The Basics Of Medicare
In order to understand the process of signing up for Medicare Advantage, it helps to first get to know the basics of Original Medicare, as well as the different parts most beneficiaries have to deal with. Medicare is split into several parts, each of which provides medical insurance for different services:
Medicare Part A
Medicare Part A is the basic coverage Medicare provides for its beneficiaries. This is a no-cost plan that covers the cost of inpatient hospitalization for eligible seniors. All U.S. citizens are automatically enrolled in Part A when they become eligible, since there is no out-of-pocket cost or monthly premium for this coverage. Services covered under Part A generally revolve around admissions to the hospital and treatments provided as part of regular inpatient care. Providers bill the Original Medicare program directly, which then pays for services according to a fixed or negotiated schedule. All Medicare-qualified providers are part of the Part A network, and they are required to bill only Medicare for covered services, unless the patient has a Medicare Advantage plan that provides the same coverage.
When To Enroll In Medicare If I Am Receiving Retirement Benefits
If youâre already collecting Railroad Retirement Board or Social Security retirement benefits when you turn 65, you will automatically be enrolled in Medicare Part A and Medicare Part B if you sign up for Medicare Part B at the time you sign up for retirement benefits.
If you live outside of the 50 United States or D.C. , you will automatically be enrolled in Medicare Part A, but will need to manually enroll in Medicare Part B.
When Can You Join A Medicare Advantage Plan
Once you find a Medicare Advantage plan you wish to enroll in, you may be able to apply online or over the phone.
When you apply for coverage, you must provide your Medicare number and the dates that your Medicare Part A and Part B coverage began. These dates are listed on your Medicare card.
Find your personal situation below to determine when you can enroll in, leave or make changes to a Medicare Advantage plan.
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What If You Miss The Medicare Advantage Initial Enrollment Period
If you miss your initial enrollment period, dont worry! Youll never have to answer medical questions , and you can apply during Medicares Annual Election Period , every year.
We at Senior65 consider ourselves the Medigap enrollment experts. We can help you choose a company that will work best for your health and financial needs, call our licensed independent insurance agents at 800-930-7956.
If your birthday falls on the first of the month both your Medicare part B and Medicare Advantage plan can start the first of the month proceeding your 65th birthday.
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Can I Change Medicare Advantage Plans During My Initial Enrollment Period
The first time you may be eligible to sign up for a Medicare Advantage plan may be during your Initial Enrollment Period. During this period, you can both enroll in a Medicare Advantage plan and switch from one plan to another. Maybe you first sign up for a plan that seems attractive but then decide you want the same coverage your spouse has. You can change Medicare Advantage plans anytime during your Initial Enrollment Period.
If you qualify for Medicare by age, your Initial Enrollment Period starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you qualify for Medicare through disability, this period starts 3 months before your 25th month of getting Social Security or Railroad Retirement Board benefits, includes the 25th month of getting disability and ends 3 months after your 25th month of getting disability benefits.
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Medicare Part D Prescription Drug Coverage
2022 Part D premiums:
- The average premium for stand-alone Medicare Part D coverage is about $43/month in 2022. There continue to be a wide range of Part D plan options available. Premiums for Part D plans start as low as about $7/month in 2022. On the higher end, plans can have premiums of up to $100/month or more, so there is a great deal of variation in price and benefits across the available plans.
- High-income enrollees pay a higher Part D premium. The threshold for high-income began to be indexed as of 2020. The income threshold for 2022 is $91,000 for a single person and $182,000 for a couple . In 2022, the additional premium for high-income enrollees ranges from $12.40/month to $77.90/month.
Part D deductible:
- Maximum of $480 in 2022, up from $445 in 2021. .
Part D out-of-pocket costs after deductible:
- Not to exceed 25% of the cost of brand-name and generic costs.
- There is no longer a donut hole in terms of the maximum amount that enrollees can be charged when they fill prescriptions. But the donut hole still exists in terms of how insurers design their coverage , how total drug costs are counted, and who covers the bulk of the cost of the drugs .
