- When you first become eligible for Medicare, you’ll need to take a few enrollment steps.
- If you’re not already receiving any kind of Social Security benefit, you’ll need to take a few additional steps.
- To avoid penalties later, enroll during your initial enrollment window.
- Decide in advance which parts of Medicare you want to use.
Medicare is available to Americans ages 65 or older and those who receive Social Security Disability Insurance (SSDI). However, there are a few steps you’ll need to take once you become eligible.
These steps will depend on how you become eligible, whether you already receive any kind of Social Security benefit, and which parts of Medicare you want to enroll in.
You’ll need to take some actions when you first become eligible for Medicare. These actions will depend on why you’re eligible for Medicare.
For example, if you’re eligible through a disability that you receive SSDI for, you’ll be automatically enrolled in original Medicare (parts A and B) after 24 months of SSDI payments.
You’ll need to take additional steps if you want to enroll in other Medicare parts, such as Part C (Medicare Advantage) or Part D.
However, if you’re eligible for Medicare because you’re turning 65 years old, you’ll need to take a few more steps. You’ll have to apply for Medicare during your initial enrollment window.
Your initial enrollment window runs from the 3 months before the month of your 65th birthday to the 3 months after it. So, if you turn 65 years old in April 2021, you’d have from January 2021 through July 2021 to enroll.
Enrolling during your initial enrollment window is important. If you miss your window, you could face late penalties later.
You’ll also need to provide Social Security and Medicare with some information that proves you’re eligible. In some cases, such as if you’re receiving Social Security retirement benefits, Social Security might already have this information; in other cases, you’ll need to provide it.
You’ll generally be asked for proof of your age, work history, citizenship, and any military service. You might need to provide supporting documents, such as your:
- birth certificate
- proof of citizenship, or permanent residency if you weren’t born in the United States
- income statements
- W-2 or other tax forms
- discharge papers or other records of any military service before 1968
If you’re applying through your local office, you can visit in person or send them a letter with your name, your Social Security number, and the date you’d like to enroll.
No matter how you become eligible for Medicare, there are some steps you need to take. You’ll take some of these actions during your enrollment window and others during your first year of Medicare membership.
These are steps to take a few months before your enrollment to help you prepare:
- Make sure your doctor and other providers accept Medicare.
- Use Medicare’s plan finder tool to research the cost of Medicare Advantage, Medicare Part D, and Medigap plans in your area.
- Determine whether you’ll be automatically enrolled in parts A and B or will need to take additional steps.
- Research how your current health plan works with Medicare.
- Look at the income requirements for any assistance programs, like Medicare Extra Help or a Medicare savings program, and apply if you think you might qualify.
- Research what Medicare covers and what it doesn’t.
- Determine if you’ll need additional coverage from a Medicare Advantage plan.
The parts of Medicare
Medicare includes five main types of benefits, including:
- Medicare Part A. Medicare Part A is hospital insurance; it covers things like inpatient stays in hospitals and skilled nursing facilities.
- Medicare Part B. Medicare Part B is medical insurance and covers things like doctor’s office visits, urgent care, and home medical equipment.
- Medicare Part C. Medicare Part C is also known as Medicare Advantage. These plans cover everything that parts A and B do, often with additional coverage included.
- Medicare Part D. Medicare Part D is prescription drug coverage.
- Medigap. Medigap is supplemental insurance that pays the out-of-pocket costs of Medicare parts A and B, like copayments and deductibles.
Medicare Part A and Part B
If you already receive Social Security benefits, you’ll be automatically enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), also called original Medicare. You can skip down to the next section in the checklist.
If you don’t receive Social Security benefits, you should do the following:
- Check to make sure you’re eligible for Medicare. You can do this online by creating a My Social Security account or by calling Social Security.
- Make sure you know when your enrollment window begins and ends.
- Gather any information and documents you might need.
- Decide whether you want to apply in person, by mail, by phone, or online.
- Decide whether you need Medicare Part A and Part B or just Part A.
If you want Medicare Part C (Medicare Advantage)
If you’re considering a Medicare Advantage plan, you should:
- Compare the costs of plans in your area using Medicare’s plan finder tool. Keep in mind that these costs will be in addition to any Medicare Part A and Part B premiums; however, some Advantage plans do cover some or all of the Part B premium.
- Make sure any doctors or other providers you use are part of the plan’s network.
- If the plan includes Part D coverage, make sure it covers any medications you take.
