that you have been collecting SSDI benefits.
Annual Election Period (AEP) – AEP runs every year from October 15th – December 7th. This is time to add, drop or change your Medicare Advantage plan for the next year. Every October 1st Medicare Advantage Plans release the next year plan benefits. It pays to compare your current plan with the new plans to make sure you are maximizing your Medicare benefits.
Open Enrollment Period (OEP) – OEP, starting in 2019, will run from January 1st – March 31st. It gives you one chance to make a like to like plan switch.
Special Election Period (SEP) – once you have enrolled into a Medicare Advantage plan, you are typically in that plan until the next AEP. However certain circumstances can open a special enrollment period, such as moving outside the plan’s service area, being Dual Eligible for Medicare and Medicaid, receiving prescription assistance from the federal government, and several others. You may have a SEP and not realize it. Our trained agents can assist to see if you qualify for an SEP.