If You Have A Disability
If youve been receiving either Social Security disability benefits or railroad retirement board disability benefits for at least 24 consecutive months, youre eligible to enroll in Medicare at any time, no matter your age.
If you have amyotrophic lateral sclerosis or end stage renal disease , youre also eligible for Medicare at any time, independent of your age.
Medicare Enrollment Deadlines And Penalties That Impact Your Retirement Budget
Each piece of the Medicare enrollment puzzle can help ensure that you enroll when you need to so that you can budget for any premiums or other costs and avoid penalties, too.
| Medicare part1 | Budget for it in retirement | Penalties you can avoid | |
|---|---|---|---|
| During Social Security sign up. | For most, Part A is premium free. | If youve worked 40 quarters in your lifetime, youll never pay a late sign-up penalty for premium-free Part A. If youve worked less than 39 credits and sign up late, youll pay an extra 10% on top of your premium for twice the number of years you delayed sign up. | |
| Part B | During Social Security sign up. If you have creditable coverage, you can postpone the Part B premium payment as long as you sign up eight months after that coverage ends. | Your premium for Part B will depend on your income. There’s also a deductible. | Your premium may increase 10% for each 12-month period you were eligible for the lifetime of your coverage. |
| Part D | When you enroll in Original Medicare must be enrolled in Parts A and B to enroll in Part D. | Your Part D premium is based on your location. | You’ll pay 1% of the national base beneficiary premium for each month of delay unless you can prove creditable coverage elsewhere. |
Medicare Part C is also referred to as Medicare Advantage these are private insurance plans that simply bundle together Parts A, B, and in some cases D. You do not have to purchase Medicare Advantage to have Medicare.
What Is The Medicare Special Enrollment Period
If you meet the criteria for a Medicare special enrollment period , you’ll be able to change your Medicare Advantage, Original Medicare or Medicare Part D plans. Qualifying situations include moving, having other coverage options, becoming eligible for Medicaid and more.
Medicare.gov has very specific rules about special enrollment periods and what Medicare changes you can make during what qualifying event. Below are the guidelines for some of the most common special enrollment circumstances.
| Special enrollment qualification | What Medicare changes you can make |
|---|---|
| Moved to a new address with different plan options | Return to Original Medicare or change coverage with Medicare Advantage or Medicare Part D |
| Changed eligibility for employer, union or COBRA coverage | Join or drop Medicare Advantage or Medicare Part D |
| Youâre eligible to be dual enrolled in Medicare and Medicaid | Enroll in, cancel or change Medicare Advantage plan or Medicare Part D |
| You have or recover from a severe or disabling condition | Enroll in or cancel a Medicare Chronic Care Special Needs Plan |
| A 5-star Medicare plan becomes available in your area | You can join the 5-star Medicare Advantage or Medicare Part D plan |
| You qualify for Medicaid, a State Pharmaceutical Assistance Program or Medicare Extra Help | You can enroll in, cancel or change Medicare Advantage or Medicare Part D several times during the year |
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S A And B If You’re 65
If you already are receiving Social Security before age 65, you’ll be automatically enrolled in Part A.
The same applies to Part B in the above situation. While you can opt out, be sure you have acceptable coverage in its place as defined by the government if you plan to enroll down the road.
“If you don’t want Part B, you need to notify Social Security to disenroll you,” said Danielle Roberts, co-founder of insurance firm Boomer Benefits.
Be aware that if you don’t enroll in Part B when you were supposed to and have no other qualifying coverage, you could face late-enrollment penalties.
That amount is 10% of the standard premium for each 12-month period you should have been enrolled. .
Individuals who aren’t auto-enrolled in Parts A and B at age 65 get a seven-month window to sign up unless they choose to delay it due to qualifying coverage elsewhere. That initial enrollment period starts three months prior to the month of your 65th birthday and ends three months after it.
Be aware, though, that if you wait until the month you turn 65 or during the three months after that to enroll, your Part B coverage will be delayed, which could cause a gap in coverage.
When To Enroll In Medicare
7 months
3 months before you turn 65
You can start enrolling in Medicare 3 months before your 65th birthday. Youll need to be eligible for Part A and Part B before you can get Part C . Youll need Part A, Part B, or both before you can get Part D.
Step 1 Learn about your Medicare benefits
As soon as possible, visit SocialSecurity.gov or call Social Security at , 8 a.m. to 7 p.m., Monday through Friday, to learn about your Part A and Part B benefits. The answers to these questions will help you enroll.
