Medicare Enrollment 101 – Get Enrolled In A Medicare Plan That Makes Sense For You
Updated October 2022
If you’re approaching your 65th birthday, then you’ve probably already received an abundance of mailers and brochures from your local Social Security office and private insurers regarding Medicare. Medicare enrollment might seem like an intimidating experience, but it really doesn’t have to be. You can sign up for this federal health insurance program as soon as three months before your 65th birthday and up to three months following that birthday, and in some cases you may even be automatically enrolled.
Medicare also covers people with certain disabilities and people who are on kidney dialysis as a part of End-Stage Renal Disease (ESRD). However, Medicare primarily covers American adults over the age of 65. In the following article, we’ll discuss a few of the differences between the parts of Medicare as well as how to enroll in the program if you qualify.
Medicare Part A Enrollment
Medicare Part A covers inpatient services, such as hospital visits and treatments. If you already receive payments from Social Security or the Railroad Retirement Board, then you will be enrolled in Medicare Parts A and B automatically beginning the month of your 65th birthday. In other words, if your birthday is June 26th then you would be enrolled in Medicare on June 1st the year you turn 65. You should receive a Medicare card three months before your 65th birthday. You can call the Social Security Administration if you don’t receive your card on time.
If you don’t receive payments from the SSA or RRB, then you’ll need to sign up for Medicare as soon as you turn 65 but preferably three months before. You can sign up online, make an appointment with your local Social Security office or call the national SSA at 1-800-772-1213 to begin. Each year after you’re enrolled, you’ll be given the chance to review your coverage and decide whether it’s working for you or not. At that time, you can switch to a new plan or add supplemental coverage. This is known as the Open Enrollment Period, and it runs from October 15 through December 7.
Not everyone can apply online for Parts A and B. According to the Social Security Administration, you can apply online if:
- You’re within three months of turning 65.
- You do not have any form of Medicare coverage at present.
- You’re not interested in receiving Social Security benefits right now.
- You do not currently receive benefits from Social Security retirement, survivor status or disability.
What happens if you don’t sign up for Medicare when you’re eligible? You have a total of seven months to sign up for Medicare during your individual initial enrollment period: three months before your 65th birthday, the month that includes your 65th birthday and the three months following your birthday month. If you don’t sign up for Medicare during this time and you don’t qualify for a special enrollment period, then you will be assessed a fee for each month that you lacked Medicare coverage when you do eventually sign up.
Rest assured that you can still sign up for Medicare during the General Enrollment period that lasts from January 1st through March 31st of each year. Special enrollment periods apply for volunteers working in foreign countries and for employees enrolled in a company plan at the time of their initial Medicare eligibility. You can learn more about special enrollment periods and yearly deadlines by visiting the Social Security website.
Medicare Part B Enrollment
We mentioned above that Medicare Part A covers hospital services, but you may be wondering what to do if you need medical coverage related to doctors’ visits and outpatient care. The following section on Medicare Part B will address your concerns. Medicare Part B covers services related to routine doctor care, such as outpatient visits. Like Part A, you’re automatically enrolled in Part B at age 65 if you receive Social Security or Railroad Retirement benefits. You will also follow the same steps for signing up for Part B as you will for Part A. The two parts go hand in hand because they cover different aspects of your medical treatment and needs, but not everyone will choose to keep Part B if they’re automatically enrolled.
Why would someone choose to forego Part B? In essence, Part B costs money whereas Part A may be covered completely for certain people. Those who receive Social Security or Railroad Retirement benefits do not have to pay for Medicare Part A, but everyone pays a premium for Part B. If you’re enrolled automatically in Parts A and B, then you’ll be sent a Medicare card that includes instructions for canceling Part B if you don’t want to pay the premiums. This is why it’s important to be on the lookout for your Medicare card; if you don’t cancel Part B when automatically enrolled, then you will be liable for the payment of its premiums.
Whether or not you need Part B depends on a couple of factors. In general, you will most likely use Part B benefits more than Part A benefits, but that doesn’t mean that you need Part B. Here are some things to consider when deciding whether to enroll in the medical portion of Medicare:
- TRICARE beneficiaries must have both Medicare Part A and Part B to keep their coverage intact.