- Ensure that you can afford any premiums and additional costs.
- Enroll in the plan you choose, then pay your first premium.
If you want Medigap (Medicare supplement insurance)
For Medigap plans, take these steps:
- Compare the costs of plans in your area using Medicare’s plan finder tool.
- Determine how much coverage you need and which Medigap plan best meets your needs.
- Make sure the premiums for the plan you choose fit into your budget.
- Know that Medigap plans apply only to Medicare parts A and B coverage. This means they don’t cover costs from Medicare Part C (Medicare Advantage) or Part D. In fact, you can’t have a Medigap and Advantage at the same time; you can only choose one or the other.
- Apply for coverage along with your initial enrollment in Medicare. This may be the only time you can sign up without providing previous medical history to qualify.
- Pay your first premium.
Medicare Part D (prescription drug coverage)
To get prescription drug coverage, you should:
- Compare the cost of plans in your area using Medicare’s plan finder tool.
- Make sure any prescriptions you currently take are on the plan’s formulary. A formulary is a list of medications that the plan covers.
- Check that your pharmacy is part of the plan’s network.
- Make sure the premium, deductibles, and other costs fit into your budget.
- Know that if you choose to enroll in Part D at a later date and go without Part D coverage, you’ll face a permanent late enrollment penalty.
- Enroll, then pay your first premium.
If you want an Advantage plan and Part D coverage
- See which Advantage plans in your area include Part D coverage. If one of these plans works for you, enroll and pay your first premium.
- If none of them work for you, you can select an Advantage plan without Part D, then purchase a separate Part D plan. Enroll in both plans and pay your initial premiums.
If you want a Medigap plan and Part D coverage
- Research Medigap and Part D plans in your area.
- Make sure both plans fit into your budget.
- Apply for your selected Medigap plan and pay your first premium.
- Enroll in your selected Medicare Part D plan and pay your first premium.
During your first year on Medicare:
- Fill out an authorization form that allows Medicare to talk to your spouse, a family member, or a friend if you’re ever unable to talk.
- Schedule your free “Welcome to Medicare” preventive health checkup.
- Create online accounts for all the Medicare parts you use, including parts A and B, Part C, Part D, and Medigap.
- Use your online accounts to monitor your coverage and claims, pay your bill, and find providers.
- Consider visiting a local State Health Insurance Assistance Program (SHIP) center to get answers to your Medicare questions and details about local coverage.
You can enroll in Medicare during certain times. These enrollment periods are specific to events in your life or to the parts of Medicare you’re enrolling in.
If you miss an enrollment period, you may pay extra fees, and some of these penalties last as long as you have Medicare.
Medicare enrollment periods include:
- Initial enrollment period. This is the 7-month window just before, during, and after your 65th birthday, when you can first enroll in Medicare. It begins 3 months before your birth month, includes the month of your birthday, and extends 3 months after your birth month. During this time, you can enroll in all parts of Medicare.
- Open enrollment period (October 15–December 7). During this time, you can switch from original Medicare (parts A and B) to Part C (Medicare Advantage), or from Part C back to original Medicare. You can also switch Part C plans or add, remove, or change a Part D plan.
- General enrollment period (January 1–March 31). If you didn’t enroll during your initial enrollment period, you can enroll in Medicare now.
- Special enrollment period. If you delayed Medicare enrollment for an approved reason, you can enroll during a special enrollment period. If you stop other insurance coverage, you have 8 months from the end of your coverage or the end of your employment to sign up without penalty.
- Medicare Advantage open enrollment (January 1–March 31). During this period, you can switch from one Medicare Advantage plan to another or go back to original Medicare. However, you can’t enroll in a Medicare Advantage plan if you currently have original Medicare.
- Part D enrollment and Medicare add-ons (April 1–June 30). If you don’t have Medicare Part A but enrolled in Part B during the general enrollment period, you can enroll in a Part D prescription drug plan at this time.
- Medigap enrollment. This 6-month period starts after the first day of the month that you apply for original Medicare or from your 65th birthday. If you miss this enrollment period, you may not be able to get a Medigap plan. If you do get one later, you may pay higher premiums, especially if you have health conditions.
- You need to take a few steps to enroll in Medicare. Which steps you take will depend on the parts of Medicare you want and whether you already receive any kind of Social Security benefit.
- It helps to be prepared with the information and documents you need to enroll before starting the process.
- You may also want to research which Medicare parts you want and what coverage is available in your area before enrollment.
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