Approaching Medicare? New to Medicare? Have questions? You’re not alone, approaching Medicare brings lots of questions such as: Do I need additional coverage? If so, when should I apply? Can I be turned down?
Just like planning a road trip – it helps to have a plan. Medicare can be confusing. Let’s start with the basics.
Stop #1 – Enrolling into Medicare
Who is eligible for Medicare? You must be a US citizen or permanent alien resident.
Will I automatically be enrolled into Medicare?
Typically, Medicare starts the first of month that you turn 65. If you are collecting your Social Security benefits and are approaching your 65th birthday, you will automatically be enrolled into Medicare Part A and Medicare Part B.
If you are disabled and collecting Social Security disability benefits, Medicare will begin on your 25th month on SSDI.
If you have ALS, you will automatically be enrolled into Medicare.
What are some situations that I need to apply for Medicare?
- If you aren’t collecting your Social Security benefits you need to contact the Social Security Administration 1-800-772-1213 to enroll into Medicare.
- If you have ESRD (end stage renal disease) and would like Medicare, you need to contract the Social Security Administration at 1-800-772-1213.
Original Medicare Enrollment Timelines:
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. This is also a good time to review what other insurance coverage you want to go along with Original Medicare (see below)
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 didn’t 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.
Stop # 2 – Applying for additional insurance
Do I need additional insurance to go along with Medicare? Original Medicare is a good base, but it was never intended to be full coverage. Medicare pays 80% after Part A and Part B deductibles are met. There is no max out of pocket protection. Original Medicare doesn’t cover prescriptions, routine vision, routine dental etc. If you want cost protection and additional benefits, you will need to purchase additional insurance sold by private companies.
Medicare Advantage, also known as Part C, has certain times that you can enroll into a plan. Your IEP, or the initial enrollment period, is the 7 months when you are first eligible for Medicare. SEP, or a special enrollment period, is a time you can enroll into a Part C plan because of scenarios such as: you moved, or are dual eligible for Medicare and Medicaid, lost your group coverage etc. AEP, or the Annual Election Period, October 15th – December 7th every year you can change, add or drop your Medicare Advantage plan.
Medigap– also known as Medicare Supplement insurance, has an Open Enrollment which starts the month you turn 65 and last for 6 months. During this time frame you can’t be turned down for a Medigap policy.
If you are past the open enrollment window you maybe medically underwritten for a Medigap insurance policy. You can be turned down, charged higher rates and/or you may have a pre-existing condition limitation for a Medigap policy. Some states have guarantee issue rules. Our seasoned agents can help answer questions about your state.
If you are under 65 and disabled, some states have guarantee issued rules for Medigap open enrollment.
Part D – also known as stand-alone prescription drug plans, have enrollment periods like Medicare Advantage. Your IEP or the initial enrollment period is the 7 months when you are first eligible for Medicare. SEP, or a special enrollment period is a time you can enroll into a Part D plan because of scenarios such as you moved, or are dual eligible for Medicare and Medicaid, loss of group coverage etc. AEP, or the Annual Election Period, October 15th – December 7th every year you can change, add or drop your Part D plan. NOTE _ You can only have one plan with prescription coverage. If you Part C plan has Part D included, then you don’t need a stand-alone Part D Plan.
Step 3 – Annual Medicare review
It’s a good idea to have regular reviews of your Medicare insurance. Coverance Insurance Solutions Inc will do free no cost no obligation Medicare review to make sure you are maximizing your Medicare benefits. Call today 888.664.2236