- Active-duty service personnel can keep TRICARE without Part B, but they need to enroll in Part B before they retire in order to ensure continuous coverage. Spouses and dependents of active-duty military members follow the same guidelines.
- Active-duty military members also can enroll in Part B during a special enrollment period if they’re disabled or at least 65 years old.
- Veterans may find Part B useful in attaining additional coverage for select treatments. If you’re a veteran but you don’t sign up for Medicare when eligible, then you may have to pay penalties for late enrollment.
- People with End-Stage Renal Disease need to enroll in Parts A and B as soon as they’re eligible.
There are also special rules for people who are still working and have benefits through their employers. If you have employer or union healthcare coverage, then you may not need Part B because you’ll still be covered under an employer-based plan for outpatient services. However, once your employer or union coverage ends, you only have eight months to enroll in Part B without incurring a penalty.
If you don’t enroll in Part B once your employer or union coverage ends, then you’ll have to wait until the General Enrollment period to enroll (January 1 to March 31), and coverage won’t start until July. Additionally, you’ll accrue penalty fees every month that you have Part B – sometimes indefinitely. You should also note that COBRA benefits and retiree benefits do not count as employer or union benefits, so if you have these types of coverage then you should enroll in Medicare when eligible.
New for 2023: If you have end-stage renal disease (ESRD) and qualify for Medicare only because of this (you’re under 65), but it’s been 36 months since a successful kidney transplant (and therefore you no longer qualify for full Medicare coverage), you can now enroll in limited Part B coverage. This limited version of Part B will cover the cost of your immunosuppressive drugs only. You’ll still need to meet the Part B deductible and cost sharing amounts, but Part B will continue to cover immunosuppressive drugs for people who otherwise would lose Medicare coverage because of a successful kidney transplant.
Medicare Advantage Plan Enrollment
In addition to original Medicare, most people also have the option to enroll in a Medicare Advantage Plan, which replaces Parts A and B and is offered through private insurers in conjunction with Medicare. People who need kidney dialysis as a result of ESRD do not qualify for most Medicare Advantage Plans, but you should check your eligibility requirements before assuming that you can’t apply. Medicare Advantage Plans come in several forms:
- Health Maintenance Organization (HMO)
- Medicare Medical Savings Account (MSA)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
Medicare Advantage Plans are also referred to as Medicare Part C. There are a few key differences between traditional Medicare and Advantage plans. Keeping up with Medicare can be extremely overwhelming, but your choices boil down to some basic options. Here are the primary pros and cons of Medicare and Medicare Advantage:
- Traditional Medicare allows you to choose any medical provider throughout the country who accepts Medicare, which provides for more consistency in your services.
- You pay a standard rate for services with original Medicare, and you can add on supplemental insurance like Medigap coverage to help lower your out-of-pocket expenses.
- Medicare Advantage Plans offer the same benefits and coverage as traditional Medicare with a few added benefits, such as prescription drug coverage and lower out-of-pocket costs.
- You may pay higher premiums upfront with Medicare Advantage, but your copays will probably be lower and you may receive added benefits.
- Offered regionally or locally, Medicare Advantage Plans restrict you to regional providers.
You can enroll in Medicare Advantage by signing up during your initial enrollment period for original Medicare or at special times throughout the year. Undoubtedly, you’ll start to receive a variety of brochures in the mail during the year that you turn 65 because Medicare Advantage is offered through private insurers rather than the Social Security Administration. When you receive these mailers, look through them carefully to determine if you want to enroll in an Advantage plan. Regardless of when you enroll in Medicare Advantage, you need to be enrolled in Parts A and B first. If you choose to enroll in Medicare Advantage, then here are some important dates to remember:
- During the three months before you turn 65, the month you turn 65 and the three months following your 65th birthday you can enroll in a Medicare Advantage Plan provided that you enroll in Medicare Parts A and B first.
