Medicare is the government medical insurance plan for older Americans and people with certain disabilities. As of 2020, more than 62-million Americans rely on Medicare for their primary health insurance needs. By the year 2032, this number will swell to nearly 80-million people. In this MedicareWire article, we’ll explain when Medicare starts and important rights you don’t want to overlook.
- The age at which Medicare starts depends on your situation. The Medicare start date for most people is their 65th birthday.
- Some people age 65 and older delay their benefits because they have coverage through an employer.
- People with certain disabilities qualify for Medicare through Social Security Disability Insurance (SSDI).
- Everyone getting Medicare benefits for the first time has an Initial Enrollment Period that comes with important benefits.
- When coverage begins depends on when you enroll.
- Medicare is not one-size-fits-all coverage. Medicare beneficiaries have health plan options.
- Medicare is not free. There are monthly costs (A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. ...) and costs when health services are used (A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.... and/or Coinsurance is a percentage of the total you are required to pay for a medical service. ...).
When to Apply for Medicare
While there are exceptions, in general, adults become eligible for Medicare on their 65th birthday. In fact, more than 11,000 people turn age 65 daily and get their eligibility for coverage. This is often a source of confusion because originally you got your Medicare and Social Security retirement benefits at the same time (i.e., retirement age).
Social Security retirement and Medicare benefits are no longer linked. If you retire at the earliest age possible, which is age 62, you won’t receive your Medicare benefits until age 65. However, if you delay taking Social Security until age 70, your Medicare benefits will start at age 65 anyway. In all cases, you can apply for Medicare up to three months prior to your 65th birthday to make sure your benefits start on time.
Medicare is also available to adults with Social Security disability benefits. If you qualify for Social Security Disability Insurance (SSDI), your Medicare benefits start on the 25th month of your Social Security benefits.
Initial Enrollment Period (IEP)
Everyone turning age 65, or getting Medicare benefits due to their Social Security disability status, gets an Initial Enrollment Period (IEP). How long it takes for Medicare to start depends on when you enroll in the program during your IEP.
If you sign up for Medicare Part A is hospital inpatient coverage for people with Original Medicare, whereas Part B is medical coverage for doctor visits, tests, etc.... and Medicare Part B is medical coverage for people with Original Medicare. It covers doctor visits, specialists, lab tests and diagnostics, and durable medical equipment. Part A is for hospital inpatient care.... during the first three months of your IEP, Medicare coverage starts on the first day of your birthday month.
This means if you turn 65 years old on November 30, your start date is November 1.
If your birthday is on the first day of the month, benefits begin the first day of the prior month. For instance, if your birthday is on September 1, your coverage begins on August 1.
When is the initial Medicare enrollment period?
When you first become eligible for Medicare, you have a 7-month window, called the Initial Enrollment Period, to sign up for Medicare Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that: Begins 3 months before the month you turn 65.
General Enrollment Period
You can sign up for Part A any time during the initial enrollment period or afterward.
If you sign up within 6 months of your 65th birthday, Medicare starts the same time as if you signed up during the initial enrollment period (first day of your birthday month or the first day of the previous month if your birthday falls on the 1st.
When is the general enrollment period for Medicare?
The general enrollment period for Medicare is January 1 to March 31.
Enrolling in Medicare After Turning 65
Retirees who sign up for Medicare after turning 65 will have to wait a month or more for coverage to begin.
If you sign up for free Part A and/or Part B:
- The month you turn 65, you will receive Medicare a month after signing up.
- One month after turning 65, you will receive Medicare two months after signing up.
- Two months after turning 65, you will receive Medicare three months after signing up.
- Three months after turning 65, you will receive Medicare three months after signing up.
Medicare Health Plans
Medicare is actually a set of insurance options that people can choose from once they are eligible. Medicare Part A and Medicare Part B are known as Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage..... About 38-million Americans choose this option.
You can also choose from a variety of private insurance company plans known as Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).... (see them here), some of which have no additional monthly premiums. Nearly 24-million Americans take this private Medicare coverage, including many people who qualify for both Medicare and Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.....
For prescription drug coverage, there are Medicare Part D is Medicare's prescription drug plan program. Plans are offered by private insurance companies and cover outpatient prescriptions.... plans (on this page), which are bundled into many Medicare Advantage plans as an extra benefit.
Exceptions To The 65 and Older Rule
For people who received SSDI for Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrig’s disease, Medicare starts automatically in the first month they receive their SSDI benefit. These beneficiaries do not need to wait 24 months. Additionally, patients with late-stage renal failure may not need to wait for 24 months either. Those with End-Stage Renal Disease who have had a transplant or receive dialysis treatments would need to be on SSDI to qualify for Medicare.
