Health Insurance

When To Apply For Medicare?

Medicare is the U.S. health insurance program for individuals who are 65 years of age and over, or those with certain health conditions. Applying for Medicare can appear to be a transitional experience or a benchmark in a lifetime. However, pursuing Medicare can likewise be difficult. That is on the grounds that it has many parts, and you need to remember many deadlines and enrollment periods. Besides, some people are automatically enrolled, while others are not. The good news is that the process is quite streamlined and simple to maneuver. Here, we will focus on when to apply for Medicare and how you can apply.

What Is Medicare?

Medicare is the health insurance program the federal government gives to individuals age 65 and more. However, you can also get Medicare before age 65 in the event that you have certain disabilities, permanent kidney failure or amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). The program assists a huge number of Americans with the expense of healthcare, however keep in mind that Medicare does not cover every clinical cost or the expense of most long-term care. The Centers for Medicare and Medicaid Services (CMS) is responsible for Medicare, yet the Social Security Administration will handle your application for Original Medicare (Part A and Part B), give you information, and manage premiums and any penalties.

Medicare Part A is hospital insurance and assists with taking care of costs like inpatient hospital care, skilled nursing facility care, hospice and home health care. Medicare Part B is clinical insurance that assists with paying for the care you get from your PCP and other healthcare suppliers, medical equipment like wheelchairs and walkers, and preventive services like influenza and pneumonia vaccinations, and yearly wellness visits. Part A is generally premium-free if you or your spouse have paid Medicare taxes for no less than 10 years. Part B, however, is optional and requires a monthly premium payment.

Who is eligible for Medicare?

You will most likely meet Medicare eligibility requirements if:

  • You are age 65 & up
  • You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You or your spouse had Medicare-covered government employment.

If you are under age 65, you can get Part A without having to pay premiums if:

  • You are a kidney dialysis or kidney transplant patient.
  • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (If you have Lou Gehrig’s disease, your Medicare benefits begin the first month you get disability benefits.)

When to apply for Medicare?

Initial Enrollment Period (IEP)

This is a 7-month window around your 65th birthday during which you can enroll for Medicare. It starts 3 months before your birthday, includes your birthday month, and goes on for 3 months after your birthday. During this time, you can sign up for all parts of Medicare without a penalty.

Before you qualify for Medicare, you should explore the type of Medicare inclusion you would prefer to have. This is because a good chance to add to, or change, your Medicare inclusion might be during the Initial Enrollment Period (IEP).  The IEP for Original Medicare, Part A, and Part B, is the time frame during which you initially become eligible for this inclusion. It is also when you can add or change Medicare plan options.

If you qualify for Medicare because:

  • You are turning 65, your IEP is seven months. It begins three months before your birthday month includes your 65th birthday month, and lasts for three months after your birthday. On the off chance that your birthday is in March, your IEP begins on the 1st of December and goes until the end of June.
  • You have been gathering disability benefits by Social Security or the RRB for 2 years straight, your IEP is likewise seven months. It begins three months before your 25th month of disability benefits and proceeds until the end of your 28th month of getting disability benefits.
  • You have begun gathering disability benefits by Social Security or the RRB because you have ALS (Lou Gehrig’s infection), your Medicare inclusion begins the very month your incapacity benefits start in.
  • You have an end-stage renal disease (ESRD) and you are gathering disability benefits by Social Security or the RRB, or you qualify for those advantages (perhaps through a relative or life partner) — your IEP begins when you are eligible for Medicare, and goes on for 90 days.

In the event that you enroll for Medicare prescription drug inclusion (regardless of whether through an independent Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan), you can stay away from late-enrollment penalties by taking on this inclusion as soon as you are eligible for Medicare. On the off chance that you choose to remain with Original Medicare and add a Medicare Supplement (Medigap) plan, the Medigap plan should accept you if you sign up for it during the six-month period that starts as soon as you turn 65 or older and enrolled in Part B. If you do not purchase a Medigap plan as of now, however, you choose to get one later, the plan might not need to accept you.

General Enrollment Period

Original Medicare’s General Enrollment Period (GEP) is from the 1st of January to March 31st each year. You can enroll in Medicare Part A or Medicare Part B during this time, in case you were not automatically selected. This enrollment period runs annually from January 1 through March 31. You can sign up for Medicare in this period if you did not enroll during your initial enrollment period.

