Most traditional medical insurance plans cover all types of medical expenses with one comprehensive plan. You may use a secondary plan for dental, vision, or prescription coverage. Still, a visit to the doctor’s office is likely covered with the same insurance that covers a visit to the emergency room.
If that’s the insurance model that you’re familiar with, Medicare’s coverage may be a new concept.
Medicare coverage is separated into parts. Parts A and B are the most popular.
Part A covers:
- hospital-related expenses
- hospice (end-of-life treatment) care
- stays in nursing facilities and rehab centers
Part B covers:
- doctor’s visits
- outpatient hospital services
- medical supplies
- preventive care
Both Parts A and B are called Original Medicare.
How to Apply
A few months before you turn 65, you should start researching Medicare and what you need to do to enroll. If you’re already receiving Social Security checks, you will automatically be enrolled in Medicare Parts A and B. Expect to receive your red, white, and blue Medicare card three months before your 65th birthday. You will be able to begin using Medicare on the first day of your birthday month.
If you’re not receiving Social Security checks, you will need to enroll three months before your 65th birthday. Medicare enrollment is handled through the Social Security Administration (SSA). You can apply at your local SSA office, online at www.ssa.gov, or by calling (800) 772-1213.
Be sure to give yourself a three-month window before your birthday. This will help ensure your coverage begins when it should.
If you’re applying because you have an illness or disability that requires Medicare coverage, you should also apply through the SSA.
The following groups are eligible for Medicare, although a few exceptions may apply:
- People over the age of 65, regardless of retirement status.
- Certain people under the age of 65 who have specific illnesses or disabilities.
- People of any age who require hemodialysis or a kidney transplant.
When to Apply?
Initial Enrollment Period
You can enroll for Medicare during your initial enrollment period. This period is a seven-month window around your 65th birthday in which you can apply. You may apply as early as three months before your birthday, the month of your birthday, or up to three months after your birthday. During this initial enrollment, you can apply for any portion of Medicare you would like.
If you would like for your coverage to begin the first day of your birthday month, you should apply three months before your birthday. Applying the month of your birthday or in the months after your birthday will leave you waiting one to three months for coverage to begin. The longer you wait to apply, the longer you must wait for coverage.
Annual Enrollment Period
If you failed to sign up for Medicare during your initial enrollment period, you can sign up during the annual enrollment period. Annual enrollment begins January 1 and lasts through March 31. If you sign up during this enrollment, your coverage will begin July 1. You will likely also pay higher premiums for waiting.
No one is obligated to sign up for Medicare. If you don’t want it, you don’t have to enroll. However, if you decide later that you do want it, you may have to pay penalties.
If you didn’t sign up for Medicare Parts A and B during your initial enrollment period, you can sign up during the annual enrollment period. Unfortunately, you will likely pay higher monthly insurance premiums. This is not always the case, but to keep your costs lower, apply during your initial enrollment period.
Not everyone has to apply for Medicare at 65. For example, if you’re still using employer-based health insurance and it lasts beyond your initial enrollment period, you don’t have to enroll in Medicare. You can wait until you’re retired or no longer covered by your employer-based health insurance.
Once you no longer have that coverage, you have 8 months of a Special Enrollment Period in which you must apply for coverage. Even if you still have employer-provided coverage after your employment ends, you must apply for Medicare Part B in this window. If you do not, you will have to pay a late-enrollment penalty to sign up for Medicare.
Keep in mind: Not all employer-based insurance plans cover medical expenses as well as Medicare. In that case, you’re required by Medicare to enroll and begin using Medicare at age 65. If you’re unsure if your employer-based coverage is good enough, check with the SSA.
During your application process, you may need help enrolling. You may also have questions and need a trusted source for answers. The Social Security Administration can help you navigate the process.
Here are three ways you can reach the SSA:
- Meet with someone in person at your local SSA office.
- Call them at (800) 772-1213.
- Visit their web site: www.ssa.gov.
You can also call the Centers for Medicare & Medicaid Services at 1-800-MEDICARE, or visit Medicare’s web site at www.medicare.gov.