6 Things to Know About Medicare Enrollment
There is a lot to know about Medicare. Even the basics can seem a little overwhelming, especially when you’re first enrolling into Medicare or a Medicare plan. Whether you’re signing up at age 65 or switching plans during an enrollment period, here are six important things to know about enrolling into Medicare.
1: Medicare isn’t just for people who are 65 and older
Most people enroll in Medicare at or around the age of 65. However, you can also enroll if you are under age 65 and have certain disabilities, or if you have End Stage Renal Disease (ESRD) — permanent kidney failure requiring dialysis or a transplant. People under the age of 65 are eligible to enroll in Medicare if they have received Social Security Disability Insurance or Railroad Retirement Board disability benefits for at least 24 months. There is no 24-month waiting period for those who have amyotrophic lateral sclerosis (ALS). Some people with ESRD are also eligible to enroll immediately.
2: Medicare is different from other types of health insurance
If you’ve had health coverage through your employer, your plan likely included medical and prescription drug coverage, along with other benefits. It also may have covered both you and your spouse. Medicare covers only one person at a time. That means you and your spouse must enroll separately. In addition, Medicare gives you options that make it possible to receive your benefits in a variety of different ways. You have the freedom to choose coverage that fits your needs, budget and lifestyle.
3: Medicare has four main parts
Each one provides coverage for specific services:
Medicare Part A is hospital coverage that also includes things like skilled nursing, hospice care and more.
Medicare Part B is medical coverage — doctors’ services, outpatient care and ambulance services all fall under the Part B umbrella. Together, Medicare Part A and Part B are known as Original Medicare.
Medicare Part C, commonly known as Medicare Advantage, is coverage offered by private insurance companies that have a contract with the federal government. Medicare Advantage plans combine your Part A and Part B benefits into one plan. Many plans also include prescription drug coverage and health and wellness benefits.
Medicare Part D is coverage offered by private insurance companies that helps you pay for your prescription drugs.
There are also separate Medigap policies offered by private insurance companies that help fill gaps in Original Medicare. Taking time to learn about your coverage options before you enroll in any plan can help you feel more confident in your decisions.
4: You can only enroll in Medicare at certain times
Generally, you have the following opportunities to enroll in Medicare or a Medicare plan:
Your Initial Enrollment Period (IEP) begins three months before your 65th birthday, includes the month you turn 65 and ends three months after that birthday. If you don’t enroll in Medicare during this seven-month window, you must wait for the next enrollment period — and you may have to pay Medicare Part B or Part D late enrollment penalties.
Medicare’s Annual Enrollment Period (AEP) is from October 15 to December 7 each year. This is generally the time when you can join or switch Medicare Advantage or Part D plans. Your new coverage begins on January 1st of the following year.
The Medicare Advantage Open Enrollment Period (OEP) begins January 1 and ends March 31 each year. During this time, if you’re in a Medicare Advantage plan and want to change your coverage, you can switch to a different Medicare Advantage plan with or without drug coverage. You can also go back to Original Medicare and, if needed, join a Part D prescription drug plan.
Finally, you may be eligible to enroll during a Special Enrollment Period (SEP). These are typically reserved for times when certain events happen in your life, and each Special Enrollment Period can have different rules, depending on the circumstances. Reasons for a Special Enrollment Period may include changing where you live, losing your current coverage or if your plan changes its contract with Medicare.
5: In some cases, you may be enrolled into Medicare automatically
If you’re getting benefits from Social Security, the Railroad Retirement Board (RRB) or the Office of Personnel Management at least 4 months before you turn 65:
You’ll be automatically enrolled in Medicare Part A and Part B starting the first day of the month you turn 65.
If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.
If you’re not receiving benefits from any of these sources at least 4 months before you turn 65, you’ll need to contact Social Security or the RRB to enroll in Medicare Parts A and B.
6: Medicare offers different enrollment options to people who are still working
If you or your spouse are actively employed by a company with 20 or more employees and you’re receiving health insurance through that employer, you can:
Choose to stay with the employer health plan as your primary coverage and delay Medicare enrollment.
Enroll in Medicare Part A and use it as secondary coverage to help pay for things the employer health plan doesn’t cover.
Choose to delay enrolling in Medicare Part B until the employment ends or the coverage stops, without paying late enrollment penalties if you enroll later.
If you or your spouse are actively employed by a company with fewer than 20 employees, the employer may require you to enroll in Medicare when you turn 65. At that point, Medicare will become your primary coverage.
Have more questions about Medicare? Our team of licensed insurance agents can answer them. When you’re ready, we can help you find and enroll in a plan that’s right for you.
We do not offer every plan available in your area. Currently we represent 4 organizations which offer 27 products in your area. Please contact Medicare.gov, 1‑800‑MEDICARE, or your local State Health Insurance Program to get information on all of your options.