Additionally, retired railroad workers also qualify for Medicare. This program works a little differently, but the end result is that they are insured through Medicare. The Railroad Retirement Board is who would process your application as opposed to the Social Security office. If you already receive RRB checks, you would be automatically enrolled in Medicare when you turn 65. If you do not receive checks yet when you turn 65, you can apply for Medicare directly through the RRB office.
How Much Does Medicare Cost?
One of the biggest misunderstandings about the Medicare program is its costs. It is not free and it does not cover everything.
All Medicare beneficiaries pay a monthly premium for their medical coverage (Medicare Part B). The premium is based on your annual income. High-income earners pay a little more than those with a lower income. For 2021, the basic Part B monthly premium is $148.50. For high-income earners, the rate is between $245 and $368 per month.
Some Medicare Advantage plans do not have an additional monthly premium but, you must continue paying your Medicare Part B premium. When a Medicare Advantage plan has a $0 premium it simply means that what you pay for your Medicare Part B each month covers the full cost of the private insurance plan.
Medicare Part A is hospital insurance and is available at no cost (aka, premium-free Part A) to people who worked (and their spouses) and paid Medicare taxes for ten or more years. If you did not pay Medicare taxes for a full ten years (40 quarters), you must pay a monthly premium for your Medicare Part A benefits. The amount you pay is based on the number of quarters you paid Medicare taxes. The more you paid in the past, the less you’ll pay for your premiums.
Does It Cover 100% Of All Healthcare Costs?
Since its inception, Medicare health insurance covers about 80 percent of all major medical costs. Medicare beneficiaries are responsible for the remaining 20 percent. Both Original Medicare and Medicare Advantage are designed to be this way.
A simple doctor visit might only require a $20 to $40 coinsurance or copay, but more complicated healthcare services can cost beneficiaries hundreds or even thousands of dollars out of pocket. The big difference between Original Medicare and Medicare Advantage is that Medicare Advantage plans have an annual cap called the maximum out-of-pocket (MOOP) limit, whereas Original Medicare has no limits.
Imagine needing cancer treatment, which can cost upwards of $2 million. With Original Medicare and no additional coverage, you would be responsible to cover upwards of $400,000 out of pocket. To insure against these costs, people often buy supplemental insurance called Medigap (learn more here).
If you’re thinking that a Medicare Advantage plan will help you avoid this issue, you’re partially right. However, most low-cost Medicare Advantage plans have a high MOOP. Some as high as $7,550 per year. That’s a lot of money to pull out of your pocket, and it does not include the monthly premiums or the cost of your medications. Read Why Medicare Advantage Plans are Bad.
Do I Need To Enroll?
When you turn 65, you need to enroll unless you already receive SSDI payments. You can enroll online, over the phone, or at your local Social Security office. At age 65 you receive an individual enrollment period (IEP) that affords you special rights. This includes the right to enroll in a Medicare Advantage plan, a Medicare Part D plan, and a Medigap plan.
Your Medigap Guaranteed-issue is a right granted to Medicare beneficiaries and applies to Medicare Supplement insurance (aka, Medigap plans). All states and the federal government enforce this essential right, which protects Medicare beneficiaries from medical underwriting.... is very important, particularly if you have one or more chronic health conditions. This right allows you to buy any Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage.... insurance you choose without going through medical underwriting. You can’t be turned down, and you cannot be canceled, so long as you continue to pay your premiums.
After your IEP, you will have the opportunity to change your health plan elections during Medicare’s Annual Election Period (AEP). This In health insurance, open enrollment is a period during which a person may enroll in or change their selection of health plan benefits. Health plan enrollment is ordinarily subject to restrictions.... period starts on 15 October and ends on 7 December. AEP is only for Medicare Advantage and prescription drug plans (Part D). If you have a Medicare supplement, you can change plans any time you want, but you may be required to answer medical questions.
There are also some situations where Medicare will give you a Special Enrollment Period (SEP). This happens most frequently if you move, no longer have employer benefits, or the plan you have is no longer available.
Is Medicare Automatic?
Enrollment in Medicare is automatic if you receive SSDI payments. It is not automatic once you turn 65 and are not on SSDI benefits. You need to enroll via phone, online, or in person at your local Social Security Administration office. It takes time to apply.
You have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B when you are first eligible. If you are eligible for Medicare at age 65, you can sign up during the 7-month period that:
- Begins 3 months before the month you turn 65
- Includes the month you turn 65
- Ends 3 months after the month you turn 65
NOTE: If you wait until the month you turn 65 (or the 3 months after you turn 65) to enroll, your Part B coverage will be delayed. This could cause a gap in your coverage.
How Do I Enroll In Medicare?
Once you turn 65, gather the required documents needed to enroll. This will include proof of citizenship or residency. You may need your birth certificate, passport, vaccination records, medical records, or other documentation to verify your date of birth and your citizenship. Additionally, you’ll need proof of income, a Social Security number, your spouse’s information, and more. You can enroll in Medicare online, over the phone, or at a Social Security Administration office. You do not need an insurance agent to enroll.
