Thursday, March 23, 2023

When Can Someone Apply For Medicare

Don't Miss

What Are The Typical Age Requirements For Medicare Coverage

Medicare Provider Enrollment Through PECOS

The typical Medicare age requirement is 65, or younger if you qualify for disability benefits. In addition to meeting the age requirement of 65, you must also be a U.S. citizen or legal permanent resident before you are eligible for Medicare.

Most people who are 65 qualify for premium-free Medicare Part A because they have worked for at least ten years and have paid Medicare taxes. Medicare Part A helps cover hospitalization, skilled nursing facility, home health care, and hospice costs. If you are not eligible for premium-free Part A because you have not worked and paid Medicare taxes, but are a citizen with permanent residency and are 65, you can pay premiums to have Part A coverage. If your spouse has worked long enough to qualify for premium-free Part A, your Part A premiums will be free after your spouse turns 62.

When you meet the requirements for Part A, you also qualify for Medicare Part B which helps cover medical out patient costs such as doctors visits, urgent care, durable medical equipment , some preventive care, and more. If you have Part B, there is a monthly premium you pay, which is $148.50 for 2021, and an annual deductible of $203.

Medicare Advantage Open Enrollment Period

Medicare Advantage Open Enrollment happens every year from Jan. 1 to March 31. If youre enrolled in a Medicare Advantage plan and want to make changes, you can do one of these:

  • Switch to a different Medicare Advantage plan with or without drug coverage
  • Go back to Original Medicare and, if needed, also join a Medicare prescription drug plan

Your new coverage begins on the first day of the month following the month you make a change and will be in effect for the rest of the year.

Explore Your Other Medicare Coverage Options

Once you are enrolled in Original Medicare, you can explore additional coverage options.

You can decide to:

  • Add a Medigap supplement insurance policy.
  • Add a Part D prescription drug plan.
  • Switch to a Medicare Advantage plan also known as Part C to replace your Original Medicare coverage.

Medicare Part D, Medigap and Medicare Advantage are all administered by private insurance companies that contract with CMS.

You can apply for these benefits online.

Use the Medicare Plan Finder tool to explore and compare plans in your area.

Read Also: When Can I Start Collecting Medicare Benefits

Penalty Fees For Late Enrollment

Medicare charges penalty fees for those who do not enroll in their Initial Enrollment Period, or they do not qualify for an exception due to employer insurance or other coverage.

Unless a person qualifies for a special exception, they will pay a monthly premium that is 10% higher for every 12-month period they were eligible for Medicare but did not sign up.

A person can qualify for a Medicare plan before 65 years of age if they meet certain criteria:

  • They have end stage renal disease and need dialysis or are on the kidney transplant list.
  • They have amyotrophic lateral sclerosis .
  • Their doctor confirms that they have a disability.

An estimated 6.2 million people qualify for Medicare because they are disabled, according to the Medicaid and CHIP Payment and Access Commission. However, significantly fewer people use these benefits.

A doctor may declare a disability for people due to several types of medical conditions, including:

  • Intellectual or developmental disabilities: These might include Down syndrome, cerebral palsy, or autism.
  • Physical conditions: Traumatic brain injury, severe back injuries, or quadriplegia qualify as disabilities.
  • Severe behavioral or psychological disorders: People with bipolar disorder or schizophrenia can qualify for Medicare early.

A doctor must submit paperwork to Medicare, declaring that a person has a disability. The individual may have a waiting period before they qualify for full Medicare benefits.

Medicare Part B Enrollment Deadlines

How to Apply for Medicare

Medicare Part B enrollment deadlines mimic those of Part A enrollment deadlines. Initial enrollment into Part B is automatic for the same people listed above in Part A. You have seven months to enroll in Part B if you dont qualify for automatic enrollment. However, there are a few differences when it comes to Medicare Part B.

First, Part B requires a premium, whereas most people dont have to pay a premium for Medicare Part A. Because of this, you may be tempted to forgo Part B coverage. You should note that if you cancel Part B coverage or decide against enrolling in it, then you may not be able to enroll in Part B until the general enrollment period. This runs from January 1 through March 31 each year.

Medicare Part B penalties are also different from Part A penalties. In essence, you get charged a 10 percent penalty fee for each full year that you lacked Medicare Part B coverage when you could have enrolled. For the following example, well return to Janice to see how much her premium would be if she failed to enroll in Medicare Part B on time.

Unfortunately, Janice will have to pay this late penalty fee indefinitely. Unlike the penalty fee for missing the Medicare Part A enrollment deadline, the penalty for missing the Part B deadline lasts for as long as you have Medicare Part B. As long as Janice keeps Medicare Part B, shell have to pay the higher premium.

