Almost everyone knows that you’re eligible for Medicare after age 65, but what’s not so well known is how to actually enroll and start receiving benefits. However, getting Medicare benefits doesn’t have to be stressful or difficult. These steps and rules will help you navigate the Medicare enrollment experience and get the care you need.
Medicare Enrollment Options
There are four parts to Medicare: A, B, C and D. Part A covers any time you have to spend at the hospital and is often worth enrolling in even if you still receive medical insurance through your employer. Part B covers the cost of visiting doctors, but like most private insurance plans, you will be responsible for a small portion of your bill. Together, Parts A and B are known as Original Medicare, which acts as the most basic Medicare package that many people are enrolled into at age 65.
In addition to Parts A and B, there’s also Part D, which covers prescriptions, and Part C, which typically includes Parts A, B and D as well as additional benefits, such as vision, dental and wellness care. (It’s admittedly not intuitive.) Part C is known as Medicare Advantage, and while it’s available in most parts of the country, some rural areas don’t have access to it. You must also already be enrolled in Parts A and B to be eligible for Part C. Medicare Advantage plans tend to have fewer out-of-pocket costs than Original Medicare, although you are limited to in-network doctors.
Automatic Enrollment: Who Gets It?
While most people have to apply for Medicare, if you already receive Social Security or Railroad Retirement Board benefits, you will be automatically enrolled in Medicare Parts A and B. It will go into effect on the first day of the month of your 65th birthday (so if you were born on August 24, it will become active on August 1 of the year you turn 65). Your Medicare card should be sent to you three months before your birthday, and the only action you should take is to stick your card into your wallet or purse unless you wish to enroll in Parts C or D as well. Other information on decisions you need to make will be mailed to you in a package.
People under the age of of 65 who have had a disability that qualifies them Social Security or Railroad Retirement benefits for 24 months or more are automatically enrolled in Parts A and B of Medicare, with coverage beginning on the 25th month of eligibility and your card arriving in the mail three months before that. People with Lou Gehrig’s disease (ALS) get their benefits on the same month that Social Security or Railroad Retirement benefits begin.
Manual Enrollment in Original MediCare
Other people must manually enroll in Medicare to begin receiving benefits. However, you must do so within a specific window of time: as early as three months before your 65th birthday to as late as three months after. Coverage is often delayed if you apply on or after your birthday, so it’s best to enroll as soon as possible. There are also financial penalties if you enroll after this time period, so make sure you do it on time. If you miss the enrollment period around your birthday, there is also an annual open enrollment period from January 1 to March 31; if you enroll after you turn 65 during this period, Medicare coverage begins on July 1.
When you enroll, you almost always want access to Part A of Medicare, which covers hospital fees and can absorb costs before any other insurance plan you have kicks in. Part B, however, might not be in your best interest if you receive health insurance through your or your spouse’s employer. In that case, you can opt out of Part B, although if you retire, you will need to enroll within eight months of your previous coverage ending. Otherwise, you will face a 10 percent hike in premiums per year that you didn’t enroll in Part B. Monthly premiums for Part B were $144.60 cents in 2020.
How to Apply
To apply for Medicare, simply visit your local Social Security Office with the appropriate documentation or mail a signed and dated letter that includes your full name, when you would like to be enrolled, the nature of your enrollment and your Social Security number. You can also call 1-800-633-4227 or apply online at www.ssa.gov.
You should keep proof of your application, namely the names of any representatives you speak to, the date and time, a handwritten receipt from the local Social Security Office or a printed-out confirmation page from the Medicare website, depending on which method you use. Post applications should be sent via certified mail, and you should request and save a return receipt. Keeping a record of your application can help you avoid Medicare Part B penalties.
Medicare Advantage isn’t available in all areas, although most parts of the country do have it. To enroll, you must either have or qualify for Medicare Parts A and B. The enrollment period is the same as for Original Medicare, although you can also upgrade to Medicare Advantage or switch Medicare Advantage plans between October 15 and December 7. If you do so, coverage begins January 1.
Unlike original Medicare, there are different Medicare Advantage plans, so it’s best to shop around for the best one for you on Medicare’s website. Medicare Advantage plans typically charge a monthly premium in addition to the separate Part B premium, the latter of which is usually deducted from Social Security checks. If you switch Medicare Advantage plans, the old plan will generally cover you until the new one is in place without a lapse in coverage. Otherwise, you should consider paying for Medigap to cover you in between plans.
Medicare Part D
Medicare Part D, which covers prescription costs, follows similar enrollment rules to Medicare Original and Medicare Advantage and can help you afford medications if you have Original Medicare or a Medicare Advantage plan that doesn’t cover them. Note that no part of Medicare covers long-term care, such as assisted living facilities. Custodial care and hospice services are covered only under certain circumstances.