What is Medicare?
Medicare is the federal health insurance program governed by The Centers for Medicare and Medicaid (CMS) to ensure older Americans and people with certain disabilities and illnesses have access to affordable medical care.
There’s a lot to know about Medicare. If your questions aren’t answered after reading this article, you can find more information in our Medicare Learning Center. Browse free resources, watch videos, design your personal Medicare timeline or connect with our team of Medicare experts. Visit priorityhealth.com/learn to learn more.
Original Medicare is health coverage offered by the federal government. It includes Part A (hospital coverage) and Part B (coverage for medical services). After your deductible is paid, Original Medicare only covers 80% of your health care costs, making you responsible for 20%. There is no limit to the amount of money you could pay out of pocket as part of that 20%.
Medicare Part C, also called a Medicare Advantage plan, is an all-in-one alternative to Original Medicare offered by private companies like Priority Health. If a Medicare Advantage plan also includes Part D prescription drug coverage, it is called a Medicare Advantage with Prescription Drug (MAPD) plan. You must be enrolled in Original Medicare before you can enroll in a Medicare Advantage plan.
Medicare Part D is coverage for prescription drugs. To get Part D coverage, you can enroll in a MAPD plan, or add a separate prescription drug plan (PDP) to Original Medicare or to a Medigap plan.
A Medigap plan provides supplemental coverage for things Original Medicare doesn’t cover and can be purchased from a private insurer.
When should I apply for Medicare?
If you’re already receiving benefits from Social Security or the Railroad Retirement Board (RRB), you don’t need to do anything. You’ll automatically be enrolled in Medicare Parts A and B on the first day of the month you turn 65. You will, however, still need to enroll in Medicare Parts C and D during your Initial Enrollment Period if you want that coverage.
If you’re not yet collecting Social Security retirement benefits, you should apply for Medicare during your Initial Enrollment Period (IEP). Your IEP spans the three months before your 65th birthday, the month of your 65th birthday, and the three months after your birthday.
Keep in mind, there are penalties for not enrolling in Medicare Parts B and D on time, and you will pay these penalties for the duration you are enrolled in Medicare. Signing up on time can also protect you from facing expensive medical bills if you get injured or sick without having the coverage you need.
If you want Original Medicare coverage but do not enroll in when you’re first eligible, you’ll have to wait for the next Medicare Open Enrollment Period (OEP), which is Jan. 1 through Mar. 31.
If you want Medicare Part C coverage, also called a Medicare Advantage plan, but do not enroll in when you’re first eligible, you’ll have to wait for the next Annual Election Period (AEP), which happens Oct. 15 to Dec. 7 each year.
How do I apply for Original Medicare?
You can enroll in Original Medicare (Parts A and B) three ways:
- Call the Social Security Administration at 800.772.1213 (TTY: 800.325.0778)
- Visit your local Social Security office.
- Sign up online at ssa.gov.
Filling out the online application is usually quick and easy and usually takes less than 10 minutes. Social Security will process your application and contact you if more information is needed.
You’re typically eligible to apply for Part A at no charge if you paid into the Medicare program through your employment taxes for at least a decade. Eligibility for Part B is tied to being a U.S. citizen or permanent resident. Those with a disability may qualify before age 65.
What information will I need to apply for Medicare?
When you’re ready to enroll in Medicare, you should have certain documents and personal information on hand to ensure the process goes smoothly.
First, you’ll need to create a My Social Security account on the Social Security Administration website. This step may require you to prove your identity, age and citizenship with your:
- Birth certificate or other proof of birth.
- Proof of U.S. citizenship or legal residency, if not born in the U.S.
- Driver’s license.
After you’ve set up your account, you may need to answer questions about the following:
- If you are collecting Social Security benefits.
- What type of health insurance you currently have.
- Employment information, such as a W-2 form, if you are currently working.
- U.S. military discharge papers for service before 1968.
What is Medicare Part C?
Medicare Part C, also called a Medicare Advantage plan, is an all-in-one alternative to Original Medicare offered by private companies like Priority Health. If a Medicare Advantage plan also includes Part D prescription drug coverage, it is called a Medicare Advantage with Prescription Drug (MAPD) plan.