- Will I get Part A at no cost? Typically, you can get Part A at no cost if you or your spouse paid into Medicare for at least 10 years. If not, you can buy it.
- Do I need to enroll in Part A and Part B? Find out if youll be automatically enrolled in Part A and Part B, or if you should sign up.
- How will Social Security bill me for my Medicare premiums? The monthly premium is automatically deducted from your Social Security check each month. If youre not collecting Social Security, youll get a bill from the federal government every 3 months.
- When will I get my Medicare card? The federal government will mail your red, white, and blue Medicare card after youre enrolled. You should get it 3 months before your 65th birthday if you’re automatically enrolled. If you need to enroll in Part A and Part B, it can take up to 2 months to get your Medicare card.
Note: You need the information on your Medicare card to sign up for Part C or Part D.
Step 2 Enroll in Part A and Part B
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Whos Eligible To Make Coverage Changes During Medicare Open Enrollment
If youre currently covered by Original Medicare or Medicare Advantage, then youre eligible to make changes during open enrollment.
However, the annual Medicare open enrollment period does not apply to Medigap plans, which in most states are only guaranteed-issue during a beneficiarys initial enrollment period, and during limited special enrollment periods. So to clarify, you cannot use the annual Medicare open enrollment period to enroll in a new Medigap plan on a guaranteed-issue basis. You can certainly apply for a new Medigap plan during this window just as you can at any time of the year. But if your six-month initial enrollment period for Medigap has ended, the Medigap insurer will use medical underwriting to determine your eligibility and premium.
In addition, if you didnt enroll in Medicare Part B when you were first eligible, you may not use the AEP to sign up. Instead, youll use Medicares general enrollment period, which runs from January 1 to March 31. The general enrollment period is also for people who have to pay a premium for Medicare Part A and didnt enroll in Part A when they were first eligible.
How To Apply For Medicare Part A And Part B
Applying for Medicare Part A and Part B is easier than ever. Once you meet eligibility requirements, you are ready to choose from a variety of Medicare Part A and Part B plans in which to enroll. As we mentioned, some beneficiaries can receive automatic enrollment, and some must 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 through Friday, from 9:00 AM 3:30 PM at 1-877-772-5772.
Medicare applications generally take between 30-60 days to obtain approval.
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How Do I Enroll In A Medicare Advantage Plan
Medicare Advantage Plans are health care options provided under Medicare Part C of the Medicare program. These plans are approved by Medicare but sold and serviced by private companies. There are several plan options available under Medicare Advantage such as managed care plans that involve a provider network to those that are specially designed for people with certain chronic diseases and other specialized health needs and some that may or may not have a provider network requirement. Most Medicare Advantage plans include Medicare prescription drug coverage.
For assistance with Medicare Advantage Plans comparisons and enrollments, please call our team of Medicare specialists at 1-855-408-1212 or you may log onto MyMedicare.gov to shop for Medicare Advantage Plans available in your area.
To enroll in any Medicare Advantage plan option you must have both Medicare Part A and Medicare Part B. Once you enroll into a Medicare Advantage plan, you will not use your Original Medicare card as your Medicare Advantage plan will replace Original Medicare. Instead the Medicare Advantage plan will provide you with a member ID card to use when visiting your medical provider. Please note, you will continue to pay the Medicare Part B premium, and you might also have to pay an additional monthly premium charged by the Medicare Advantage plan.
When Is The Medicare Supplement Open Enrollment Period
Medicare Supplement open enrollment begins when you have Medicare Part B and are at least age 65. It continues for six months.
This open enrollment period for Medicare Supplement is a little later than your initial enrollment period because it starts when you turn 65, not three months before your birthday.
This is the best time to buy a Medigap plan because youâll have preferred pricing, and you canât be denied coverage because of a preexisting condition. Plus, any plan you get is guaranteed renewable, helping you reduce the cost of medical bills for as long as you choose to keep the policy.
2 key points when choosing the best Medicare Supplement for you
What happens if you miss your Medigap open enrollment when you turn 65?
However, if your circumstances qualify you for a guaranteed issue period, then you’ll have the freedom to change your plan without going through the underwriting process.
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Medigap Late Enrollment Penalty
Late enrollment for Medigap doesnt cause you to incur a penalty. However, in order to get the best rates for your Medigap plan, youll need to enroll during your open enrollment period.
This period starts on the first day of the month you turn 65 and lasts for 6 months from that date.
If you miss open enrollment, you may pay a much higher premium for Medigap. You may also be refused a Medigap plan after open enrollment ends if you have health problems.
