When Are You Eligible For Each Part Or Plan In Medicare
Here is an at-a-glance overview of when youll be eligible for each part of Medicare:
- Part A. Youre eligible to enroll for Medicare Part A during the initial enrollment period. Youll automatically be enrolled at age 65 for Medicare Part A if youre currently receiving Social Security disability benefits or railroad retirement board disability benefits.
- Part B. As with Medicare Part A, youre eligible to enroll for Medicare Part B during initial enrollment, and youll be automatically enrolled if you receive disability or retirement benefits.
- Part C . To enroll in Medicare Part C, you must first have parts A and B. You sign up for Medicare Part C during initial enrollment or other enrollment periods.
- Part D. You can enroll in a Medicare Part D prescription drug plan when you first get Medicare during initial enrollment. If you dont sign up for Medicare Part D within 63 days of your IEP, you may incur a late enrollment penalty.
- Medicare supplement . The initial enrollment period for Medigap is triggered by the start of the month when you turn 65 years old and sign up for Part B. Initial enrollment for Medigap lasts for 6 months from that date.
Is There Any Way To Get Out Of Late Enrollment Penalties
There are two possible scenarios:
1) If you receive bad advice from a federal employee about Medicare enrollment.
You can request equitable relief from the Social Security Administration if you are charged late enrollment penalties for failing to enroll in Medicare due to erroneous advice you received from a federal employee. To do this, you should write a letter to your local Social Security office. Be sure to include as many specific details as you can, such as who you spoke to, the date and time of your conversation, any notes you took, and the actions you took as a result of the advice you received.
2) If you had creditable coverage, but your Medicare plan does not have a record of it.
If you receive notice from your Medicare drug plan or Medicare Advantage plan that you owe late enrollment penalties, you can request a review by completing the reconsideration request form you get with the notice. You can include whatever proof necessary to make your case, such as information you have about previous creditable drug coverage.
If you lose creditable coverage through an employer or through another source, your Medicare carrier will reach out to verify your prior qualifying coverage. Be sure to respond to any correspondence about verifying creditable coverage. Without a response, a penalty will be assessed and it can be difficult to appeal the decision.
When Can You Change Medigap Plans
Just as you can enroll at any time of the year , you also can change Medicare Supplement plans at any time. But again, if its not during your Medigap Open Enrollment Period or if you dont have a guaranteed issue right, you must pass the providers medical underwriting process to qualify in most states.
Some states including California, Washington, Oregon, Missouri and some others allow you to change Medicare Supplement plans without going through the underwriting process.
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How To Cancel Medicare Part B
The Part B cancellation process begins with downloading and printing Form CMS 1763, but dont fill it out yet. Youll need to complete the form during an interview with a representative of the Social Security Administration by phone or in person.
Due to the COVID-19 pandemic, all Social Security Administration offices are currently closed. The SSA is still answering phone calls, and you can access many services on its website. See the latest COVID-19 updates.
Call a Licensed Agent:
You can schedule an in-person or over-the-phone interview by contacting the SSA. If you prefer an in-person interview, use the Social Security Office Locator to find your nearest location. During your interview, fill out Form CMS 1763 as directed by the representative. If youve already received your Medicare card, youll need to return it during your in-person interview or mail it back after your phone interview.
What happens next depends on why youre canceling your Part B coverage.
When Can You Enroll In A Medigap Plan
If you do consider enrolling in a Medigap plan Medigap plans, you should try to apply for a plan during your 6-month Medigap Open Enrollment Period. Your Medigap Open Enrollment Period is a 6-month period that starts the day you are both 65 years old and enrolled in Medicare Part B.
During your 6-month Medigap Open Enrollment Period, you do not have to undergo medical underwriting, which means the insurance company cannot turn you down or charge you higher premiums because of any pre-existing health condition.
If you don’t change Medicare Supplement insurance plans during your Medigap Open Enrollment Period, your insurer can force you to undergo medical underwriting, and they can now assess your health history during the application process and can turn you down if it chooses.
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Who Can Use Medicare Easy Pay
Anyone who pays a Medicare Part A or B premium can sign up for Easy Pay at any time. To set up Easy Pay, you can contact Medicare for the appropriate form, or it can be printed online.
Once the form is submitted, however, ongoing participation in the Easy Pay program does not require Internet access.
You must have a bank account set up for the automated monthly payments to be withdrawn from.
How To Enroll In A Medicare Advantage Plan
You usually have several choices if you want to enroll in a Medicare Advantage plan.
- Arrange a time to talk with us, and we can help you enroll. Use the links below to set up a phone call.
