You want to enroll in Medicare, but it seems like all of the information out there is in another language. At HealthMarkets, we make it easy for you to enroll in Medicare. Just follow our simple guide below.
Am I Eligible for Medicare?
Medicare is a federal health insurance program for people ages 65 or older and for people under 65 who have certain disabilities or conditions. If you are 65 years of age or older and a U.S. citizen or a permanent legal resident, you’re most likely eligible for Medicare. If you’re younger than 65, you may be eligible for Medicare if one of the following applies to you:
- You have been entitled to Social Security disability benefits for at least 24 months (not necessarily consecutive);
- You have Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS);
- You receive a disability pension from the Railroad Retirement Board and meet certain conditions; or
- You have been diagnosed with End-Stage Renal Disease (ESRD) and receive maintenance dialysis or have had a kidney transplant.
If you are not sure if you are eligible for Medicare, your local HealthMarkets agent can give you more information.
When Can I Enroll in Medicare?
The period during which you can enroll in Medicare depends on why you are eligible to enroll.
I Am Eligible Because I Turned 65
If you are already receiving Social Security benefits when you turn 65, you will automatically be enrolled in Medicare Part A. Your Medicare card will be sent to you in the mail. If you are not receiving Social Security benefits, you don’t have to wait until your 65th birthday to enroll in Medicare. In fact, you can sign up for Medicare between the three months before you turn 65, during the month of your 65th birthday, and three months after your birthday.
Your coverage begins the first day of the month after you enroll. If you join before you turn 65, your coverage begins on the first day of your birthday month. For example, if your birthday is June 4, you can enroll any time from March 1 to September 30 of the year you turn 65.
If you miss this seven-month window, you might be eligible for a Special Enrollment Period (SEP). If you get health insurance through your employer’s group health plan, you can sign up for Medicare Part A and/or Medicare Part B at any time, as long as you or a family member is working for that employer. You also have a Special Enrollment Period for the eight months after either your employment ends or the insurance plan you get through your employment ends.
General Enrollment Periods
You can sign up for Medicare Part A and/or Medicare Part B during the General Enrollment Period (GEP), which occurs every year from the beginning of January through the end of March. People who enroll in Parts A and/or B during the General Enrollment Period will begin receiving benefits on July 1 of that year.
If you don’t sign up for Medicare Part B when you are first eligible, you may have to pay an enrollment penalty if you choose to enroll later; your monthly premium for Part B could increase by 10 percent for each 12-month period during which you were eligible but didn’t sign up.
If you or your spouse paid Medicare taxes for at least 10 years, you don’t have to pay a premium for Medicare Part A. Most people are eligible for premium-free Part A at the age of 65, when they are eligible to get Social Security.
If you aren’t eligible for premium-free Part A and you don’t enroll in Medicare Part A as soon as you are able to, you may have to pay a Part A late enrollment penalty. Your monthly premium could increase by 10 percent.
I am Eligible Because I Have a Disability, ALS, or ESRD
If you are under the age of 65 but have a disability or condition that qualifies you for Medicare, the dates that you enroll in Medicare are a bit different. Individuals who receive disability benefits from Social Security or the Railroad Retirement Board will automatically be enrolled in Medicare on the 25th month that they receive disability benefits. They will receive a Medicare card in the mail about three months before they are eligible (the 22nd month of benefits).
Individuals with ALS don’t have to wait; they get Medicare benefits in the first month they receive disability benefits from Social Security or the Railroad Retirement Board.
If you have End-Stage Renal Disease (ESRD), you may be able to enroll in Medicare, but you will not be automatically enrolled. If you have ESRD, you are eligible for Medicare at any age if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and one of the following applies to you:
- You’ve worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee
- You’re already getting or are eligible for Social Security or Railroad Retirement benefits
- You’re the spouse or dependent child of a person who meets either of the two requirements above
ESRD patients who are not sure if they qualify for Medicare can contact a HealthMarkets agent to discuss their health insurance options.
Individuals who enroll in Medicare due to ESRD will receive coverage beginning on the first day of the fourth month of dialysis treatments, regardless of when they sign up. Benefits can be applied retroactively if you wait until after your fourth month of dialysis treatments to enroll.
You may be eligible to receive Medicare coverage as early as the first month of dialysis if you take part in a home dialysis training program offered by a Medicare-certified training facility, so you can learn to give yourself dialysis treatments at home.
How Do I Enroll in Medicare Advantage?
Medicare Advantage, also known as Medicare Part C, provides the benefits of Medicare Parts A and B but is offered by private health insurance providers rather than the government.
There are many kinds of Medicare Advantage plans, including Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Most people who have Medicare Part A and Medicare Part B are eligible to join a Medicare Advantage Plan, as long as they live in an area served by the plan. The Kaiser Family Foundation reports that 93 percent of Medicare beneficiaries have access to a Medicare Advantage plan as an alternative to traditional Medicare. People with ESRD are generally not able to join Medicare Advantage plans.