Medicare Supplement Open Enrollment Period

Assuming that you need to add a Medicare Supplement (Medigap) plan to your Original Medicare (Part A and Part B) inclusion, your six-month Open Enrollment Period begins in the month in which you turn 65 and are enrolled in Medicare Part B. Medicare’s open enrollment runs from the 15th of October to the 7th of December. During this window, you can change from Original Medicare to Part C or Part C back to original Medicare. You can likewise switch Part C plans or add, eliminate, or change a Part D plan. On the off chance that you miss this window, your acceptance into a Medigap plan may not be guaranteed.

Special Enrollment or Election Periods (SEPs)

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In the event that you delayed Medicare enrollment since you had private health insurance from an employer, you can later sign up for Medicare during a special enrollment period. You have 8 months from the end of your inclusion or the end of your employment during which you can sign up without penalty. Some unique conditions may qualify you to enroll in Medicare during a Special Election Period (SEP). For Original Medicare, Part A, and Part B, a few examples of these circumstances incorporate, however, are not restricted to:

  • You are covered through an employer or union’s group health plan (yours, your spouse’s, or a relative’s in case you are disabled). You can pursue Original Medicare (Part A and Part B) anytime, as long as you (or your companion, or relative in case you are disabled) are working.
  • Your coverage through an employer or union’s group health plan ends. You have eight months to enroll in Medicare, beginning the month after the employment ends, or the employment-based health plan insurance closes, whichever happens first.

Other Medicare plans, for instance, Medicare Advantage plans and Medicare Prescription Drug Plans, have other specific Special Election Periods. Some examples of these situations for Medicare Advantage and Medicare Prescription Drug Plans include, but are not restricted to:

  • Losing your coverage — for example, Medicare canceling your plan’s contract
  • Moving to a new location that is not in your plan’s service area
  • Moving to, living in, or moving out of a facility such as a long-term care hospital or skilled nursing facility

How to apply for Medicare?

In case you are getting benefits from the SSA or the Railroad Retirement Board (RRB), you do not need to apply for Medicare. You will automatically be enrolled in Medicare parts A and B as you come close to your 65th birthday.

Your Medicare card and enrollment information will be sent to you 3 to 4 months before your birthday. Be that as it may, on the off chance that you would prefer to enroll in Part D or want to change to Medicare Advantage (Part C), you can do this during your initial enrollment period.

In case you are not automatically enrolled, you will need to apply for original Medicare (Parts A and B) and any extra coverage you need. Your enrollment period will rely upon several factors, including your employment status and the sorts of coverage you need.

How to enroll in original Medicare?

Before you start the process of enrolling in Medicare parts A and B, you might want to think about the kind of Medicare coverage you ultimately need. The following steps will help you get ready:

  1. Figure out if you have been automatically enrolled in either Part A or Part B of Original Medicare.
  2. Choose if you want Part B or if you would like to defer enrollment.
  3. Go over the Medicare Advantage plans in your area to find out if those coverage options and costs work better for you than original Medicare.
  4. If you choose to stay with original Medicare, consider your Part D options and whether a Medigap plan would be useful to you.

Medicare applicants are given a checklist by the SSA which may be helpful. It mentions the types of forms you will need for the process, such as proof of military service, tax forms, and W-2s. Once you have all the information you need for applying, you can start the enrollment process.

There are various ways to enroll in Original Medicare:

  • By mail. You can send a letter to your local SSA office with your name, your Social Security number, and the date you would like to enroll. They will send you the necessary information and any additional requests for enrolling.
  • By phone. Call SSA at 800-772-1213 (or 800-325-0718 for TTY), Monday through Friday, 7 a.m. to 7 p.m.
  • In-person. Visit your local SSA office; you can find it through the SSA office locator.
  • You can visit SocialSecurity.gov to begin enrollment.

If you are already receiving benefits from SSA or RRB, you will automatically be signed up for Medicare. In case you have any questions or want to discuss your coverage, you can call RRB at 877-772-5772 (or 312-751-4701 for TTY), from Monday to Friday, 9 a.m. to 3:30 p.m.

How to enroll in Medicare Advantage?

