Health Care Reform:

Medicare Eligibility and Enrollment

Who can get Medicare? Basically, two groups are eligible:

1. Most people 65 and older.
2. People younger than 65 who have certain disabilities and illnesses.
3. People of any age with kidney failure that requires dialysis or a kidney transplant.

You might assume that signing up for a big government program like Medicare would be confusing. But it's usually easy. Most people are signed up automatically for Original Medicare (Parts A and B).

Medicare Eligibility and Enrollment for People 65 and Older

Any U.S. citizen who is 65 or older is eligible for Medicare. If you're already getting Social Security checks, enrollment into the program should be automatic. You'll get your Medicare card three months before your 65th birthday.  The benefits kick in on the first day of the month of your 65th birthday. 

If you're not getting Social Security payments already, you have to enroll in Medicare. The Social Security Administration (SSA) handles the enrollment process for Medicare. Call SSA at (800) 772-1213, visit the web site (www.ssa.gov), or apply at your local Social Security office. Apply three months before your 65th birthday. That way, you can be sure that your benefits will start on time.

If you live in Puerto Rico and want it, you need to sign up for Medicare Part B.

Medicare Eligibility and Enrollment for People With Disabilities and Illnesses

Regardless of age, people with Lou Gehrig's disease, kidney failure, and some other disabilities also get Medicare. However, they might have a waiting period before they can get Medicare benefits. Here are the details.

• Lou Gehrig's Disease (ALS). As soon as you get Social Security Disability benefits for ALS, you should be automatically enrolled in Medicare. There is no waiting period.
• Kidney failure. To qualify, you must have end-stage renal disease and need dialysis or a kidney transplant. Usually, you can't get Medicare until three months after you start dialysis. Once you've been diagnosed with kidney failure, call the Social Security administration at (800) 772-1213 to enroll in Medicare.
• Other disabilities for which you get Social Security Disability benefits. You can't get Medicare until two years after you qualify for Social Security Disability. At that point, the Social Security Administration should sign you up automatically.

If you are not getting Medicare coverage and feel that you should, call the Social Security Administration at (800) 772-1213.

Medicare Enrollment Periods

Pay close attention to Medicare enrollment deadlines. In general, Medicare limits your ability to add or drop coverage after official enrollment periods. Here are some details:

• Initial Enrollment Period. If you are not automatically enrolled, you must sign up during your "initial enrollment period" for Part A and/or Part B. This lasts seven months, starting three months before the month of your 65th birthday and ending three months after. During this time, you can sign up for any Medicare coverage you would like. However, if you wait to sign up the month of your birthday or the three months that follow, you will have to wait one to three months for coverage to begin.
• Other enrollment periods. If you did not enroll in Parts A and B during the initial enrollment period, you may do so between Jan. 1 and March 31, with coverage beginning in July of that year. You may have to pay a higher monthly premium for coverage. However, if you are covered under a group health insurance plan through your job and/or your spouse's job, or your employment ends after the initial enrollment period, you may enroll in Medicare during a Special Enrollment Period without incurring a late enrollment penalty.
• You may join, switch or drop a Medicare Prescription Drug Plan between Oct. 15 and Dec. 7. Changes will go into effect Jan. 1, 2013. You will also pay a penalty -- in higher premiums -- if you join late. However, you may join a 5-star Medicare Prescription Drug Plan, as rated by Medicare, any time. Go to www.medicare.gov/find-a-plan to see ratings. 
• You may join a Medicare Advantage Plan (Part C) during the 7-month period when you first become eligible for Medicare, or you may join, switch, or drop a Part C plan between Oct. 15 and Dec. 7. You may switch to Original Medicare (Parts A and B) and sign up for a Medicare Prescription Drug Plan between Jan. 1 and Feb. 14.
• Watch out for Medicare penalties. If you don't sign up during your initial enrollment period for some programs -- like Medicare Parts A and B and Medicare Prescription Drug Coverage (Part D) -- you might pay a higher monthly fee when you sign up later. There are some exceptions. If you have drug coverage now that is as good as Medicare's or better, you shouldn't be charged a late penalty if you sign up later. Likewise, if you (or your spouse) are still working when you turn 65 and have health insurance through that job, you can wait to sign up for Part B without having to pay higher premiums. 
• Sign up for Medigap early. If you need a Medigap plan, you should buy it within six months of getting Medicare Part B. During that period, you're protected. You're guaranteed to get any Medigap plan you want. But if you try to buy it after those six months, the insurance company can charge you a higher price or turn you down altogether.