Enrolling in Medicare

Enrolling in Medicare is simple and often automatic. Follow these four steps to learn what you should do:

 

 

First Step to Enrolling in Medicare

Medicare is for people ages 65 and older, and for those who are disabled or have end-stage renal disease. Medicare Part A covers hospital stays and other inpatient services. Part B covers doctor visits and other outpatient services.

If you currently get Social Security or Railroad Retirement payments:

  • In most cases, you'll be enrolled in Medicare Part A & B automatically on the first day of the month of your 65th birthday. For example, if you turn 65 on May 15, you are enrolled on May 1. Or, if you are under age 65 and disabled, you will be automatically enrolled 24 months after you begin drawing disability benefits.
  • Your Medicare card should come in the mail three months prior to your 65th birthday. If you do not receive your card, call the Social Security Administration at 800-772-1213.

If you are close to age 65 and not getting Social Security or Railroad Retirement payments:

  • You must sign up to get Medicare benefits.
  • To sign up, call Social Security at 800-772-1213.
  • You can also apply in person at your local Social Security office.

 

If you live in Puerto Rico and get Social Security or Railroad Retirement benefits:

  • You will automatically be signed up for Part A benefits. However, you must sign up for Part B during the initial enrollment period so you don't incur a late enrollment penalty.
  • To sign up, call Social Security at 800-772-1213.

To sign up for both Medicare and Social Security retirement benefits:

  • You can apply online here.
  • Or call 800-772-1213.
  • Or visit your local Social Security office.

If you qualify for Social Security benefits, you do not pay for Medicare Part A coverage.

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Step 2 for Enrolling in Medicare

Everyone pays a monthly fee for Medicare Part B insurance, which is usually taken out of your Social Security payment. The standard premium amount for 2017  is $134. However, because the Part B premium increased more than the cost-of-living adjustment for Social Security, most people will pay less than that amount. If you were enrolled in Medicare prior to 2017 and you pay your Part B premium through Social Security, you will pay $109 on average per month in 2017. You may choose not to participate in Medicare Part B insurance, which covers doctor visits and other outpatient medical services. Keep in mind that in most cases, your Part B premium may be higher if you didn't sign up for Part B when you first became eligible.

Also, if your modified adjusted gross income -- as reported on your IRS tax return from two years ago -- is above $85,000 for single filers or $170,000 for joint filers, the monthly adjustment will vary from about $54 to $295, with a maximum premium of $428.60 in 2017.

If you are still working and you are covered under your union or employer's health insurance -- or if you are covered under your spouse's employee health insurance -- Medicare Part B may not be necessary until you lose that coverage.

If you were enrolled in Medicare automatically and do not want Part B:

  • A form that comes in the mail with your Medicare card allows you to opt out of Part B.
  • Indicate that you do not want Part B coverage on the form.

If you are enrolling yourself in Medicare:

  • Indicate that you do not want Part B when you enroll by phone, online, or in person.

If you opt out of Part B when you are enrolled, you will pay higher premiums if you decide you want it later, with some exceptions. The premium goes up 10% every year that you could have had Part B.

You will not pay more for signing up later:

  • If you are covered by another group health plan when you turn 65
  • If you sign up for Part B within eight months of losing group health coverage

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If you decline Part B at first, and do not sign up within eight months after your other health coverage ends, you can only sign up during Medicare's General Enrollment Period: January 1 to March 31 of each year, and your coverage will begin July 1 of that year.

Before opting out of Medicare Part B, it would be a good idea to talk to the group benefits administrator with your other health insurance plan. In some cases, Medicare Part B would be your main insurance even if you have other coverage.

If you sign up for Part B, you will pay a deductible each year before Medicare starts to pick up health care costs for Part B services. The Part B deductible for 2017 is $183. Beneficiaries may be able to get help from their state to pay this premium and deductible. If you have Part A and Part B and are not enrolled in a private plan (see below) you are in what is called Original Medicare.

Step 3 for Medicare Enrollment

Your retiree health insurance plan may pay for some of the deductibles or co-payments that you have to pay with Medicare coverage. If you don't have retiree health benefits, you can decide to participate in a Medicare Advantage plan that covers some of the gaps in Medicare coverage. Or you can buy specially designed health insurance that supplements Medicare, called Medigap insurance.

Medigap Insurance

Medigap plans are sold by private companies to seniors who have Original Medicare. These plans are meant to help pay for services Medicare alone does not.

If you are going to buy a Medigap plan, you should do so within six months of taking Medicare Part B. During this six-month window, insurers:

  • Can't deny you coverage
  • Can't delay the start of your coverage
  • Can't charge you more based on pre-existing health problems

If you try to buy a Medigap policy after your six-month enrollment period has ended, you are not guaranteed coverage.

To learn about Medigap plans offered in your area, you can use the online Medicare Personal Plan Finder. Or, you can request a copy of ''Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare'' by calling 800‑MEDICARE (800‑633‑4227).

Medicare Advantage Plans

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These plans allow seniors to receive both Medicare Parts A and B benefits through a private health insurer that contracts with Medicare. Medicare Advantage plans cover hospitalization, outpatient care, and, often, prescription-drug coverage under one plan. Many also include extra services that original Medicare doesn't cover, such as dental and vision care. In most cases, Medicare Advantage plans will require you to receive your care from a physician in the health plan’s network, unless it’s an emergency. You will not have the ability to go to any provider that accepts Medicare, like you do with Original Medicare. To join a Medicare Advantage plan, you must already have Medicare Part A and Part B. Your Medicare Advantage plan may also require a monthly fee for some of the plan's extra benefits.

If you are in a Medicare Advantage Plan, you cannot also have a Medigap policy. Medicare Advantage plans cover some of the same benefits that a Medigap plan offers.

Once you join a plan, you are typically locked in for the calendar year. You will be allowed to switch plans between October 15 and Dec. 7 each year during the Medicare Annual Enrollment Period.

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:

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 800-772-1213.

Step 4 for Medicare Enrollment

Medicare Part D provides you with 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 includes prescription drug benefits.
  • Keep your existing Medigap plan that covers prescription drugs; people enrolled in Medigap plans with drug coverage cannot also enroll in a Medicare Part D prescription drug plan.
  • Keep the prescription drug benefits you get from your employer or other health plan (instead of getting drug benefits from Medicare).

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Compare the various plans that are available in your area and enroll with the Medicare plan finder at Medicare.gov or call 800-MEDICARE (800-633-4227). As with Part B, if you don’t enroll in Part D when you are first eligible, you will pay a late enrollment penalty unless you had other drug coverage.

Free personalized counseling services are also available through State Health Insurance Assistance Programs, or call 800-677-1116.

With new health care laws, Medicare changes may affect you.

 

WebMD Medical Reference Reviewed by Sarah Goodell on November 15, 2016

Sources

SOURCES: 

American Association of Retired Persons (AARP) web site. Centers for Medicare and Medicaid Services. Medicare.gov web site: ''Medicare & You 2017'' handbook (https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf) and "Part B Costs." Laschober, M. Heath Care Financing Review, Spring, 2005.

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