Also Check: Can People On Medicare Use Good Rx

Can I Get Medicare Early If I Retire Early

If you retire earlier than age 65, you will not be eligible for Medicare. Although Medicare is often thought of as insurance for retired people, the Medicare age requirement is still 65. Some people continue to work past age 65 and have insurance coverage through their employer. Many people retire before they turn 65 and must purchase health insurance or are covered on their spouses insurance plan. Although you may be eligible for social security retirement benefits if you retire early, it does not change your age requirement for Medicare health insurance coverage.

Documents You Need To Apply For Medicare

To begin the application process, youll need to ensure you have the following documentation to prove identity:

  • A copy of your birth certificate
  • Your drivers license or state I.D. card
  • Proof of U.S. citizenship or proof of legal residency

You may need additional documents as well. Make sure to have on hand:

  • Your Social Security card
  • W-2 forms if still active in employment
  • Military discharge documents if you previously served in the U.S. military before 1968
  • Information about current health insurance types and coverage dates

If you are already enrolled in Part A and have chosen to delay enrollment in Part B, you will need to complete additional forms .

  • 40B form: This form allows you to apply for enrollment into Part B only. The 40B form must be included in your online application or mailed directly to the Social Security office.
  • L564 form: Your employer must complete this form if you delayed Part B due to creditable group coverage through a said employer. The completed L564 form also must be included in your online application or mailed directly to the Social Security office.
  • Recommended Reading: Which Is Primary Medicare Or Private Insurance

    Medicare Special Enrollment Period

    Special situations may come up that give you the chance to sign up for or change your Medicare plan outside of your Initial Enrollment Period or the Annual Enrollment Period.

    There are several special cases that make you eligible for a Special Enrollment Period.

    Here are some common situations:

    • You move: If you move to an address outside your plans service area, into a nursing home, or you have different plan options at your new address, youll be able to apply for a new plan.
    • You want to switch to a 5-star Medicare plan: Every year, Medicare evaluates plans based on a 5-star rating system. Medicare considers these plans excellent. You can make the switch once to a 5-star plan anytime from Dec. 8 through Nov. 30 if one is available in your area.
    • You lose your current coverage: This applies if you or your spouse will retire or change to a job that doesnt offer coverage. It doesnt apply if your insurance company cancels your coverage because you didnt pay your monthly premiums.
    • Your plan changes its contract with Medicare: Enrollment in a plan depends on the plans contract with Medicare, and for various reasons these contracts could change.

    Your new coverage begins on the first day of the month after you sign up.

    Applying For Medicare Online

    When Can You Enroll in Medicare for the First Time?

    If your situation is relatively straightforward, applying online can be your best option. Here are the steps to follow:

    Although an online application is the most convenient for many, there are reasons you may not want to apply online, including any of the following scenarios:

    • You dont want to send precious documents, like your original birth certificate, through the mail.
    • You have questions surrounding Medicare.
    • You live outside the US, in which case online enrollment isnt an option.
    • You want to sign up for Part A, but you wish to postpone your Part B coverage . You can explain this better in person, and you want to make sure you’ve crossed your t’s and dotted your i’s for delaying Part B coverage.

    There may be other reasons why applying online may not be best for you. The point is, if your situation is complicated, perhaps its better to go with one of your other two options.

    Recommended Reading: Does Medicare Cover Refraction Test

    What Are My Insurance Options If I Cannot Get Medicare At Age 62

    If you dont qualify for Medicare, you may be able to get health insurance coverage through other options:

    • Employer-provided insurance

    LeRon Moore has guided Medicare beneficiaries and their families as a Medicare professional since 2007. First as a Medicare provider enrollment specialist and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.

    Moore holds a bachelors degree from Southern New Hampshire University and is A+ Certified with a Medical Records Clerk Certification and Medical Terminology Certification from Midlands Technical College.

    Hes passionate about educating, informing, and resolving issues concerning Medicare and Medicare Advantage Plans, and considers it imperative that he does all he can to educate and inform the senior community as much as possible about Medicare.

    How To Sign Up For Medicare

    You sign up for Original Medicare Part A and Part B through the Social Security Administration or the Railroad Retirement Board .

    • If you arent yet getting Social Security or Railroad Retirement benefits, you need to apply for Medicare.
    • If you already get Social Security or Railroad Retirement benefits, the SSA or RRB will automatically sign you up for Medicare Part A and B so its effective the month of your 65th birthday.

    Read Also: Is Mutual Of Omaha A Good Company For Medicare Supplement

    Sign Up: Within 8 Months After You Or Your Spouse Stopped Working

    Your current coverage might not pay for health services if you dont have both Part A and Part B .

    Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?

