How to Apply for Medicare and Choose the Right Plan For You

 

Who is Eligible?

If you are a U.S Citizen or a permanent legal resident who has lived in the U.S. for at least five years and is 65 years of age or older, you are eligible. There are certain circumstances that allow some who are younger to apply for Medicare, the criteria to meet for eligibility are as follows:

• For the last 2 years, you have received Social Security Benefits or Railroad Retirement Board disability benefits.
• You have end-stage renal disease
• You have ALS or Lou Gehrig's disease
   

Types of Coverage 

There are 4 Parts of coverage for Medicare, the process needs to begin with you understanding what coverage is needed. 

• Medicare Part A
• Medicare Part B
• Medicare Part C
• Medicare Part D

 

Medicare Part A - Hospital Insurance 

Part A helps with the costs of inpatient, hospice, home health and skilled nursing care. It does not cover care like assisted/memory for long-term periods. 
 

Medicare Part B - Medical Insurance 

Part B is for necessary medical and preventative care. This includes but is not limited to visits to your Dr., lab testing, diagnostic screenings, durable medical equipment, ambulance transport and other outpatient services. 
 

Medicare Part C - Medicare Advantage 

Part C is referred to as Medicare Advantage, this plan usually includes Part A, Part B and Part D (not in all cases).
 

Medicare Part D - Prescription Drug Coverage 

Part D covers the costs of prescribed drugs.
 

When to Sign Up

You are automatically enrolled in Medicare Part A and Medicare Part B when you turn 65 to receive Social Security Retirement or disability benefits; if not you will need to enroll to receive coverage. Although there is a standard 7-month Initial Enrollment Period that is : 3 months before your 65th birthday, your birthday month and 3 months after it is highly suggested to enroll in the 3 months prior to avoid any lapses in coverage. If you wait until the 3 months after your benefits may be delayed. 

Enrollment Periods 

 

Initial Enrollment Period 

Your Initial Enrollment Period is the 3 months before you turn 65, your birthday month and the 3 months after your birthday to make a 7-month enrollment period. This 7-month enrollment window is the first time that you are able to apply for Medicare, as stated before it is important to sign up, preferably within the initial 3-month period in order to avoid paying any late enrollment penalities on your premiums.
 

General Enrollment Period 

From January 1 to March 31 every year you are able to:

• Apply for Part A and B if you missed your Initial Enrollment Period. 

• Enroll in a Medicare Advantage Plan if you enroll in Original Medicare during this time.

 

During this time, you might be able to sign up for Part D (Prescription Drug Coverage) if you have already had Medicare Part A and are adding Part B for the first time.  
 

Special Enrollment Period (SEP) 

If you missed your Initial Enrollment Period, you likely will have to enroll during a Special Enrollment Period for Original Medicare, if you've had certain life events. Some (but not all) of these are:

• Lose group health coverage from employer.
• SEP for Individuals Impacted by an Emergency or Disaster.
• SEP to coordinate with Termination of Medicaid Coverage.

The time period for the SEP depends on the style of life event you experience. 
 

Medigap Open Enrollment Period 

Once you enroll in Part B, the Medigap open enrollment period begins and lasts for 6 months. In order to meet eligibility requirements for Medigap you must have both Part A and Part B but you can not purchase a Medigap plan if you have a Medicare Advantage plan. 
 

Late Enrollment Penalties 

 

Medicare Part A Penalty 

If you do not enroll when you turn 65, you may have to pay a late enrollment penalty.  Your monthly Part A premium may go up to 10% and you may have to pay the penalty for twice the number of years you didn't sign up. Please note that if you meet the criteria for premium-free Part A, you typically would not have to pay a penalty, even if you are past the enrollment age of 65.
 

Medicare Part B Penalty 

These penalties last the lifetime of your Part B coverage, like Part A, this penalty is 10% but for each year of eligibility without enrollment. Please note that if you did not enroll because you still have insurance from an employer and enrolled in a SEP you won't have to pay a penalty. 
 

Medicare Part D Penalty 

A Part D penalty is 1% of the national base premium of the current year and is multiplied by the months you didn't have prescription coverage. You will have to pay this penalty if:

• You didn't have a Medicare Advantage Plan (Part C) with prescription drug coverage for 63+ days
• You go 63+ days or more without creditable drug coverage
• You cannot show you had creditable prescription drug coverage

 

Need Assistance? 

Enrollment periods can be confusing, especially when it comes to choosing the plan that is right for you. MedicareOptions.PRO licensed insurance agents are here to answer your questions and to help you understand which plan may be best for you. Call us today to get the assistance you need to sign up for Medicare. 

Are you currently on Medicare and moving? Call today for assistance.