Remember, you must be enrolled in Medicare Part A and Part B to be eligible for Medicare Advantage, and you have to live in the plans service area. If you are under 65 and have end-stage renal disease , you can generally enroll in a Medicare Advantage plan.
Start comparing plans by entering your zip code on this page.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
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What Else Do I Need To Know
- Medicare can help cover your costs for health care, like hospital visits and doctors services.
- Most people dont pay a premium for Part A, but you do pay a monthly premium for Part B.
- If you cant afford the monthly premium, there are programs to help lower your costs. Get details about cost saving programs.
Sign Up For Original Medicare
Most Americans need to sign up for Medicare Part A, hospital insurance, and Medicare Part B, medical insurance when they reach 65. You can do so online or through your Social Security office.
In most cases, you wont receive Medicare benefits automatically unless you sign up. But if you already receive benefits from Social Security or the Railroad Retirement Board, youll be automatically enrolled.
If you dont enroll in Part B during the seven months around your 65th birthday, your Initial Enrollment Period, you could incur a penalty.
There is an exception, though: If youre still working and have health coverage through your job, you can sign up for Part A, which usually involves no premium, and you may be able to delay signing up for Medicare Part B . To avoid penalties for delayed enrollment, you must have medical coverage through your or your spouses job.
If you or your spouse have worked for at least 10 years, you typically wont pay a premium for Medicare Part A coverage.
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How To Apply For Medicare Part B
If you’re nearing 65 and you’re not receiving Social Security or Railroad Retirement Board benefits, you’ll want to apply for Part B as soon as you can. Similar to Part A, you can apply doing any of the following:
- Call the Social Security Administration at
- Go to your local Social Security office
- Sign up online at ssa.gov
If you already receive Social Security or RRB benefits, you don’t need to do anything. You’ll receive a Medicare red-white-and-blue card about three months before your 65th birthday. If disabled, you’ll receive your card during your 25th month of disability. Even if you dont want Part B, you can follow the instructions on that same card and return it.
Dont Register For Medicare Alone
If youre uncomfortable with applying for Medicare alone, we can help! Our services are completely free for you. If you would like an agent by your side when applying, contact us. We can walk you through setting up all your coverage, including Medicare, Medigap, Part D, and more.
Plus, when you use us to apply, you get unlimited support from our Client Service Team. That means if you have any issues with claims or appeals, we can help at no additional cost. You can compare rates online or give us a call today at the number above.
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When To Sign Up For Medicare Plans
When you sign up for the various Medicare coverages and when each one comes into effect varies with the different Plans. A general outline follows specific situations or health conditions touch off a number of different enrollment periods. For fuller details see the publications.
Enrolling in Medicare parts A & B:
Part A
For qualified individuals, you should sign up during the “Initial Enrollment Period” of seven months around the month you turn 65 . Note that this may be before you can or choose to file for Social Security benefits. If you enroll prior to the birthday month, you will start being covered as of your birthday month. If you enroll during the last four months of the period, coverage will start with an additional month’s delay.
If you didn’t sign up for Part A during your Initial Enrollment Period, you can sign up during the “General Enrollment Period” between January 1 and March 31 each year. Coverage will begin July 1. If you are a qualified individual, there may be a penalty premium for late sign-up, as mentioned above .
In certain cases, if you did not sign up for Plan A when initially eligible because you were covered under a group health plan based on current employment, you can sign up later during a “Special Enrollment Period”. See Publication 11219 for details.
Part B :
Part C and Part D :
Some addiitonal information on Medicare sign up can be found at the following non-US government links:
I Am Receiving Social Security Retirement Or Railroad Retirement Board Benefits
You will be enrolled in Original Medicare automatically when you turn 65. Youll get your Medicare card in the mail. Coverage usually starts the first day of your 65th birthday month.
If you have other , you can delay Part B and postpone paying the premium. You can sign up later without penalty, as long as you do it within eight months after your other coverage ends. If you dont qualify to delay Part B, youll need to enroll during your Initial Enrollment Period to avoid paying the penalty. You may refuse Part B without penalty if you have creditable coverage, but you have to do it before your coverage start date. Follow the directions on the back of your Medicare card if you want to refuse Part B.
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How Do I Know If Im Enrolled In Medicare Easy Pay
When processing for Medicare Easy Pay is complete, you will receive what looks like a Medicare Premium Bill, but it will be marked, This is not a bill. This is just a statement notifying you that the premium will be deducted from your bank account.
From that point on, you will see your Medicare premiums deducted from your bank account automatically. These payments will be listed on your bank statement as Automatic Clearing House transactions, and occur around the 20th of each month.