Medicare Advantage, or Medicare Part C, is a private bundled health insurance plan. It provides the same inclusion as parts A and B. Moreover, it usually also provides prescription coverage. Certain Medicare Advantage plans also cover vision, dental, and other healthcare benefits. This plan may place an annual cap on your out-of-pocket expenses. This can be really useful if you think you might have any large healthcare expenses.

However, a Medicare Advantage plan will be an extra expense apart from any premiums you pay for other parts of Medicare. Most Medicare Advantage plans will provide coverage for some or all of your Medicare Part B premium costs. Make sure to assess your healthcare needs with the costs of coverage when figuring out what parts of Medicare are right for you.

If you want to sign up for Medicare Advantage, you can do that during your initial enrollment period. You can also change your choice during Medicare’s open enrollment period, which lasts from the 15th of October 15 till the 7th of December. If you enroll outside these times, you would have to pay a late enrollment fee, and your coverage will not begin until July 1.

There are two ways you can sign up for Medicare Part C:

  • Look for Part C plans with Medicare.gov’s plan finder tool.
  • With a private company. Insurance organizations offer Part C plans, and you can directly sign up with them through their website or via phone.

How to enroll in Medicare Part D?

Enrollment in Medicare Part D is not automatic for everyone. If you choose to get prescription medication coverage, you will need to select and buy a Medicare Part D plan. Note that you can just get a Part D plan as an extra to original Medicare (parts A and B). On the off chance that you have Medicare Advantage (Part C), you are not eligible for a Part D arrangement.

You can enroll in Medicare Part D during your initial enrollment period, a 7-month window around your 65th birthday. On the off chance that you do not enroll during that time, you will have the option to join later. However, you may need to pay a late enrollment penalty. You may likewise have the option to enroll during the open enrollment time frame, which is from the 15th of October till the 7th of December.

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You can enroll in Medicare Part D in various ways:

  • By phone. You can call 800-633-4227 (or 877-486-2048 for TTY).
  • Contact a private insurance company. You can also contact private insurers that provide Part D plans, through their website or via phone and enroll directly with them.
  • Use Medicare.gov’s plan finder tool to compare Part D plans available in your area.

Can I sign up for Medicare online?

The Medicare application on the Social Security site permits you to apply completely online. Most of the time, you will not have to sign anything or send in any supporting documents. You can apply for Medicare online by visiting the Medicare segment of the Social Security site. The application is totally free. When you apply, you will have the option to keep track of the status of your application at any time.

Start by opening a ‘My Social Security’ account at socialsecurity.gov/myaccount, adhering to these guidelines. A part of the process will incorporate verifying your identity. Thus, you may require your:

  • Date and place of birth.
  • Email address.
  • Medicaid number, if applicable, with start and end dates.
  • Permanent Resident Card if you aren’t a U.S. citizen.
  • Security number.
  • Start and end dates for group health insurance through your (or your spouse’s) employer.
  • Start and end dates of employment with the employer providing your group health plan.
  • Valid U.S. mailing address.
  • W-2 and tax forms.

When your account is set up, you can begin the Medicare application process. It is unlikely that you will have to sign anything physically. At the point when you are done applying online, you will get a confirmation number. Keep it safe and use it to check the situation with your application through your My Social Security account. Social Security will inform you as to whether more data is required.

What documents do I need to apply for Medicare?

If you are enrolling in person for Medicare benefits, you might want to have the following documents ready before starting the application.

Birth certificate

Usually, you need to be at least 65 years old in order to receive Medicare benefits. However, if you have a qualifying disability or condition, you are eligible for Medicare regardless of age. Keep in mind that you can start the enrollment process three months before turning 65 years old, which is when your Medicare Initial Enrollment Period (IEP) normally starts.

Proof of U.S. citizenship or legal residency

You must be a U.S. citizen or a legal resident of the United States for at least five consecutive years to be qualified for Medicare.

Your Social Security card (if already receiving SSA benefits)

If you are already receiving benefits from Social Security or the Railroad Retirement Board, you may be required to give your Social Security card when applying for Medicare.

Health insurance information

Based on your circumstances, you might be able to use Medicare together with other types of health insurance. If you already have a health insurance policy, you would be required to provide documents that mention the details of your current coverage and the terms and conditions of your insurance plans. Medicare can use these important documents to help determine which insurance provider will pay first for any health care services you receive.