- From October 15th through December 7th of each year, you can switch from a traditional Medicare plan to a Medicare Advantage Plan or make other changes to your coverage as needed. This is open to anyone with Medicare, either Original or Advantage.
- From January 1st through March 31st of each year, you can make a one-time change to your Medicare Advantage plan if you’re already enrolled in one. This means going from one private plan to another or dropping MA for Original Medicare. If you drop your MA plan and enroll in Original, you can then sign up for a standalone Part D plan as well. This period is only for people who are currently enrolled in MA plans.
If all of these dates and qualifications sound confusing, then you’re not alone. Many people struggle to keep up with Medicare guidelines, and you can always find assistance by speaking with your local Social Security office or by checking out the Medicare website.
Medicare Part D Enrollment
Medicare Part D is technically a supplemental portion of Medicare that you can add on to Parts A and B as well as Medicare Advantage. Part D covers prescriptions and helps you manage and potentially reduce your out-of-pocket expenses related to prescription drugs. Medicare Part D enrollment guidelines mirror those of Medicare Advantage Plans. In other words, you can enroll when you’re first eligible for Medicare or during the open enrollment period from October 15th through December 7th.
To join a Medicare Part D drug plan, you need to find an insurer that offers this type of coverage. You can start by visiting the Medicare website where you can use the “Medicare Plan Finder” to find an approved plan. You can also apply to a Part D plan via paper application or over the phone by dialing 1-800-MEDICARE. Unless you join a Part D plan right when you’re eligible, you may have to pay a penalty fee for enrolling in a Part D plan after your initial eligibility window has passed.
Medigap and Supplemental Insurance Plan Enrollment
In addition to original Medicare, you also have the option to obtain extra coverage through a supplemental plan like Medigap. This type of plan may help to offset the cost of copays and deductibles that original Medicare doesn’t cover. In order to enroll in Medigap, you need to contact a private insurer that’s licensed to sell you a plan. In addition, you cannot cover your spouse or dependents with Medigap insurance. Each member of your family will need to purchase a separate Medigap plan in order to get coverage. Medigap coverage purchased after 2006 does not cover prescription drugs; for drug coverage, you need to enroll in a Part D plan.
Important Tips for Enrolling For Medicare
Keep in mind that you need to enroll early if you’re not automatically enrolled by your 65th birthday. Why does early enrollment matter? Many people assume that if they already have insurance through an employer or a private source that they don’t need to enroll in Medicare. This isn’t necessarily the case. You still need to enroll in Medicare even if you don’t plan to retire anytime soon. Otherwise, you may be charged a penalty fee for each month that you lacked Medicare coverage when you were eligible. Here are some additional tips to help you avoid enrollment pitfalls:
- Get advice well before your 65th birthday so that you can decide whether to keep Part B or switch from original Medicare to Medicare Advantage. Meet with a financial adviser to ensure that you’re on the right track when it comes to retirement expenses.
- Research Advantage plans thoroughly, and don’t just pick the least expensive option. You might end up paying more in out-of-pocket costs with a zero-premium option than you would if you chose a moderate premium option.
- Decide whether you need additional coverage for prescription drugs. If you need several brand name prescriptions, then you’ll most likely fall into the “donut hole” or Medicare coverage gap. However, only about 19 percent of Medicare beneficiaries fell into this gap in 2009, so it may not be a problem for you. Only pay for additional drug coverage if you’re likely to hit the coverage gap.
- Check out the ratings on Advantage plans available through the Centers for Medicare & Medicaid Services. The CMS offers a yearly report on which plans members find most beneficial. A higher star rating indicates a better plan.
Enrolling in a Medicare plan doesn’t have to be complicated if you research your options ahead of time. Talk with friends and family who have already enrolled to find out what they recommend. When in doubt, visit your local Social Security office to learn more about the process. Begin your research by visiting the Medicare website to find out more about important deadlines and application requirements, and you can always check out our articles on the different parts of Medicare for more information. Now that you know a bit more about the various aspects of Medicare enrollment, you can make a more informed decision when it’s time to sign up.