A Medicare Advantage plan can lower your out-of-pocket costs with predictable copayments, lower deductibles and out-of-pocket maximums. Most Medicare Advantage plans also offer extras such as vision, hearing and dental coverage, mental health support, fitness memberships, an over-the-counter allowance and travel health coverage.
This type of plan may be right for you if:
- You want predictable copays, deductibles and an out-of-pocket maximum.
- Paying a lower monthly premium is important to you.
- You want Part D prescription drug coverage bundled with Parts A and B coverage (included on MAPD plans).
- You want additional coverage for pre-existing conditions.
Keep in mind, you must be enrolled in Medicare Parts A and B before you can enroll in a Medicare Advantage plan.
When can I apply for Medicare Part C?
You can enroll in Medicare Part C during your Initial Enrollment Period (IEP). If you want a Medicare Advantage plan but decide not to enroll in when you’re first eligible, you’ll have to wait for the next Annual Election Period (AEP), which happens Oct. 15 to Dec. 7 each year.
AEP is also when you can make changes to your current Medicare Advantage plan or return to Original Medicare. If you make changes, your coverage is effective on Jan. 1 of the upcoming year.
How can I apply for Medicare Part D?
If you take prescription drugs, you should consider Medicare Part D prescription drug coverage. Original Medicare doesn’t cover most drugs so Part D coverage may help lower your overall prescription drug costs.
You can enroll in Part D coverage through a private insurance company that offers Medicare Advantage with Prescription Drug (MAPD) plans, such as Priority Health. Medicare Part D monthly premiums, copayments and deductibles vary by plan.
You should make sure the medication you’re currently taking is covered before enrolling an MAPD plan by checking the formulary—an insurers list of approved drugs.
When can I apply for Medicare Part D?
If you’re going to enroll in Part D coverage, you should do so during your IEP to avoid paying a late enrollment penalty when you do enroll. That penalty will apply for the duration of your Part D coverage unless you have creditable coverage – coverage as good as or better than Original Medicare, from an employer or union, for instance.
Important Medicare terms you need to know.
Here’s a quick overview of important dates and terms you need to know when it comes to applying for Medicare and switching or dropping plans.
Initial Enrollment Period — The three months before your birthday, during your birthday month and the three months after your birthday is called your Initial Enrollment Period (IEP). During this time, you can apply for Original Medicare (Parts A and B), a Medicare Advantage plan (Part C) and/or prescription drug plan (Part D).
Annual Enrollment Period — Oct. 15 through Dec. 7 of each year is the Annual Enrollment Period (AEP). If you have Medicare Parts A and/or B or are already enrolled in a Medicare Advantage plan or Part D prescription drug plan, the Annual Enrollment Period (AEP) is when you can switch to a different plan or health insurance provider. Your new plan benefits take effect on Jan. 1 of the upcoming year.
Open Enrollment Period — Jan. 1 through Mar. 31 of each year is the Medicare Advantage Open Enrollment Period (OEP) when you can change to a different Medicare Advantage (Part C) plan, or disenroll from your plan and return to Original Medicare.
You must already be enrolled in a Medicare Advantage plan to make changes during this time, and you are only allowed one plan change. When you make a change during OEP, your new plan starts on the first day of the next month.
Medigap period — You have a six-month Medigap open enrollment period that begins on the first day of the month in which you are both 65 or older and enrolled in Medicare Part B. During this time, you can add a Medigap plan to your Original Medicare and/or Part D plan. This is the best time to apply because you’ll be accepted into a Medigap plan at a preferred rate.
Special Enrollment Period — In some situations, you may be eligible for a special enrollment period (SEP). An SEP gives you the opportunity to change your Medicare Advantage coverage outside of normal time constraints. Some examples include:
- If you move outside the area your plan covers.
- You lose your current coverage, such as an employer or union plan, or Medicaid eligibility.
- Your plan no longer meets the standards CMS requires.
- Your plan doesn’t renew its contract with CMS.
You have lots of options when it comes to Medicare; you may also have lots of questions. Our customer service team was recently named to Newsweek’s America’s Best Customer Service 2024 List1 and would be happy to answer any questions you have. Call toll-free at 888.389.6648 (TTY 711), seven days a week, 8 a.m.-8 p.m.
