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Health Care Reform:

Health Insurance & Affordable Care Act

Enrolling in Medicare

Step 3 for Medicare Enrollment continued...

If you are in a Medicare Advantage Plan, you don't need a Medigap policy. Medicare Advantage plans usually cover the same benefits that a Medigap plan offers.

Medicare has imposed a number of restrictions on when you can join or leave a Medicare Advantage plan. In general, you must join within three months of your 65th birthday. If you already have Medicare, you need to join a Medicare Advantage plan by either May 15 or June 30, depending on the specifics of your current coverage. If you miss that date, you will have to wait until Nov. 15.

Once you join a plan, you are typically locked in for the calendar year. You will be allowed to switch plans between Nov. 15 and Dec. 31 each year.

To learn about Medicare Advantage plans offered in your area, you can use the online Medicare Personal Plan Finder.

Medicare for People With Disabilities

If you are under age 65, you are eligible for Medicare if:

  • You are disabled and are getting Social Security disability payments
  • You have Lou Gehrig's disease (ALS)
  • You have kidney failure (end-stage renal disease) and you need dialysis or a kidney transplant

Keep in mind that there may be a waiting period before you can start receiving Medicare, depending on your illness. You can enroll in Medicare by calling or visiting your local Social Security Office or by calling Social Security at 1-800-772-1213.

Step 4 for Medicare Enrollment

In January 2006 Medicare launched its new prescription drug plan -- also called Medicare Part D. It provides you with some insurance coverage for brand name and generic prescription drugs. Medicare works with insurers and other private companies to offer a number of different plans.

You have quite a few options. You can:

  • Buy a plan that offers the drug benefit alone
  • Choose a Medicare Advantage plan that has prescription drug benefits
  • Keep an existing Medigap plan (H, I, or J) that covers prescription drugs, as long as you don't sign up for the new drug benefit
  • Keep the prescription drug benefits you get from your employer or other health plan (instead of getting drug benefits from Medicare)
  • As of June 2010, the types of Medigap Plans that you can buy changed. Medigap offered two new plans -- M and N -- and eliminated Plans E, H, I and J. However, if you already bought Plan E, H, I, or J before June 1, 2010, you can keep that plan. Contact your plan for more information.

To join the program, you need to pay a premium each month. Prices vary depending on the plan, but the monthly cost is about $38. You will also have to pay a deductible and -- depending on how much you spend -- other drug costs. People with limited incomes may qualify for financial assistance.

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