You can enroll in Medicare Advantage when you first become eligible for Medicare. The Initial Enrollment Period (IEP) begins three months before the month in which you turn 65 and ends three months afterward, for a seven-month enrollment period. If you’re eligible for Medicare due to a disability and you are under 65, you can sign up for a Medicare Advantage plan during the 22nd through the 28th months in which you receive Social Security or Railroad Retirement Board Benefits.
If you currently have Medicare Part A and you get Medicare Part B for the first time by enrolling during the General Enrollment Period (January 1-March 31), you can enroll in Medicare Advantage plans from April 1 through June 30. You can also change your Medicare or Medicare Advantage Plan during the Medicare Open Enrollment Period, which occurs every year from October 15 through December 7. If you miss any of these time periods, you may still be able to enroll in Medicare Advantage during a Special Enrollment Period.
Medicare Advantage plans are popular because they include more than just the basic benefits of Medicare Parts A and B. Plans include features such as emergency care and wellness programs. In 2019, 90 percent of Medicare Advantage plans offered prescription drug coverage. If you’re interested in a Medicare Advantage plan, get a quote from HealthMarkets today.
How Do I Enroll in Medicare Part D?
You can purchase Medicare Part D in addition to Original Medicare if you need prescription drug coverage. These plans are run by private companies approved by Medicare and have different levels of coverage. If you have a Medicare Advantage Plan (Medicare Part C), do not enroll in Medicare Part D or you will be disenrolled from Medicare Advantage and re-enrolled in Original Medicare.
You can enroll in Medicare Part D when you first enroll in Medicare. You can also join a Medicare Part D plan during the Annual Enrollment Period, which occurs yearly from October 15 through December 7. If you decide not to enroll in Medicare Part D during the Initial Enrollment Period because you already have creditable drug coverage, you won’t have to pay a late enrollment penalty if you decide to enroll in Medicare Part D at a later date. ‘Creditable coverage’ is prescription drug coverage that pays at least as much as Medicare’s prescription drug coverage on average. So if you’re getting credible drug coverage through an employer, you don’t need to enroll in Medicare Part D as well.
However, if you are without creditable prescription drug coverage for 63 or more consecutive days after your Initial Enrollment Period ends, you may have to pay a Part D late enrollment penalty if you decide to sign up for Medicare Part D.
If you choose not to enroll during your initial enrollment period, you can still enroll in Medicare Part D during Medicare Annual Enrollment, which occurs every year from October 15 to December 7. If you drop a Medicare Advantage Plan and switch to Original Medicare during the Medicare Advantage Disenrollment Period (January 1 through February 14), you have until February 14 to add your Medicare Part D prescription drug coverage.
Just like Medicare Parts A, B, and C, there are Special Enrollment Periods during which you may be eligible to enroll in Medicare Part D. Talk with your HealthMarkets agent to determine if you are eligible for a Special Enrollment Period and get a quote for a Medicare Part D Plan.
How Do I Enroll in Medigap?
Medicare supplement insurance plans, also called Medigap plans, cover some of the costs associated with health care that are not covered by Original Medicare. If you are enrolled in a Medicare Advantage plan, you don’t need Medigap; Medigap is only for people who are enrolled in Original Medicare. There are several Medigap plans to choose from.
You have a six-month Medigap Open Enrollment Period during which you can buy any Medigap policy sold in your state. Your Open Enrollment Period for Medigap begins on the first day of the month in which you are 65 or older and enrolled in Medicare Part B. During this time, you can purchase a Medigap policy from any insurer, regardless of your health. If you miss this window of time, you can still apply for Medigap coverage. However, an insurance company may choose not to sell you a policy if you are not in good health. You may be required to answer a series of health-related questions from your physician in order to obtain coverage outside of the Medigap Open Enrollment Period.
Get a Medigap quote now to explore your options.
How Can I Get Medicare Coverage Now?
The Medicare deadlines can sneak up on you, and it can be hard to figure out exactly when you’re supposed to enroll in each part of the Medicare plan. If you miss a deadline, you could pay a penalty on your premium. Your agent can help you get your health insurance straightened out so you don’t have to worry about it.
At HealthMarkets, we can help you explore the Medicare options that work best for you. If you’re thinking about enrolling in Medicare or Medigap, contact your local HealthMarkets agent.
Sources: “Original Medicare (Part A and B) Eligibility and Enrollment.” Centers for Medicare and Medicaid Services. 2015. | “When can I sign up for Part A & Part B.” Medicare.gov. 2015. | “Part B late enrollment penalty.” Medicare.gov. 2015. | “Part A late enrollment penalty.” Medicare.gov. 2015. | “Signing Up for Medicare: special conditions.“ Medicare.gov. 2015. | “Understand Medicare Part C & D Enrollment Periods.” Centers for Medicare & Medicaid Services. Aug. 2015. | “Medicare Advantage 2018 Data Spotlight: First Look.” Kaiser Family Foundation. 10 Dec. 2014. | “How to get drug coverage.“ Medicare.gov. 2015. | “When can I join a health or drug plan?“ Medicare.gov. 2015. | Singletary, Michelle. “The truth about paying the Medicare Part D penalty.” Washington Post. 1 Nov. 2013. | “Part D late enrollment penalty.“ Medicare.gov. 2015. | “When can I buy Medigap?“ Medicare.gov. 2015.