Review Your Medicare Choices Each Year
Whether you enroll in original Medicare or a Medicare Advantage plan, you generally do not need to renew coverage every year. That being said, plans are sometimes discontinued or their benefits and costs may change to the point that the plan no longer meets your needs. Its not unusual for pharmacy and provider networks to change, for costs to increase, or the list of covered prescription drugs to vary. Thats why its a good idea to review your plan each year and compare it against your current health care needs.
Your health insurer is required to send you an Annual Notice of Change by September 30 each year. The notice outlines any changes in coverage and costs expected to begin the following January. If you decide to change your health care plan after reviewing those updates, you can do so during Medicares open enrollment period. The period runs from October 15 to December 7. During this time, you can switch from original Medicare to Medicare Advantage or vice versa. You can switch from one Medicare Advantage plan to another or from one Medicare Part D plan to another. You can also enroll in Medicare Part D if you have not done so already, although late enrollment penalties may apply.
If you find that the new health care plan is not meeting your needs, you can reverse some plan decisions January 1 to March 31 of the following year. Guidance for the renewal process is offered through the U.S. governments phone line at 1-800-MEDICARE or through your local SHIP.
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The questions were likeliest to answer are those that will interest other readers. So, its better not to ask for super-specific advice that applies only to you.
About me
I hold a doctorate in economics from the University of Wisconsin and taught economics at the University of Delaware for many years. In 2009, I co-founded SocialSecurityChoices.com, an internet company that provides advice on Social Security claiming decisions. You can learn more about that by clicking here.
Got any words of wisdom you can offer on todays question? Share your knowledge and experiences on our. And if you find this information useful, please share it!
Disclaimer: We strive to provide accurate information with regard to the subject matter covered. It is offered with the understanding that we are not offering legal, accounting, investment or other professional advice or services, and that the SSA alone makes all final determinations on your eligibility for benefits and the benefit amounts. Our advice on claiming strategies does not comprise a comprehensive financial plan. You should consult with your financial adviser regarding your individual situation.
Important Things To Know About Social Security Benefits
Now before we dive into how this may impact Medicare decisions, there are three things to keep in mind.
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Who’s Eligible For Medigap
If youre enrolled in both Medicare Part A and Part B, and dont have Medicare Advantage or Medicaid benefits, then youre eligible to apply for a Medigap policy. These plans are standardized, and are designed to cover some or all of the out-of-pocket costs that are incurred when you have a Medicare-covered claim .
You have a federal right to buy a Medigap plan during the six months beginning when youre at least 65 years old and have enrolled in Part B. This is known as your Medigap open enrollment period. After this time runs out, you will have only limited chances to purchase one down the road.
Some states allow people of any age or health status to purchase Medigap coverage at any time without medical underwriting, but most dont. In many states, Medigap plans may not be available for people who have Medicare before age 65. There are 33 states that require Medigap plans to be guaranteed issue in at least some circumstances when an applicant is under age 65, but the rules vary from one state to another you can click on a state on this map to see details about state-based Medigap rules.
If youre enrolling in Medicare due to your age, the primary factor that will affect your ability to purchase a Medigap policy regardless of your health will be whether you enroll during your Medigap Open Enrollment Period.
What Is The Medicare Eligibility Age
For just about everyone, the Medicare eligibility age is 65. At that point, youll have access to Medicare Part A and are able to purchase Medicare Part B. For some with disabilities or End Stage renal disease, though, eligibility may come at a younger age. Most people are eligible to receive part A without having to pay for it, but there are a few exceptions, which well note in further detail below. For help with healthcare planning and other questions about finances and retirement, consider working with a financial advisor.
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What Happens If I Miss My Medicare Enrollment
If you miss your initial enrollment period, you can still sign up for Medicare, but you could face late enrollment penalties. Anyone can sign up during the Medicare general enrollment period, which happens from Jan. 1 to March 31 each year. If you meet the qualifying circumstances, you can sign up any time through a Medicare special enrollment period.