If you wish to defer Medicare enrollment, you dont need to inform Medicare. Simply dont sign up when you become eligible.
To avoid penalties when you do decide to enroll, you should:
- have alternative during the time youre eligible for Medicare
- make sure to enroll during the 8-month period when your current coverage ends, known as a special enrollment period
If you decline Medicare coverage and never enroll, you wont receive Social Security benefits or Railroad Retirement Board benefits. Youll also need to return any payments youve already received through these programs.
Does Medicare Cover The Costs Of Durable Medical Equipment
Medicare does cover durable medical equipment, which is equipment that serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home. Original Medicare normally pays 80% of the Medicare-approved amount after you meet your Part B deductible and you are responsible for a 20% coinsurance. Medicare only covers durable medical equipment if your provider says it is medically necessary for use in the home. You must also order the equipment from suppliers who contract with Original Medicare or your Medicare Advantage Plan. If you have a Medicare Advantage Plan, your plan will have its own cost and coverage rules for durable medical equipment. For a more comprehensive list of what is covered, please visit Durable Medical Equipment section in the Medicare and You handbook.
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To Qualify For Medicare You Need To Get Disability Benefits From:
- Social Security
- Railroad Retirement Board
Youll automatically get Part A and Part B after you get disability benefits for 24 months. Well mail you a welcome package with your Medicare card.
If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
If you live in Puerto Rico or outside the U.S.
Medicare Enrollment Deadlines That Matter To Your Finances
Theres a lot of financial planning that goes into your transition to retirement. You may continue to work and earn even a partial paycheck past the traditional retirement age of 65. You may end work years earlier, and transition to a post-work budget, too.
One essential piece of retirement financial planning that will impact you for every year past age 65 is Medicare enrollment. It has a specific start timeyour 65th birthdayand financial penalties and costs if you dont thoroughly follow the rules about sign up and coverage.
If you work at a large company, you may get some help with these money-related questions, says Tyler De Haan, director of business development retirement solutions for Principal®. At smaller companies, you may have to do some research, but its worth it. Especially if youre going to forego coverage, you really want to make sure you have your ts crossed and your is dotted, he says.
The following considerations can help guide you through what you need to do to successfully enroll in Medicare, avoid financial penalties, and protect your retirement budget.
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When You First Get Medicare
- I’m newly eligible for Medicare because I turned 65.
-
What can I do?
Sign up for a Medicare Advantage Plan and/or a Medicare drug plan.
When?
During the 7-month period that:
- Starts 3 months before the month you turn 65
- Includes the month you turn 65
- Ends 3 months after the month you turn 65
If you join
Signing Up For Medicare Part D
Signing up for Medicare Part D is simple. Once you enroll in Medicare Part A and Part B, you can enroll in Medicare Part D.
Like other parts of Medicare, unless you have creditable coverage, enrolling during your initial enrollment period is best to avoid future penalties. To enroll, you must apply through Medicare and choose to enroll in any plan in your service area.
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Applying For Medicare Part A And Part B Online
Applying for Medicare Part A and Part B online is a quick and easy process on the Social Security website, taking approximately ten minutes. After you have applied for Medicare Part A and Part B online, you can check the status of your application and appeal, request a replacement card, and print a benefit verification letter.
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Medicare Deadline: 65 Or Older And Still Working
If you are 65 or older, currently employed, and get health care coverage through your employer, you can wait to sign up for Medicare until you retire or your coverage with your employer ends. In this scenario, you have an 8-month window to sign up for Medicare . This is considered a Special Enrollment Period.
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What Youll Get With Tufts Health Plan
Tufts Health Plan is the only plan in Massachusetts that is rated 5 out of 5 Stars for five years in a row, 2016-2020, by the Centers for Medicare and Medicaid Services. That’s because we know nothing is more important than your health.
Ready to take the next step? Chat with us! We’re local and ready to help: 1-844-455-3303 .
Or, click the button below for other simple ways to enroll:
Medicare Deadline: 65 Or Older And Have Health Insurance Through Your Spouse
If you have health insurance through your spouses employer, you dont need to sign up for Medicare when you turn 65 or retire. You can sign up for Part A and Part B up to 8 months after your spouses employer coverage ends. This is considered a Special Enrollment Period.
Important reminder: You are not automatically covered by Medicare through your spouse. Unlike health insurance you may have had through your employer, Medicare does not allow you to receive coverage through your spouse.In order to receive Medicare coverage, you must apply for it individually.
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