Top 5 Things You Need To Know About Medicare Enrollment
1. People are eligible for Medicare for different reasons.
Some are eligible when they turn 65. People under 65 are eligible if they have received Social Security Disability Insurance or certain Railroad Retirement Board disability benefits for at least 24 months. If they have amyotrophic lateral sclerosis , theres no waiting period for Medicare. Some people with End Stage Renal Disease may be eligible for Medicare. Its important to know the different ways that people qualify for Medicare so you can help current and former employees and their dependents anticipate their eligibility for Medicare so they can make timely and appropriate decisions about their enrollment.
2. Some people get Medicare Part A and Part B automatically and some people need to sign up for them.
People living in the United States and U.S. Territories who are already collecting Social Securityeither disability or retirementare automatically enrolled into Part A and Part B when theyre first eligible. These people will get a packet of information a few months before they turn 65 or receive their 25th month of Social Security Disability or Railroad Retirement Board benefits. At that time, they can choose to keep or decline Part B, but cant decline Part A unless they withdraw their original application for Social Security and pay back all Social Security cash benefits.
3. Enrolling in Medicare can only happen at certain times.
You Automatically Get Medicare
- You should already have Part A and Part B , because you have ALS and youre already getting disability benefits.
- We mailed you a welcome package with your Medicare card.
Sign up for Part B if you live in Puerto Rico or outside the U.S.
- Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.
Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months after your Part A starts, you might have to wait to sign up and pay a monthly late enrollment penalty.
- Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.
Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.
If You Disagree With Our Decision
If you disagree with the decision we made about your income-related monthly adjustment amounts, you have the right to appeal. The fastest and easiest way to file an appeal of your decision is online. You can file online and provide documents electronically to support your appeal. You can file an appeal online even if you live outside of the United States.
You may also request an appeal in writing by completing a Request for Reconsideration , or contact your local Social Security office. You can use the appeal form online, or request a copy through our toll-free number at 1-800-772-1213 . You dont need to file an appeal if youre requesting a new decision because you experienced one of the events listed and, it made your income go down, or if youve shown us the information we used is wrong.
If you disagree with the MAGI amount we received from the IRS, you must correct the information with the IRS. If we determine you must pay a higher amount for Medicare prescription drug coverage, and you dont have this coverage, you must call the Centers for Medicare & Medicaid Services to make a correction at 1-800-MEDICARE . We receive the information about your prescription drug coverage from CMS.
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Employer Or Military Retiree Coverage
If you or your spouse has an Employer Group Health Plan as retiree health coverage from an employer or the military , you may not need additional insurance. Review the EGHPs costs and benefits and contact your employer benefits representative or SHIIP to learn how your coverage works with Medicare.
How Do I Know Im Enrolled In Medicare
After you apply for Medicare, Social Security will review and process your application. Theyll contact you if they need more information.
When youre approved for Medicare Part A and/or Part B, Social Security will send you a welcome packet that includes the following:
- Your confirmation letter
- Your red, white and blue Medicare ID card
- A Welcome to Medicare booklet that walks you through decisions you may have to make with your Medicare coverage
- The Medicare & You handbook
If youve applied for a private Medicare plan such as a Medicare Advantage, Medicare Cost, Medigap or Medicare Prescription Drug plan, when your enrollment is accepted youll get a separate confirmation letter and ID card.
Medicare helps pay for your health care costs and covers preventive care including a visit with your doctor each year. So once you get Medicare Part B, schedule your initial Welcome to Medicare visit with your doctor. And each year you get an Annual Wellness Visit with your doctor.
For more helpful tips, review this checklist, how to use Medicare your first year.
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When Should You Sign Up For Medicare Benefits
Before I answer the question about when to sign up for Medicare benefits, let me assure you that enrolling in Medicare and understanding how it works doesnt have to be complicated. Ill show you how easy it is to figure out when to sign up for Medicare benefits. Keep in mind, there are three Medicare enrollment opportunities and its important to know which one apply to you.
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How Do I Change My Medicare Coverage
Your Medicare choices are not set in stone after the first time you enroll. You can make changes to your Medicare coverage during a few special Medicare enrollment periods.
- The Medicare Annual Enrollment Period , October 15 December 7
- The Medicare Advantage Open Enrollment Period, January 1 March 31
- The Medicare Special Enrollment Period for qualifying life events dates vary based on qualifying event
Learn how to make changes to your Medicare coverage during these three time periods:
Sign Up: Within 8 Months After Your Family Member Stops Working
- If you have Medicare due to a disability or ALS , youll already have Part A .
- 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 until you turn 65. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
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If Youre Not On Active Duty
As a general rule, Medicare will be the primary payer or the policy that pays first for all Medicare-approved services from non-VA providers. Medicare will pay up to its defined coverage limits.