- After a beneficiarys costs reach the catastrophic coverage threshold , additional out-of-pocket costs are capped at the greater of 5% of the cost of the drug or a copay of $3.95 for generics and $9.85 for brand-name drugs.
Learn more about Medicare Part D.
Can I Change Medicare Advantage Plans Anytime During My Special Enrollment Period
Outside of the Medicare Open Enrollment Period, you may be able to change your Medicare Advantage plan during a Special Enrollment Period . Usually youâll be granted a SEP if you move or lose other insurance coverage. Life events that may qualify you for a Special Enrollment Period include:
- You move to an address that is outside your planâs service area
- You move to an address that has new plan options
- You move into a skilled nursing facility or long-term care facility
- Medicare terminates your plan
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Enrolling In A Medicare Supplement
During your initial Medigap enrollment period you cant be denied Medigap coverage or be charged more for the coverage because of your medical history.
But after that window ends, Medigap insurers in most states can use medical underwriting to determine your premiums and eligibility for coverage.
If youre under 65 and eligible for Medicare because of a disability, there are 33 states that provide some sort of guaranteed issue period during which you can purchase a Medigap plan. But in the majority of those states, the carriers can charge additional premiums for people under 65. You can click on a state on this map to see how Medigap plans are regulated in the state.
To find out about Medigap policies in your state, contact your State Department of Insurance or your State Health Insurance Assistance Program, or call 1-855-593-5633 to speak with one of our partners, who can help you find a plan in your area.
All Medicare Advantage Plans Are The Same False
Medicare Advantage plans, which you buy from commercial insurance companies, vary considerably in what they cover. There are other differences too. Zero premium plans do not charge you a monthly fee, but you will have to pay for a larger percentage of the costs of medical services you receive. Other plans charge you a monthly premium but will require you to pay less for copays as you receive medical and healthcare services.
The bottom line is, avoid becoming a victim to companies that push you to buy plans that might cost too much, or that do not cover the cost of services you really need. As you can see, Medicare Advantage plans are complicated and have a lot of moving parts. So shop carefully and be sure to opt for a plan that best fits your needs. Chances are you will select the best plan if you work with an expert a qualified Medicare consultant who can guide you.
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Medicare Sign Up: What You Cant Do
The annual Medicare open enrollment period does not apply to Medigap plans, which are only guaranteed-issue in most states during a beneficiarys initial enrollment period, and during limited special enrollment periods.
If you didnt enroll in Medicare when you were first eligible, you cannot use the fall open enrollment period to sign up. Instead, youll use the Medicare general enrollment period, which runs from January 1 to March 31.
Medicares general enrollment period is for people who didnt sign up for Medicare Part B when they were first eligible, and who dont have access to a Medicare Part B special enrollment period. Its also for people who have to pay a premium for Medicare Part A and didnt enroll in Part A when they were first eligible.
If you enroll during the general enrollment period, your coverage will take effect July 1.
Learn more about Medicares general enrollment period.
How To Join A Medicare Advantage Plan
Not all Medicare Advantage Plans work the same way. Before you join, take the time to find and compare Medicare health plans in your area. Once you understand the plan’s rules and costs, here’s how to join:
- Use Medicare’s Plan Finder.
- Visit the plan’s website to see if you can join online.
- Fill out a paper enrollment form. Contact the plan to get an enrollment form, fill it out, and return it to the plan. All plans must offer this option.
- Call the plan you want to join. Get your plan’s contact information.
When you join a Medicare Advantage Plan, you’ll have to give these:
- Your Medicare number
This information is on your Medicare card.
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Enrolling In Medicare With A Qualifying Disability Or Medical Condition
With a qualifying disability, you usually become Medicare-eligible after you’ve received disability benefits for 24 months. You will have a 7-month Initial Enrollment Period that includes your 25th month of disability, the 3 months before and the 3 months after.