Tax information

You might also have to show some of your tax record information, for instance, a W-2, when you enroll or Medicare. The number of years that you have worked and paid Medicare taxes can help figure out whether you are qualified for premium-free Medicare Part A (hospital insurance). Your reported income from two years prior can decide the amount you will pay for your Medicare Part B (medical insurance) premium.

Military documents

There are some particular guidelines regarding Medicare and veteran’s health insurance benefits, and you would have to provide records of your military service if you are receiving any such military or veteran’s benefits.

Part B enrollment application

If you originally chose not to enroll in Medicare Part B and now want to sign up, you would have to fill out a Part B enrollment application.

How do I sign up for Medicare when I turn 65?

Most people become eligible for Medicare when they turn 65. The steps you need to follow to enroll in Medicare will differ based on whether you are collecting retirement benefits when you enter your Initial Enrollment Period (IEP).

  • If you are getting Social Security retirement benefits or Railroad Retirement benefits, you should be automatically enrolled in both Medicare Part A and Part B.
  • If you are not getting Social Security retirement benefits or Railroad Retirement benefits, you will need to actively enroll in Medicare.

In case you are eligible for automatic enrollment, you do not need to contact anybody. You ought to get a package via the post office three months before your coverage begins with your new Medicare card. There will likewise be a letter clarifying how Medicare functions and that you were automatically enrolled in the two Parts A and B. In the event that you get Social Security retirement benefits, your package and card will come from the Social Security Administration (SSA). If you get Railroad Retirement benefits, your bundle and card will come from the Railroad Retirement Board. In case you are 65 but are not getting Social Security retirement advantages or Railroad Retirement benefits, you should effectively enroll in Medicare.

In order to actively enroll in Medicare, you should follow these steps. If you choose to sign up for Medicare during your Initial Enrollment Period, you can enroll for Parts A and/or B by:

  • By applying online at www.ssa.gov
  • Calling Social Security at 800-772-1213
  • Mailing a signed and dated letter to Social Security that includes your name, Social Security number, and the date you would like to be enrolled in Medicare
  • Visiting your local Social Security office

If you are qualified for Railroad Retirement benefits, sign up for Medicare by calling the Railroad Retirement Board (RRB) or contacting your local RRB field office. Keep evidence of when you tried to enroll in Medicare, to secure yourself from incurring a Part B premium penalty if your application is lost.

  • If you apply online, print out and save your confirmation page.
  • If you sign up at your local Social Security office, ask for a written receipt.
  • If you sign up through the mail, use verified mail and request a return receipt.
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  • Write down the names of any representatives you speak to, along with the time and date of the conversation.

Medicare enrollment application

You can go to www.cms.gov and directly access the Medicare enrollment application from there. Click on ‘Forms’, and download the application once it has opened.

If you applied for Medicare online, you can keep track of the status of your application through your Medicare or Social Security account. You can also keep track of your enrollment on Medicare.gov. You will be able to find information about your enrollment status by providing your:

  • Date of birth
  • Last name
  • Medicare number
  • Medicare Part A effective date
  • ZIP code

You can also check the status of your application by going to or calling your local SSA office.

Conclusion

Applying for Medicare is a significant step as you come close to your 65th birthday. Additionally, one can be loaded up with questions — but you do not need to enroll alone. Whenever you have finished your Medicare application, make sure to investigate the two other time-critical choices: enrolling in Medicare Part D for drug coverage and purchasing Medicare Supplement (Medigap strategy) to Original Medicare. Both the CMS and the SSA can be significant assets during your enrollment period. They can help you settle on the right decisions for your circumstance.

Sandra Johnson

Sandra Johnson was a few years out of school and took a job as a life insurance agent in California, selling coverage door-to-door for Prudential. The experience taught her about the technical components of insurance and its benefits for individuals and society, as well as the misunderstandings people often have about insurance. She has over ten years’ experience in the insurance industry, having worked as both a Broker and Underwriter, assisting clients across a broad range of industries. At Insurance Noon, Sarah diligently gathers all the required information and curates up pieces to provide meaningful insurance solutions. Her personal value proposition is to demonstrate a genuine interest in always adding value for clients.Her determined approach to guiding clients has turned her into a platinum adviser to multiple insurers.

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