What Happens If I Don’t Enroll On Time?
In nearly all cases, if you do not enroll in Medicare Part B when you are first eligible, you’ll have to pay a late enrollment penalty. You’ll have to pay this Medicare penalty for as long as you have Part B and have a gap in your health coverage. Go to www.Medicare.gov to learn all the details.
When to Choose a Medicare Advantage Plan (Part C)
You can enroll, switch, or cancel a Medicare health plan (Medicare Advantage Plan (Part C) during the following times:
- Initial Enrollment Period: March, April, or May
- Open Enrollment Period: October 15 – December 7
- Medicare Advantage Open Enrollment Period: January 1 – March 31
During the Medicare Advantage Open Enrollment Period, you can switch to another health insurance plan or go back to your Original Medicare health insurance. If you switch Medicare Advantage plans or go back to Original Medicare (with or without a Medicare drug plan), your new coverage will begin on the first day of the month after your new plan gets your request for coverage.
Keep in mind, if you go back to Original Medicare you may not be able to buy a Medicare Supplement policy. Once you cancel a Medigap plan, the insurer has the right to deny coverage based on preexisting conditions. You only have a guaranteed issue right when you first qualify for Medicare.
When to Enroll in Medicare Part D
Medicare Part D (drug coverage) can be enrolled in three months before you turn 65 during the enrollment period. You can also enroll up to three months after you turn 65 years old.
Prescription Drug Coverage for the Disabled
If you are under 65 years old and receive Medicare due to a disability, you can enroll in Medicare Part D three months before the 25th month you receive Social Security or Railroad Retirement Board benefits. You can also enroll up to three months afterward.
Medicare Part D coverage will begin the first day of the 25th month you receive social security benefits.
In other words, you must receive 25 months of disability benefits from the social security administration or Railroad Retirement Board before you can receive Medicare Part D.
Annual Enrollment Period for Medicare Part D
The annual Enrollment Period (AEP) starts October 15 and ends December 7. Changes go into effect on January 1.
Changes you may want to make during the AEP are:
- Going from a Medicare Advantage Plan that offers drug coverage to one that does not offer it.
- Enroll in a Medicare Prescription Drug Plan.
- Switch to another Medicare Prescription Drug Plan.
- Disenroll from a Medicare prescription drug coverage plan.
Special Enrollment Period for Medicare Part D
A Special Enrollment Period (SEP) is available depending on eligibility:
- If you lived outside of the United States and recently moved back into the country.
- You have Medicare and Medicaid or Extra Help for your Medicare prescription coverage.
- The Extra Help assistance has been changed, so you need help with covering the costs of your prescription drugs.
- You’ve lost your prescription drug coverage.
- There’s been a change to your Medicaid benefits.
- There’s been a change to your employment situation or union.
- You joined a Pharmacy Assistance Program.
- You’ve moved outside of your service area.
- Your Medicare contract is ending or has ended.
- You’ve left the PACE program (Program of All-Inclusive Care for the Elderly).
- You are either moving into or moving out of a nursing facility or long-term care facility.
- You enrolled in the Medicare Advantage Plan.
- You want to choose a different Medicare plan.
- You’ve been affected by a weather-related emergency or major disaster.
- You have recently been released from prison.
- You received lawful presence status in the U.S.
Late Enrollment Penalty for Medicare Part D
The late enrollment penalty is an amount that is added to your Medicare drug coverage (Part D) monthly premium when you:
- Enroll in Medicare Part D after the Initial Enrollment Period.
- You don’t have Medicare drug coverage for 63 days or more.
- You do not have creditable prescription drug coverage for 63 or more days.
The late enrollment penalty is permanent and will have to be paid for as long as you receive Medicare drug coverage.
When Does Medicare Part D Start?
Medicare Part D plans begin the first month after you enroll on the first day of the month. If you sign up for Medicare Part D coverage on January 20, your coverage will begin on February 1.
Medicare Supplement Insurance (Medigap)
Medigap fills the gaps in Original Medicare to provide full coverage for those who need it. Original Medicare pays for a lot of health care services, but not all of them. The medical insurance provided by Medigap can help with the costs of:
- A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share....
- Health care services when traveling outside of the United States
When to Buy a Medigap Policy
You can purchase a Medigap policy during your six-month Medigap Open Enrollment Period. This period starts the month you turn 65 years old and have Medicare Part B. It’s possible to buy a Medigap policy after this time, but they are usually more expensive.
Need Help Enrolling In A Medicare Health Plan?
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Citations & References
- Part A & Part B sign up periods | Medicare
- Your Medicare card | Medicare
- Contact Social Security | SSA
- Medicare Benefits | SSA
- The United States Social Security Administration
- CMS 40B | CMS