You may also qualify for Medicare due to Lou Gehrig’s disease or end-stage renal disease . Enrollment for ALS or ESRD is unique, so you’ll want to review the rules for each carefully.
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AARP encourages you to consider your needs when selecting products and does not make product recommendations for individuals.
Please note that each insurer has sole financial responsibility for its products.
AARP® Medicare Supplement Insurance Plans
AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare.
Insured by UnitedHealthcare Insurance Company, Hartford, CT or UnitedHealthcare Insurance Company of America, Schaumburg, IL or UnitedHealthcare Insurance Company of New York, Islandia, NY . Each insurer has sole financial responsibility for its products. Policy form No. GRP 79171 GPS-1 .
Not connected with or endorsed by the U.S. Government or the federal Medicare program.
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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You Can Switch Medicare Plans At Any Time If Youre Not Satisfied With The Coverage You Have False
You are not necessarily committed to stay indefinitely with the first plan you choose. However, because Medicare.gov doesnt want to deal with the complication of having enrollees change plans constantly, certain fairly stringent rules are in force that controls when people can enroll in or change plans.
To summarize:
That Is Everything You Need To Know About Medicare In All Its Forms False
This article has given you a motherlode of information on many aspects of Medicare, and I hope you have learned a lot.
But has this article given you everything you need to know? Has it prepared you to move ahead and enroll without fear of making any mistakes? Unfortunately, no.
Your success enrolling in Medicare in all its shapes and sizes will be greatly improved if you work with a licensed Medicare advisor, like one of the Medicare Concierges at CoverRight.
CoverRight is on a mission to make the Medicare plan selection process easy to understand and help you find the best Medicare plans suited to your specific situation. Try our self-guided quiz to see for yourself.
Free Medicare Resources
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When Can I Enroll In Medicare If I Do Not Qualify For Retirement Benefits
If you are not eligible for retirement benefits from Social Security or the RRB, you will not be automatically enrolled into Original Medicare. However, you can still sign up for Medicare Part A and/or Part B during your IEP. You may not be able to get premium-free Medicare Part A, and the cost of your monthly Part A premium will depend on how long you worked and paid Medicare taxes. You will still have to pay a Medicare Part B premium.
When Can You Enroll In Medicare Advantage
You can enroll in Medicare Advantage during your Initial Enrollment Period. But you must first sign up for Parts A and B during your Initial Enrollment Period.
You can also enroll if you qualify for a Special Enrollment Period. If you lose your health insurance at your job, you can sign up for a plan up to eight months after losing your coverage.
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When Does Medicare Part A And B Coverage Start
To avoid a gap in coverage, sign up for Medicare Part A and Part B in the three months before your 65th birthday. If you do, your coverage will start in your birthday month.
If you sign up toward the middle or end of your Initial Enrollment Period, your coverage will start from one to six months after your birthday month, depending on when you enroll.
Automatic Enrollment Into Medicare For Those Diagnosed With Als Or Esrd
If a beneficiary has Amyotrophic Lateral Sclerosis, that individual will automatically be enrolled in Part A and B starting the month that disability benefits begin. Individuals with the end-stage renal disease dont need to receive Social Security disability benefits to qualify for Medicare. They can still continue to work. If you have ESRD, you can enroll in Medicare at any time before turning 65.
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Sign Up: Within 8 Months After You Or Your Spouse Stop Working
- Most people dont have to pay a premium for Part A . So, you may want to sign up for Part A when you turn 65, even if you or your spouse are still working.
- Youll pay a monthly premium for Part B , so you may want to wait to sign up for 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 Will My Medicare Advantage Start
Learn your Medicare Advantage effective date
Medicare Advantage, also known as Medicare Part C,replaces Original Medicare with equivalent benefits. They usually have small local networks of doctors, $7,550 out-of-pocket maximum and can offer extra benefits such as prescription drugs and dental coverage.
If you have decided that a Medicare Advantage policy is the right insurance for you, then you should sign up when youre first eligible.
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