How To Enroll For Medicare
If you meet the requirements for those 65 and older, you can receive Medicare Part A without paying any premiums. However, if you or your spouse did not pay Medicare taxes, you may have to pay for Part A. Medicare Part A covers hospital insurance. Medicare part B covers things like outpatient care, preventive services and medical equipment. It can also cover part-time home health services and physical therapy. Should you decide you also want Medicare Part B, you must pay a monthly premium.
If you have received Social Security disability benefits for 24 months, you will automatically be enrolled in Medicare at the start of the 25th month. If you have Lou Gehrigs disease, you are automatically enrolled the first month you begin receiving benefits. For these situations, enrollment includes both Medicare Part A and Part B. However, if you have end-stage renal disease, your Medicare benefits are determined on a case-by-case basis. In this case, you will need to manually apply.
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Special Enrollment Periods For Medicare
Medicare special enrollment periods can happen any time during the year due to changes to your personal circumstances.
Examples of Medicare Special Enrollment Qualifying Events
- Moving somewhere outside of the coverage area of your current Medicare Advantage plan
- Phasing out of your employers health insurance plan
- Your current Medicare Advantage provider ending its contract with Medicare
Signing Up For Premium
You can sign up for Part A any time after you turn 65. Your Part A coverage starts 6 months back from when you sign up or when you apply for benefits from Social Security . Coverage cant start earlier than the month you turned 65.
After your Initial Enrollment Period ends, you can only sign up for Part B and Premium-Part A during one of the other enrollment periods.
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Healthmarkets Can Answer Your Medicare Eligibility Questions
If you are eligible for Medicare and are ready to shop for a plan, HealthMarkets can help. We make it easy to compare plans, get free Medicare quotes, and enroll. Answer a few short questions and to see what kind of Medicare plan might work for your lifestyle, and which plans fit. Get started now.
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References:1.MDCR Enroll AB 2. CMS.gov. January 19, 2021. Retrieved from https://www.cms.gov/files/document/2019cpsmdcrenrollab2.pdf | 2.Part B costs. Medicare.gov. Retrieved from https://www.medicare.gov/your-medicare-costs/part-b-costs. Accessed on December 13, 2021 | 3.Part A costs. Medicare.gov. Retrieved from https://www.medicare.gov/your-medicare-costs/part-a-costs. Accessed on December 13, 2021
When Should You Enroll For Medicare
Just because you qualify for something doesnt mean you need to sign up, right? Not always. In the case of Medicare, its actually better to sign up sooner rather than later. While its true that Medicare isnt mandatory, there are fees for signing up outside of your initial eligibility window. Also known as the initial enrollment period , this 7-month window gives you some flexibility in enrolling in Medicare once you qualify.
If you dont get automatic enrollment , then you must sign up for Medicare yourself, and you have seven full months to enroll. The IEP starts three months before the month you turn 65 and ends three months after the month you turn 65.
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Initial Enrollment Period |
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Coverage start dates vary based on when you sign up. If you sign up during the first three months of your IEP , then your health insurance will take effect on the first day of your birthday month. If your birthday falls on the first of the month already, then your coverage will start on the first of the previous month. The longer you wait to sign up, the later your coverage will start, which is why its a good idea to check your eligibility and enroll as soon as youre able.
This initial signup period applies to people who dont get automatically enrolled. People who are already enrolled in Social Security and those with disabilities will be automatically enrolled into original Medicare depending on their situation.
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Am I Eligible For Medicare Part B
When you receive notification that youre eligible for Medicare Part A, youll also be notified that youre eligible for Part B coverage, which is optional and has a premium for all enrollees.
Part B costs $170.10/month for most enrollees in 2022, although Part B costs more if your income is more than $91,000 .
Its important to enroll in both Part A and Part B. You have an enrollment window that runs for seven months . And while you can enroll in the three months following your 65th birthday, its best to enroll in Part B early, or you could have gaps in health coverage. If you wait too long, you could end up locked out of Part B and have to wait until the next general Medicare enrollment period.
If you dont enroll during your initial window, you wont lose eligibility for Part B, but you will be penalized with an increased premium when you eventually enroll, which climbs 10% for each year that youre eligible but dont enroll in Part B . The General Enrollment Period for Medicare A and B runs from January 1 to March 31 each year, for coverage effective July 1 with an increased premium if the late enrollment penalty applies.
Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to sign up for Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
Note: When completing the forms CMS-40B and CMS-L564:
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on their behalf and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
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More Resources For Medicare Beneficiaries
When approaching the age to qualify for Medicare benefits, visit the official Social Security Administration Medicare website to determine your eligibility and calculate your premium. In the meantime, read more about when and how to apply for Medicare and visit medicare.gov to prepare for when that time comes.
Will The Medicare Age Be Raised To 67
In recent years, the proposal to raise the Medicare eligibility age to 67 began to gain traction. However, many are actually in favor of lowering the Medicare age below 65 rather than pushing it back to 67.
As of now, there has not been any indication that either of these proposals will become law. The standard Medicare enrollment age is currently 65 and there are no plans of changing that in the near future.
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Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.
Stacy Crayder
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When Is Trail The Best Choice
We prefer the simplicity and depth-of-coverage Medicare Supplements offer seniors. You get to utilize the Original Medicare benefits youâve been paying into for years.
While we do recommend a Medicare Supplement to the majority of retired teachers we meet, there are always going to be exceptions.
If you take a rare, very expensive medication, weâd encourage you to stay on TRAILâs Medicare Advantage plan. As you saw earlier, their drug coverage is very simple and very good. The most youâd ever pay for a drug is a $100 copay. Youâre probably not going to find another drug plan out there like it.
The other scenario is if youâre covered through the VA. One of our clients is eligible for 100% coverage through the VA. He kept the TRAIL plan, because he knew if he ran into a scenario where he wasnât covered, he could always fall back on the VA. He could go to the VA hospital in Jacksonville if the TRIP option left him hanging.
So those are the two most common situations where weâd recommend you stay on TRAIL: you have a very expensive drug or you also get coverage through the VA.
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How Social Security Helps Pay For Medicare
In addition to automatically enrolling you in Medicare, if you are receiving Social Security or Railroad Retirement Board benefits, your Medicare Part B premium will be automatically deducted from your monthly benefit payment.
If you are not receiving Social Security or Railroad Retirement Board benefits yet, you will get a bill called a Notice of Medicare Premium Payment Due . Bills can be paid for by check or money order, a credit or debit card, or through online bill pay services.
In conclusion, as youre starting to think about Medicare and retirement, do some research and make sure you understand how your Social Security benefits can or will play a role.
Footnotes
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How Old Do You Have To Be To Get Original Medicare
The typical age to enroll in Original Medicare is 65 years or older. However, in certain cases, you may be eligible to enroll in Medicare at a younger age.
To be eligible for Medicare at age 65, you must be an American citizen for at least five years.
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Are you wondering if you can get Medicare before age 65? You may be eligible for Medicare before age 65 if you receive Social Security Disability benefits or if you have specific diagnoses. To receive Original Medicare before age 65 you must meet one of the following qualifications:
- Receiving Social Security Disability Income for 24+ months
Medicare Eligibility At 65 And Older
You can apply for Medicare the year you turn 65, but you generally must meet three eligibility requirements to qualify for full Medicare benefits at this age.
The chief requirement is that you must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years.
In addition, you must meet one of the following other requirements:
- You or your spouse must have worked long enough to also be eligible for Social Security benefits or for railroad retirement benefits. This usually means you have worked for at least 10 years. You must be eligible for these Social Security benefits even if you are not yet receiving them.
- You or your spouse is either a government employee or retiree who did not pay into Social Security but did pay Medicare payroll taxes while working.
If you pay Medicare payroll taxes for 10 full years, you wont have to pay premiums for Medicare Part A, which covers hospital care.
You dont need the work credits to qualify for Medicare Part B, which covers doctor visits or outpatient services, and Medicare Part D, which covers prescription drugs. Everyone pays premiums for both regardless of work history.
If you are still working at 65, you dont have to sign up for Medicare but there are benefits to signing up while still employed. Similarly, if you have never worked, you can still get Medicare. It may be more expensive depending on your spouses work history.
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