Everything You Need to Know to Enroll in Medicare

Everything You Need to Know to Enroll in Medicare

Jan 30 2020

Are you confused about how to apply for Medicare? This comprehensive guide has everything you need to know to enroll in Medicare when you’re ready.

How to apply for Medicare

If you’re approaching your 65th birthday, it’s time to start thinking about your Medicare options. Medicare is the federal health insurance program created more than a half-century ago to make sure older Americans, and people with certain disabilities and illnesses, have access to affordable medical care.

You don’t have to be retired to apply for Medicare, but you may need to apply during a seven-month period surrounding your 65th birthday or you could incur penalties.

If you’re already receiving benefits from Social Security or 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. Just keep an eye out for your red-white-and-blue Medicare card to come in the mail.

Otherwise, you can apply in person at your nearest Social Security office, over the phone or online. You’ll need to pay attention to specific enrollment deadlines and plan details to make sure you’ve set up benefits correctly. Here’s what you need to know to apply for Medicare benefits.

How can I apply for Medicare?

Filling out the online application is usually quick and easy. Social Security will process your application and contact you if more information is needed.

Your initial Medicare enrollment window spans seven months, beginning three months before the month of your 65th birthday, the month of your 65th birthday, and ending three months after it. If you don’t enroll in Medicare on time, you may incur penalties.

There are four parts of Medicare that cover specific services:

  • Part A covers hospital care.
  • Part B covers medical and doctor services.
  • Part C is Medicare Advantage. Once you have Parts A and B, you can enroll in a Medicare Advantage plan. Private companies—like Priority Health—manage Medicare Advantage plans (Part C).
  • Part D is prescription drug coverage.

Reminder: If you already receive Social Security benefits when you turn 65, you’ll be automatically enrolled in Medicare parts A and B. Otherwise, you’ll need to sign up.

How can I apply for Medicare online?

You can begin by creating a My Social Security account before you enroll.

Filling out a Medicare application usually takes less than 10 minutes to complete. After Social Security processes your application, the agency will contact you if more information is needed.

Medicare is managed by the Centers for Medicare and Medicaid Services (CMS). Social Security works with CMS by enrolling people in Medicare.

You can apply for Medicare, even if you delay receiving your retirement benefits. The first time you are eligible to begin applying is three months before the month of your 65th birthday.

When can I apply for Medicare benefits?

You will automatically receive Medicare benefits when you reach age 65 if you are already receiving benefits from Social Security or the Railroad Retirement Board (RRB). Those Medicare benefits include Part A (hospital insurance) and Part B (medical insurance).

To help inform you of your new benefits, you will receive a “Welcome to Medicare” packet three months before your 65th birthday. It’s important to read all materials because you’ll need to make important decisions that are tied to deadlines.

Even if you’re delaying your Social Security retirement benefits, you can still apply for your Medicare benefits. The best time to sign up for your benefits is during the three months before the month you turn 65.

That’s because your Part B coverage will likely be delayed if you wait to apply for Medicare the month you turn 65 or later. Your Initial Enrollment Period (IEP) spans seven months, which includes the three months before your birthday, your birthday month and three months after you turn 65.

If you decide not to enroll in Medicare when you’re first eligible, you’ll have to wait for another enrollment period. Those who miss that initial window risk financial penalties, so it’s important to pay attention to deadlines. 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.

What documents do 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 need to create a My Social Security account. This step may require you to prove your identity, age and citizenship. The Social Security website requires these documents to be on hand when creating your account:

  • 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

When it’s time to enroll in Medicare and after you’ve set up your Social Security account, you may need to answer questions about the following:

  • If you are collecting Social Security benefits
  • What type of health insurance you have and dates of coverage
  • Employment information such as a W-2 form if you are working
  • U.S. military discharge papers for service before 1968

How long before you turn 65 can you apply for Medicare?

You can apply for Medicare before your 65th birthday. The earliest you can submit your application is three months before the month of your 65th birthday. In total, your Initial Enrollment Period spans for seven months.

How can I apply for Medicare Part A?

Most people will automatically be enrolled in Medicare Part A, which covers hospital stays, hospice care and some skilled nursing care. In most cases, you won’t have to pay a premium for Part A. After all, so many enrollees have already paid for it through their payroll taxes.

Medicare Part A covers most hospital costs after you pay the first $1,408 (your “Part A deductible”). This is why many opt to buy a Medicare Advantage or Medigap plan  to cover deductibles and out-of-pocket costs.

You can sign up for Medicare Part A during your Initial Enrollment Period (IEP). If you didn’t sign up when you were first eligible, you can sign up for Part A during the Medicare Open Enrollment Period (OEP), Jan. 1 through Mar. 31.

You can enroll in Part A 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

How can I apply for Medicare Part B?

When you’re first eligible for Medicare, during your Initial Enrollment Period, you can also sign up for Medicare Part B. Medicare Part B covers 80% of the costs of doctor visits and everyday Medical services after you pay the first $198 (your “Part B deductible”).

Part B can be an important choice if you or a family member/spouse is disabled, still working and have employer-provided coverage. If this is the case, you may have options to delay your enrollment in Part B. But if you don’t have other coverage, you should sign up for Part B as soon as you’re eligible, or you could pay penalties later.

The federal government sets the standard Part B premium which you will have to pay every month. The standard Part B premium amount in 2020 is $144.60 (or higher, depending on your income).

Similar to Part A, you can apply for Part B through the Social Security Administration by phone, in person or online at ssa.gov. If you already receive Social Security or RRB benefits, you’ll be automatically enrolled.

How can I apply for Medicare Part C?

