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 have been getting Social Security or Railroad Retirement payments for at least four months,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. 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 under age 65 and disabled, you will be automatically enrolled 24 months after you begin drawing disability benefits. You will get your Medicare card in the mail 3 months before your second year of disability ends.

If you have Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s disease) you will be automatically enrolled in Parts A and B the same month your disability benefits begin. If you have End Stage Renal Disease (ESRD) you have the option of enrolling in Parts A and B, but you need to be enrolled in order to get the full Medicare benefits for dialysis and kidney transplant services. You can enroll in Medicare by calling or visiting your local Social Security Office or by calling Social Security at 800-772-1213.

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 2021 is $148.50. Most people will pay that amount unless your income is higher. If your modified adjusted gross income -- as reported on your IRS tax return from two years ago -- is above $88,000 for single filers or $176,000 for joint filers, the monthly premium will vary from about $208 to $475 in 2021.

 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.

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

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.

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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 (for example, if you work for a small employer)”.

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 2019 is $185. 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, such as deductibles and co-insurance.

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 and can be charged more if you have health problems.

To learn about Medigap plans offered in your area, you can use the online federal tool. 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. You are still responsible for paying your Part B premium.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 premium 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 and have Medicare because you are disabled, have ALS, or kidney disease you can still sign up for a Medicare Advantage Plan or a Medigap plan. You may also be eligible for a Special Needs Plan, a plan designed specifically for people with certain chronic conditions or disabilities.  You have to live in the plan’s service area and may have to use their network of providers but the network will include providers who specialize in your condition. To find out more about Special Needs Plans and whether you can enroll in one, go to Medicare’s website.

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.

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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. New Medigap plans do not cover prescription drugs.
  • Keep the prescription drug benefits you get from your employer or other health plan (instead of getting drug benefits from Medicare).

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. Open enrollment for Part D plans is generally from October 15th to December 7th with coverage starting on January 1st. To shop for and enroll in a Part D plan, use the Medicare Plan Finder.

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 17, 2020

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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