Medicare Insurance Enrollment
Medicare insurance is available to you beginning in the year you turn age 65. It is also available to certain other individuals who meet the eligibility requirements, such as individuals suffering from end-stage renal disease and those with disabilities who qualify for federal health insurance benefits. There are several enrollment periods that occur when you become eligible for Medicare that may affect how and when you access these important benefits.
Medicare Enrollment Requirements
Your enrollment into Medicare begins when you meet the following eligibility requirements:
- You are age 65 or older.
If you are under the age of 65 (special conditions):
- You are entitled to Social Security Disability Insurance benefits for at least 24 months (you need not be qualified for 24 months in a row or have received those benefits in order to qualify for Medicare).
- You receive a disability pension benefit from the Railroad Retirement Benefit Board.
- You currently suffer from amyotrophic lateral sclerosis (ALS) disease.
- You have kidney failure that requires regular dialysis (or a kidney transplant) often referred to as end-stage renal disease (ESRD).
Any of these triggers will make you eligible to apply for or receive Medicare. The two initial parts of Medicare that you qualify for include Part A hospital insurance,which pays for expenses associated with hospitalization and Part B medical insurance,which covers those expenses associated with physician services you receive, preventive care, and medical supplies on an outpatient basis. Parts A and B of Medicare are also referred to collectively as Original Medicare. You may also sign up for optional additional benefits, such as Medicare Advantage Plans (Medicare Part C), Medicare Supplement Insurance (Medigap plans designed to supplement Original Medicare), and the Medicare Prescription Drug Plan (Medicare Part D).
Part A and Part B come to you automatically when you have begun receiving retirement benefits from either Social Security or the Railroad Retirement Board (including residents of Puerto Rico), if you are age 65 and have a disability,or if you suffer from ALS. Under these circumstances, you will receive your Original Medicare benefit card in the mail three months prior to your 65th birthday or on the 25th month of your qualifying disability. You still need to enroll in any of the optional parts of Medicare (i.e. Part C, D, or Medigap) during the open enrollment periods.
If you do not receive disability benefits from Social Security or the Railroad Retirement Board, or if you qualify for Medicare because you suffer from ESRD, you have to sign up for Medicare health insurance benefits. This process takes place during the enrollment periods described below.
Medicare Insurance Open Enrollment
Three months prior to the month of your 65th birthday and up to three months after,you will have the opportunity to enroll in a Medicare plan, including Original Medicare and any supplementary parts. This period of time is known as your initial enrollment period (IEP). For example, if your birthday is on July 1, your open enrollment begins on April 1 and ends on Oct. 31. You can sign up for Part A, which does not charge a premium (it was funded by the FICA taxes paid during your working lifetime), and Parts B, C, D, or any Medigap plans. Note that if you choose to enroll in a Medicare Advantage Plan or Medigap coverage, you must first be enrolled in Parts A and B). Medical expense coverage under Part B, Medicare Advantage Plans, Prescription Drug Plans, and Medicare Supplement Insurance (Medigap) all come at an additional cost,depending on your income.
If you miss your initial enrollment period, you will not be eligible to enroll in any special enrollment period in order to obtain your Medicare health insurance. You will be required to wait until the following Jan. 1 in order to enroll. This period, between Jan. 1 and March 31 each year, is known as the general enrollment period (GEP). If you enroll during the general enrollment period, your Medicare health insurance will become effective on July 1.
If you fail to sign up for Part A when eligible and defer until the GEP to enroll,you face a penalty equal to twice the number of years that you could have had Part A coverage (if you were not eligible for the premium-free Part A). This cost is a monthly premium amount that is up to 10% higher than what you would have paid during the IEP. If you do not enroll in Part B during your IEP or drop this coverage and decide to re-enroll during the GEP, you will also be subject to a higher premium of up to 10% for each 12-month period thereafter and a penalty payment of 20%, which you will be subject to for as long as you have Part B coverage. If you have limited financial resources or other special circumstances, you may qualify for help in paying your premiums from your state government.
The open enrollment and special enrollment periods occur when you make changes to your Medicare Advantage (Part C) or Medicare Supplement Insurance (Medigap) plan selections, move to a service area that no longer provides your Part C option,or your plan makes changes to its Medicare contract. You should be aware of those circumstances that permit you to change your plan options in order to secure your Medicare benefits as well as avoid any costly delays in your coverage.
Medicare Enrollment Application
As mentioned above, if you have begun receiving retirement benefits from Social Security or the Railroad Retirement Board, receive Social Security and have a disability, or suffer from ALS, you automatically receive Medicare Parts A and B without having to apply. If not automatically enrolled in Original Medicare or to enroll in any of the supplementary parts, you will need to apply for coverage in each of the following ways:
– For Part A, you must visit the Social Security website in order to apply or visit your local Social Security office for assistance in applying for your Part A hospital insurance coverage.
– To apply for Part B, you must complete the Application for Enrollment in Medicare Part B, available in both English and Spanish. The completed form should be returned to your local Social Security office within your prescribed IEP in order to ensure the availability of your coverage without penalty or higher premium costs.
– If you wish to enroll in a Medicare Advantage Plan, Medigap insurance, or a Prescription Drug Plan, you must enroll in Parts A and B before applying for the additional coverages. You may also wish to seek assistance from an expert who can help guide you through the application process as well as answer any questions you may have about Medicare. This includes helping you understand how Medicare Part A, B, and Medicare Advantage Plans work together, when or if you should apply for a Medicare Supplement Insurance Plan (Medigap) or a Prescription Drug Plan under Medicare Part D.
Medicare Solutions, operated by HealthPlanOne, LLC, is a provider of solutions for your Medicare needs. Whether you need MedicareAdvantage (Medicare Part C), Medigap (Medicare Supplemental Insurance),Medicare Prescription Drug Plans (Medicare Part D), or assistance with managing your Original Medicare enrollments, Medicare Solutions provides you with the information you need to choose the options that meet your Medicare health insurance needs.