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Turning 65? Here’s What You Need to Know about Medicare

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If you’re turning 65, or qualifying for Medicare by disability, you might be wondering how to sign up for Medicare. Maybe you’d like to understand what Medicare is all about. Here’s a quick summary of Medicare basics and what you need to know about signing up.

Before you sign up for Medicare, understand the Medicare program

If you’re one of the 10,000 people who become eligible for Medicare every day*, and are not sure what it’s all about, you’re not alone. Here’s a quick overview for you.

Original Medicare is the federal health insurance program signed into law in 1965. It includes Part A, hospital insurance, and Part B, medical insurance. It’s available to qualified people aged 65 and older, and those younger than 65 who qualify due to a disability.

Medicare covers many medical services, but in many cases, it comes with out-of-pocket costs to you. There are deductibles and copayments or coinsurance amounts that you might need to pay.

Medicare Part A generally covers inpatient hospital costs. Your out-of-pocket costs depend partly on how long you stay in the hospital and whether you’ve paid the Part A deductible. If you have worked for at least 10 years while paying Medicare taxes, you typically don’t pay a premium for Part A.

Medicare Part B may cover doctor visits, preventive care, durable medical equipment, and certain other medical services and items. For many covered items and services, you’ll pay 20% of the Medicare-approved costs. Most people pay a monthly Part B premium.

Original Medicare is the core of the program, but you might have other Medicare coverage options. We’ll get to that. But first, how do you sign up for Medicare?

How to sign up for Medicare at age 65 (or when you qualify)

Did you know that many people don’t have to sign up for Medicare, because they’re automatically enrolled when they turn 65? Many people are automatically enrolled before they turn 65 if they qualify because of a disability.

Generally, you’re automatically enrolled in Medicare Part A and Part B when any of these happens:

  • You turn 65 and you’re already receiving retirement benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). You’ll generally get enrolled the month you turn 65.
  • You’re younger than 65, but you’ve been receiving SSA or RRB disability benefits for 24 months in a row. You’ll be automatically enrolled in Medicare the 25th month of getting disability benefits.
  • You’re younger than 65, and you have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). You’re eligible for Medicare the month that your disability benefits begin, and you’ll be automatically enrolled in Medicare that month.

Please note that to be eligible for Medicare, you must also be a citizen of the United States, or a permanent legal resident of at least 5 years in a row.

In some cases, you’re not automatically enrolled, and you’ll need to apply for Medicare. For example:

  • You’re not receiving SSA or RRB retirement benefits when you turn 65. (For instance, you might be still working.) If you’re covered by an employer’s health plan, you might be able to delay enrolling in Part B.
  • You live in Puerto Rico. Even if you qualify for automatic enrollment as described above, you’ll need to enroll in Medicare Part B manually.
  • You have end-stage renal disease (ESRD, which is permanent kidney failure). You might qualify for Medicare before age 65, but you’ll need to enroll manually.

When can I apply for Medicare?

If you need to apply for Medicare, here’s when you can apply.

  • During your Initial Enrollment Period (IEP) – for most people, this is a seven-month period that starts three months before your birthday month, includes the month you turn 65, and continues for three months after that.

If you’re under 65 and receiving disabiity benefits, your IEP is usually also a seven-month period. It starts three months before the 25th month that you receive disability benefits. You become eligible for Medicare the 25th month, and your IEP continues for three months after that.

  • During the General Enrollment Period – from January 1 – March 31 every year.
  • During a Special Enrollment Period – in some cases, you may be able to apply for Medicare outside the regular enrollment periods. For example, if you’re covered through an employer’s group plan when you turn 65, you might decide to delay Part B enrollment. Your Special Enrollment Period generally starts the month that employment ends, or your employment-based coverage ends (whichever happens first), and continues for eight months.

How or where do I apply for Medicare?

You apply for Medicare through the Social Security Administration (or, if applicable, the Railroad Retirement Board or RRB).

  • Visit ssa.gov.
  • Call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. Representatives are available Monday through Friday, from 7AM to 7PM, all U.S. time zones.
  • Stop in to your local SSA office.
  • Call the RRB (if applicable) at 1-877-772-5772. TTY users call 1-312-751-4701. Monday through Friday, 9AM to 3:30PM, to speak to an RRB representative. 

Are there more Medicare coverage options I can sign up for?

You might have heard that Medicare has four “parts.” We already talked about Medicare Part A and Part B. Here’s the rest of the story.

  • Medicare Part C is the Medicare Advantage program. This is a way for you to get your Medicare Part A and Part B coverage through a private, Medicare-approved insurance company instead of directly through the government. If you decide to sign up for a Medicare Advantage plan, be aware that you’ll still pay your monthly Medicare Part B premium as well as any premium the plan may charge. Read more about Medicare Part C.
  • Medicare Part D is prescription drug coverage. It’s optional coverage available through private, Medicare-approved health insurance companies. You can get it through a Medicare Advantage prescription drug plan, or a stand-alone Medicare Part D prescription drug plan. Read more about Medicare Part D.
  • There’s another kind of optional coverage you might want to know about. If you stay with Original Medicare, Part A and Part B, you might be able to buy a Medicare Supplement insurance plan to help with Medicare’s out-of-pocket costs. Copayments, coinsurance, and deductibles are some of the Medicare expenses that a Medicare Supplement insurance plan may help cover. However, the scope of coverage varies among the different Medicare Supplement plans – for example, not every plan covers deductibles. Learn more about Medicare Supplement insurance plans.

You’ve learned a lot about Medicare in a short time! You might want to check out some Medicare coverage options and think about what may work best for you. To start looking at plans in your area, type your zip code into the box on this page.

*Politico Magazine, 2018

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