Get With the Program! How to Enroll in Medicare

Here’s how to get started:

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With 10,000 baby boomers turning 65 every day,[1] understanding how and when to enroll in Medicare is a big deal for a major slice of the U.S. population, especially since late enrollment can lead to penalties that last a lifetime. Here’s how to get started with Medicare:

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Part A

Generally speaking, you’re automatically enrolled in Medicare Part A (hospital insurance) the month you qualify for Medicare if you’re already receiving Social Security, Railroad Retirement Board retirement or disability benefits. For example, if you turn 65 on May 9th and you’re receiving Social Security benefits, you’ll be automatically enrolled in Medicare May 1st. Enrollment also will occur automatically if you live outside the 50 states or Washington, D.C., (in Puerto Rico, for example).

If you’re not automatically enrolled:

  • You can enroll in Part A during your Initial Enrollment Period (IEP), which typically begins three months before the month you turn 65 (and become Medicare-eligible) and lasts for seven months.
  • If you miss your IEP, you can sign up during the General Enrollment Period, which runs from January 1 through January 31 each year. You may have to pay a late-enrollment penalty.
  • In certain situations, you can sign up for Medicare during a Special Enrollment Period – when certain events happen in your life, such as moving or losing other insurance coverage. You usually don’t have to pay a late-enrollment penalty if you’re eligible for a Special Enrollment Period.
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Part B

Enrollment periods for Medicare Part B (medical insurance), including automatic enrollment, are the same as with Part A, with several exceptions:

  • Some beneficiaries decide to delay Part B enrollment – for example, you might do this if you’re still covered through an employer-based health plan. If you qualify for automatic Medicare enrollment, you’ll receive instructions about delaying or opting out of Part B during you IEP.
  • If you delay Part B enrollment because you’re already covered by an employer’s plan, you may qualify for a Special Enrollment Period to enroll in Part B without penalty when the employer-based coverage ends. There may be other situations when you can qualify for a Special Enrollment Period.

It is important to either sign up for Medicare Part B when you are initially eligible, or you may be assessed with a late enrollment penalty that can be tacked on to your Part B premium for as long as you have Medicare.

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Part C (Medicare Advantage)

People already enrolled in Original Medicare, Part A and Part B, may decide to receive their Medicare benefits through a Medicare Advantage plan. Medicare Advantage policies are sold by Medicare-approved commercial health insurance companies and are available in a variety of plan types, including HMOs and PPOs. Frequently, Medicare Advantage plans include benefits not offered with original Medicare, such as vision and dental. Most also include Medicare prescription drug coverage (Part D) in a single monthly premium.

Beneficiaries generally can enroll in a Medicare Advantage plan during the following periods:

  • Initial Coverage Election Period (ICEP): If you enroll in Medicare Part B when you are first eligible for Part B, your ICEP to enroll in a Medicare Advantage plan will be the same as your Medicare Part B Initial Enrollment Period, which begins three months before you are first eligible for Part B and lasts for seven months. If you delay your enrollment in Part B and later enroll using the General Enrollment Period or a Special Enrollment Period, then your ICEP will be only the three months before the month your Medicare Part B goes into effect.
  • Annual Election Period: This election period occurs annually from October 15 to December 7. During that time, you have the option of enrolling in, switching, or dropping Medicare Advantage plans. Your coverage changes will take effect January 1 of the following year.
  • Special Election Period: Under special circumstances, such as moving or losing other coverage, you may qualify for this election period, during which you may be able to enroll in, disenroll from, or switch Medicare Advantage plans.
  • Medicare Open Enrollment Period: Starting in 2019, a new enrollment period which runs from January 1 until March 31 replaces the Medicare Advantage Disenrollment Period. The new open enrollment period will allow Medicare beneficiaries to switch to a different Medicare Advantage or Medicare Advantage plan with Part D prescription drug coverage (MAPD), drop a current Medicare Advantage plan and return to Original Medicare (Parts A and Part B), or sign up for a stand-alone Medicare Part D Prescription Drug Plan (if you return to Original Medicare).
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Part D (Prescription drug)

Qualifying beneficiaries have the option of receiving their prescription coverage through a Medicare Part D Prescription Drug Plan. Periods for enrolling in a Part D plan include:

  • Initial Enrollment Period: This begins three months before the month you become Medicare-eligible and lasts for seven months. During this time, you may enroll in a Part D plan of your choosing.
  • Annual Election Period: Every year from October 15 to December 7, you may enroll in or change your prescription drug plan. Coverage changes will take effect Jan. 1 of the following year.
  • Medicare Open Enrollment Period: You can enroll in a Medicare Part D Prescription Drug Plan during this period if you want to drop your Medicare Advantage plan and return to Original Medicare, or switch from one Medicare Advantage plan with Part D prescription drug coverage to another. This period extends from January 1 to March 31 each year.  
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Medigap (Medicare Supplement)

Medigap plans are available to people enrolled in original Medicare Part A and Part B and are used to cover co-pays, deductibles and other costs not covered by Medicare. The best time to enroll in a Medigap plan typically is during the Medigap Open Enrollment Period (OEP), which begins on the first day of the month that a beneficiary is both enrolled in Medicare Part B and is age 65 or older. This enrollment period lasts for six months.

During this time, you’re generally guaranteed enrollment in a Medigap plan of your choosing, as long as you’re enrolled in Medicare Part A and Part B and you live within the Medigap plan’s service area. An insurance company cannot deny you enrollment in a Medigap policy based on any pre-existing conditions* during your Medigap OEP. If you miss this enrollment period, you may be subject to medical underwriting.

If you miss your Medigap Open Enrollment Period, in most cases you won’t get it again. However, there are certain situations when you may have guaranteed issue rights to enroll in a Medigap plan.

*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.

 

 

[1] Matthew Frankel, “9 Baby-Boomer Statistics That Will Blow You Away,” The Motley Fool, July 29, 2017

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