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 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 care
- stays in nursing facilities and medical rehab centers
Part B covers:
- doctor’s visits
- outpatient hospital services
- medical supplies
- preventive care
Medicare parts A and B are called Original Medicare.
It’s a good idea to start looking into Medicare a few months before you turn 65. If you’re already receiving Social Security checks, you’ll 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 can begin using Medicare on the first day of your birthday month.
If you’re not receiving Social Security checks, you’ll need to enroll three months before you turn 65. Medicare enrollment is handled through the Social Security Administration (SSA). You can apply at your local SSA office, online, 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 age 65, regardless of retirement status
- certain people under age 65 who have specific illnesses or disabilities
- people of any age who require hemodialysis or a kidney transplant
There are specific times when you can apply for Medicare. These are called enrollment periods.
Initial enrollment period
The initial enrollment 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 initial enrollment, you can apply for any portion of Medicare.
If you want coverage to begin the first day of your birthday month, make sure to 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, beginning January 1 and lasting through March 31.
If you sign up during this enrollment, your coverage will begin July 1. You’ll likely also pay higher premiums.
You aren’t 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. This might result in higher monthly insurance premiums. 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 eight months of a special enrollment period to 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 don’t, you’ll have to pay a late-enrollment penalty to sign up for Medicare.
Not all employer-based insurance plans cover medical expenses as well as Medicare does. 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:
You can also call the Centers for Medicare & Medicaid Services at 800-MEDICARE, or visit Medicare’s website.