When Do I Sign Up For Medicare Advantage
Before you sign up for Medicare Advantage, make sure you weigh the pros and cons of Medicare Advantage vs. Medicare Supplements. If you choose to sign up for Medicare Advantage, you can do so during your IEP.
If you missed your IEP, you can join during the Medicare Annual Enrollment Period. For those currently enrolled in a Medicare Advantage plan, you also have another opportunity to make changes during the Medicare Advantage Open Enrollment Period.
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Exceptions To The Part B Late Enrollment Penalty
You may avoid the Medicare Part B late enrollment penalty under some circumstances. That is, you may qualify for a Special Enrollment Period if you or your spouse are working and youre covered through a group health plan through the employer or union.
If you qualify for a Special Enrollment Period, you likely wont be charged penalties when you sign up for Medicare Part B. Additionally, this period begins the month that your employment ends, or the month that your insurance coverage through the group health plan ends, and lasts for 8 months.
Canceling Part B Because You Got A Job With Insurance
If you have had Part B for a while but no longer need it because youve rejoined the workforce with access to employer-sponsored health insurance, congratulations! But before you drop Part B, find out if your jobs coverage is primary or secondary to Medicare.
A primary payer health plan pays before Medicare. That means your employer-provided health plan will cover its share of your health care costs first, and if theres anything left over that Medicare covers, Medicare will pay what remains.
Conversely, a secondary payer health plan covers only costs left over after Medicare covers its share.
If your health plan at work is a primary payer, thats great. Feel free to drop your Part B coverage if you wish. The Part B premiums might not be worth any additional coverage you receive. But if you have secondary-payer insurance at work, its usually better to keep Part B, or you could get stuck paying Medicares share of your health care expenses.
Talk to your human resources department at work to find out if your employer-sponsored plan is primary or secondary to Medicare. Generally, businesses with 20 or fewer employees have secondary payer plans, while larger companies have primary payer plans.
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Applying For Medicare With Employer Coverage
Can you still enroll in Medicare coverage, even if youre not yet seeking retirement? The answer is yes! Medicare coverage can coincide with your group coverage through your employer. If your employer has more than 20 employees, your group coverage will work as your primary insurance, and Medicare will be your secondary insurance.
You can choose to apply for Part B, or you can wait until leaving your employer group coverage. For more information on the benefits of obtaining Medicare while receiving group coverage through work, give our team a call, and we can review the pros and cons.
Sometimes beneficiaries dont want to apply for Part B when they initially become eligible because of employer health coverage. Should you lose your health insurance through your employer, or if you prefer to switch over to Medicare, you can apply any time while receiving coverage through your employer.
Decide On Medicare Advantage
Now that youve enrolled in Medicare Part A and Part B, you need to decide whether you want to stay with Original Medicare, Parts A and B, or sign up for Medicare Part C, also called Medicare Advantage.
With a Medicare Advantage plan, you continue to pay a premium for Part B while a private insurance carrier delivers your services. That company contracts with Medicare to deliver both Part A and Part B benefits. Policies vary, but most include prescription drug coverage and other benefits that arent covered by Original Medicare. You enroll with a private insurer to get your Part C/Advantage plan. You can compare plans at medicare.gov.
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How To Apply For Medicare
Medicare enrollment is easier than ever. Once you meet eligibility requirements, you are ready to choose from a variety of plans in which to enroll. As we mentioned earlier, some beneficiaries can receive automatic enrollment, and some have to apply manually.
There are three ways to apply for Medicare Part A and Part B:
If you have previously been a railroad employee, you can enroll in Medicare by contacting the Railroad Retirement Board, Monday Friday, from 9:00 AM 3:30 PM at 1-877-772-5772.
Medicare applications generally take between 30-60 days to obtain approval.
Signing Up Late: General Enrollment Period
Part A. If you didn’t sign up for Medicare Part A when you were first eligible, you can sign up for Part A anytime, without penalty.
When coverage begins. Your Part A coverage will go back to six months before the date you signed up .
Part B, C and D. If you didn’t sign up for Medicare Part B when you were first eligible, you can sign up for Part B during a General Enrollment Period, which happens between January 1 through March 31 each year. You will also have from April 1 through June 30 of that year to add a Medicare Advantage plan or Medicare Part D plan.
When coverage begins. When you sign up for Part B, C, or D during a General Enrollment Period, your coverage will start July 1.
Late sign-up penalty. Individuals who did not sign up for Medicare Part B when they turned 65 might face a penalty of higher lifetime premiums when they do sign up. However, most individuals who were covered by a group health plan through an employer are not subject to the penalty. If you didn’t sign up for Part B because you had group health benefits through work, you should be able to sign up during your Special Enrollment Period.
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