Part C, commonly known as Medicare Advantage, allows private health insurance companies, such as Priority Health, to provide Medicare benefits in addition to what’s covered by Parts A and B. These plans areknown as Medicare Advantage with Prescription Drug (MAPD) plans when they come with prescription coverage (Part D). In short, these types of plans often offer everything Original Medicare does, plus much more.

Medicare Advantage plans can help lower your out-of-pocket costs with predictable copayments, deductibles and out-of-pocket maximums. In addition to helping cover prescription drugs, MAPD plans can also offer extras, such as a gym membership or dental coverage.

Coverage under Medicare Part C is very similar to that of a typical health insurance plan. However, it also offers dental, vision and other coverage benefits not found in Parts A and B. Keep in mind, Medicare plan costs can vary from person to person.

Medicare Advantage plans tend to be a smart option for Medicare-eligible individuals looking to save money and have lower coverage needs. As with any health insurance plan, the lower the premium, the higher the deductible. You can explore the cost of Priority Health Medicare Advantage insurance plans with this helpful calculator.

You can enroll in Medicare Part C during your Initial Enrollment Period (IEP) beginning before your 65th  birthday or during the Annual Election Period (AEP), which happens Oct. 15 to Dec. 7 each year. AEP is when you can also make changes to your plan. If you don’t already have a Medicare Advantage plan, you can enroll in one during this time. If you’re currently enrolled in a Medicare Advantage plan, you can choose a different 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 (Parts A and B) doesn’t cover most drugs. Part D may help lower your prescription drug costs and help protect you against higher costs in the future.

With Part D, you can receive coverage through a private insurance company, such as Priority Health if you’re in Michigan, that offers  Medicare Advantage with prescription drug (MAPD) plans. Medicare Part D monthly premiums, copayments and deductibles vary by insurers.

You can check to see if the medication you’re taking is covered by checking your insurer’s formulary—a list of approved drugs. One example is the Priority Health Medicare Advantage formulary. If your medications are not included on this list, Part D may not be the right choice for you.

The sooner you apply for Part D, the better. Ideally, this is done during your initial enrollment period.

If you decide to wait to enroll in Medicare Part D and you don’t have “creditable coverage” (coverage as good as or better than Original Medicare) – for instance from an employer or union – you could end up paying a late enrollment penalty. This late enrollment fee will be added to your monthly premium once you do enroll and will continue for as long as you have Medicare.

Medicare vs. Medicaid: What’s the difference?

Medicare and Medicaid often get mixed up because they sound similar. While both of these government programs provide health care to specific populations, there is a big difference between them. When it comes to Medicare vs. Medicaid, here’s what you need to know:

Medicaid is an assistance program providing coverage for low-income Americans. Medicare is a federal insurance program serving individuals 65 and over—along with individuals under 65 with certain disabilities, as well as dialysis patients.

Patients with Medicaid usually pay very little of their medical costs. Patients with Medicare pay part of their medical expense costs through deductibles for hospital coverage and a small monthly premium for non-hospital coverage.

Because funding comes from federal and state dollars, Medicaid coverage varies from state to state. Medicare is a federal program and is essentially the same across the country. Medicare medical bills are paid from trust funds set up and paid into through Social Security.

When should I apply for Medicare — can you sign up anytime?

Here’s a quick overview and reminder of important dates when it comes to applying for Medicare and switching or dropping plans.

Your 65th birthday — The three months before your birthday, your birthday month and the three months after— is 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).

Medigap period — You’ll also have a six-month Medigap (Medicare Supplement) open enrollment period that begins on the first day of the month in which you are both 65 or older and enrolled in 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 it’s your “guaranteed issue” period and you’ll be accepted into a Medigap plan, even if you have health problems.

Annual Election Period — Between Oct. 15 and Dec. 7 if you have a Medicare Advantage or Part D prescription drug plan, the Annual Election Period (AEP) gives you the chance each year to 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 is the Medicare Advantage Open Enrollment Period (OEP), when you can change to a different Medicare Advantage or MAPD plan or disenroll from your plan and return to Original Medicare. But you must already be enrolled in a Medicare Advantage or MAPD 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.

Special Election Period — In some situations, you may be eligible for a special election period (SEP). SEP gives you the opportunity to change your Medicare Advantage (Part C) and prescription drug (Part D) plans or go back to Original Medicare (Parts A and B) outside of the normal time restraints. These situations involve scenarios where your plan or parts of your plan are no longer available because you have moved or your coverage has changed.

When can I apply for Medicare benefits in Michigan?

Your 65th birthday is a big milestone for many reasons.  The first being this is the age when you’re eligible for Medicare, the federal health insurance program that will pay for most of your medical costs. If you already receive Social Security benefits when you reach 65, you’ll automatically be enrolled in Medicare the first day of the month of your birthday. If you haven’t started Social Security yet, now’s the time to apply for Medicare in Michigan and across the country.

You’re typically eligible to apply for Medicare Part A (hospitalization coverage) at no charge if you paid into the Medicare program through your taxes for at least a decade. Eligibility for Part B (medical insurance) is tied to being a U.S. citizen or permanent resident. Those with a disability may qualify before age 65.

You can apply online or over the phone, although you’ll need to pay close attention to enrollment deadlines and the details of the plan to make sure you’ve set up your benefits correctly.

In most cases, you should apply for Medicare when you turn 65. The Initial Enrollment Period starts three months before your 65th birthday, your birthday month, and extends three months after, providing a seven-month period for your initial enrollment. If you apply late, you put yourself at risk for financial penalties, so make sure you enroll during your enrollment window.

If you opt to enroll in Part C, you will have a choice of Medicare Advantage options that can bundle Parts A, B and D into one plan. For example, Priority Health offers Medicare Advantage plans in 68 Michigan counties.

As you approach your 65th birthday, remember to review this comprehensive guide for everything you need to know about Medicare in Michigan.

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