TRICARE will usually act as the secondary payer. If there are costs remaining that TRICARE covers, TRICARE will help pay for them. Having both forms of insurance can significantly reduce your out-of-pocket costs. Its important to know that just because TRICARE pays for some of the costs Medicare doesnt cover, it may not pay for all of them.
An exception is when you receive care from a military hospital or any other federal healthcare provider. TRICARE will usually be the primary payer for these services.
How to get your questions answered
If at any time you have questions about who pays for what, you can call Medicares Benefits Coordination & Recovery Center at 855-798-2627 . You can also call TRICARE for Life at 866-773-0404.
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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.
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How Do I Sign Up For Medicare At Age 65 If Im Still Working
Medicare Part A is premium-free for most people but you typically pay a monthly premium for Medicare Part B.
So, you may want to delay enrollment in Part B if youre still working and have health insurance through your employer or other organization when you turn 65.
You should check with your plan benefits administrator before you turn 65 to see if your employer coverage changes when you become eligible for Medicare.
If you have the option to choose between Medicare and your employer plan, compare your monthly premiums and benefits before you turn 65 so you know which option makes the best financial sense for you.
Be aware that theres a late enrollment penalty for Medicare Part B if you dont sign up during your Initial Enrollment Period. You may avoid the penalty if you qualify for a Special Enrollment Period for example, if youre covered under an employment-based group health plan.
Do You Have To Sign Up For Medicare If You Are Still Working
The most common reason for people not signing up for Medicare when they turn 65 is because they are still working. Because theyre still working, theyre likely covered under their employers health insurance plan and are also unlikely to be collecting Social Security retirement benefits.
Being covered under your employer-provided health insurance plan has no bearing on your Medicare eligibility. Medicare works in conjunction with several other types of health insurance including health insurance provided by employers or unions and wont prevent you from enrolling.
However, if you are not collecting Social Security retirement benefits at least four months before you turn 65, you will not be automatically enrolled in Medicare when you turn 65. In this case, you will have to manually sign up for Medicare when youre ready to enroll.
Many people choose to delay their Social Security retirement benefits until a later age when they can collect the full amount. If you choose to delay your retirement benefits, you must still sign up for Medicare manually once youre eligible in order to avoid any late enrollment penalties .
Some people who are still working sign up for Medicare anyway, because Medicare can work as extra insurance along with an employer group health insurance plan. Some people may decide that Medicare is more affordable than their employers insurance, so they may continue working but disenroll from their group plan and enroll in Medicare instead.
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You Automatically Get Medicare When You Turn 65
- Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.
Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.
The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medical hospital insurance if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
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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.
How Do I Sign
Here are a few ways to enroll in Medicare.
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You can apply online at the Social Security website.
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You can call your local Social Security office or their toll-free Number at 1-800-772-1213, Monday-Friday, 8:00 a.m. to 7:00 p.m.
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You can visit your Social Security office in person.
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You can call Fair Square Medicare at 1-888-376-2028. We can walk you through the whole process, step by step.
If you have trouble enrolling online, we created this video to help you apply for Medicare.
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Who Qualifies For A Special 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.
How Do I Sign Up For Medicare If I Have A Disability
If you have already qualified for Social Security disability benefits, then you will be automatically enrolled after you have been qualified for those benefits for 24 months. If you do not currently receive these benefits, then you will need to apply for disability benefits first. Eligibility for Medicare for disabled people depends on their disability determination through the Social Security Administration. There is no separate Medicare disability eligibility.
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How To: Enroll In Medicare Part A And Part B
Some people are automatically enrolled in Medicare Part A and Part B. Some people are not.
You’ll be automatically enrolled in Medicare Part A and Part B if:
- You’re receiving Social Security or Railroad Retirement Board benefits when you turn 65 or
- You’re eligible for Medicare because of a disability or medical condition.
You must enroll yourself in Medicare Part A and B if:
- You’re not receiving Social Security benefits when you become eligible for Medicare.
How Do I Apply For Medicare Online
Learn the steps to take to apply for Medicare Parts A and B, Medigap, Medicare Advantage, and Medicare Part D online.
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What you should know
1. If you are not automatically enrolled in Medicare, you can enroll online through the Social Security Administration . | 2. Before you enroll in Medicare, research your coverage options, create your personal account, complete the online application, and confirm your enrollment. |
3. Use Medicares online tool to research and compare Medigap, Medicare Advantage, and Medicare Part D prescription drug plans available in your area. | 4. You can pay your Medicare health coverage premiums online or through the mail. |
The best way to apply for Medicare is online. The Social Security Administration handles your Medicare application and enrollment. Due to the COVID-19 pandemic, you can only enter social security offices if you have an appointment. Services are also available online and by phone or fax.
Applying for Medicare online is quick and easy. Doing so offers many advantages, such as the ability to start your application immediately rather than waiting for an appointment. You also dont need to complete the application in one sitting. You can stop and restart without losing previously entered information. In fact, there is never a reason why it would be better to apply in-person than online, according to the SSA.
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