    When Should I Sign Up For Medicare

    How to Apply for Medicare &  Medicaid

    Generally, we advise people to file for Medicare benefits 3 months before age 65. Remember, Medicare benefits can begin no earlier than age 65. If you are already receiving Social Security, you will automatically be enrolled in Medicare Parts A and B without an additional application. However, because you must pay a premium for Part B coverage, you have the option of turning it down. You will receive a Medicare card about two months before age 65. If you would like to file for Medicare only, you can apply by calling 1-800-772-1213. Our representatives there can make an appointment for you at any convenient Social Security office and advise you what to bring with you. When you apply for Medicare, we often also take an application for monthly benefits. You can apply for retirement benefits online.

    If you didnt sign up when you were first eligible for Medicare, you can sign up during the General Enrollment Period between January 1 and March 31 each year, unless you are eligible for a Special Enrollment Period.

    Recommended Reading: Can I Buy Private Health Insurance Instead Of Medicare

    Your Medicare Special Enrollment Period

    If your employer has at least 20 employees and youre still working and covered under that plan when you turn 65, you can delay your enrollment in Medicare . In that case, youll get an eight-month special enrollment period to sign up for Medicare if and when you leave your job or your employer stops offering coverage. It will start the month after you separate from your employer, or the month after your group health coverage ends whichever happens sooner.

    Sign up during those eight months, and you wont have to worry about premium surcharges for being late. And the eight-month special enrollment period is also available if youre delaying Part B enrollment because youre covered under your spouses employer-sponsored plan, assuming their employer has at least 20 employees.

    But note that in either case, it has to be a current employer. If youre covered under COBRA or a retiree plan, you wont avoid the Part B late enrollment penalty when you eventually enroll, and you wont have access to a special enrollment period to sign up for Part B youll have to wait for the general enrollment period instead.

    How To Enroll In Medicare With The Government

    Medicare is a federal health insurance program for people who are 65 and older. When you are turning 65 and enrolling in Medicare for the first time, there are important dates and other things to consider before making your decision.

    There are coverage gaps in Original Medicare . Most people choose one of two ways to cover the gap, Medicare Supplement plans , or Medicare Advantage Plan.

    You May Like: Does Medicare Plan F Cover International Travel

    Read Also: Do Any Medicare Supplement Plans Cover Dental And Vision

    Medicare Part C Enrollment Deadlines

    Medicare Part C is usually referred to as a Medicare Advantage Plan. In these plans, you get the benefits of Medicare Parts A, B and D at once. Many people choose Medicare Advantage because there are more flexible options, in terms of benefits and premium costs. But some simply like the convenience of having a private insurer administer their health insurance.

    Typically, Medicare Advantage Plans have their own set of enrollment and modification guidelines because theyre administered by private insurers. However, if you decide to enroll in a Medicare Advantage Plan, there are some dates you should keep in mind.

    Lets say that your birthday is October 5. You have an initial enrollment period that lasts from July 1 through January 31 to enroll in a Medicare Advantage Plan. Medicare now gives you a three-month trial run of your MA plan. If you dont like it, you can switch to a new MA plan or drop it in favor of original Medicare within those first three months. If you dont change plans during the trial period, you can use the Medicare Advantage Open Enrollment to change your plan one time during that period as long as its before March 31. Otherwise, youll have to wait until open enrollment starts in the fall for coverage that starts in a new calendar year.

    How Does My History Of Receiving Ssdi Affect When Or If I Can Receive Medicare

    Some Common Misconceptions Around Medicare Examined

    You typically become eligible for Medicare after 24 months on SSDI. After receiving SSDI for 2 years, you are automatically enrolled in Medicare Part A and Part B. During the 2-year waiting period, you can apply for Medicaid or enroll in a low-cost private health plan through the marketplace at You may be able to keep your Medicaid eligibility once you get Medicare.

    Also Check: How Do I Submit Medical Bills To Medicare For Reimbursement

    Retirees And Those Still Working

    If you paid into a retirement system that didnt withhold Social Security or Medicare premiums, youre probably still eligible for Medicareeither through your retirement system or through your spouse. To receive full Medicare coverage at 65, you must have earned enough credits to be eligible for Social Security.

    Each $1,470 you earn annually equals one credit, but you can only earn a maximum of four credits each year. You will receive Social Security benefits at retirement if you have earned 40 credits10 years of work if you earned at least $5,880 in each of those years. If you continue to work beyond age 65, things get a bit more complicated. You will have to file for Medicare, but you may be able to keep your companys health insurance policy as your primary insurer. Or, your company-sponsored insurance plan might force you to make Medicare primary, or other conditions may apply to you.

    Theres a lot to consider that makes it prudent to talk to a person knowledgeable in Medicare about your specific choices. This could be your Human Resources department or a Medicare representative.

    If you continue to work beyond 65, theres a lot to consider that makes it prudent to talk to a Medicare expert about your choices.

    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.

    Don’t Miss: Is Smart Vest Covered By Medicare

    More articles

    Popular Articles