Are you turning 65? Maybe you’ve already enrolled in Medicare and have additional questions? You’ve come to right place. Medicare can be confusing, but it doesn’t have to be. Here’s your guide to help you along the way. Let’s start with the basics.
Medicare is a federal health insurance program for people in the U.S. who are 65 and older that includes younger people with disabilities. Medicare differs from the Medicaid program, which offers health and other services to eligible low-income people of all ages.
You’re entitled to Medicare if you’re at least 65 and a U.S. citizen, or a permanent legal resident for the past five years. Medicare also covers some disabled people under age 65. People who receive Social Security disability insurance usually become eligible for Medicare after a two-year waiting period, although those with end-stage renal disease (permanent kidney failure) and amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease) can be eligible immediately.
If you’re receiving Social Security benefits when you turn 65, you will be enrolled automatically in Medicare Part A, which covers hospital costs, and Part B, which covers doctor visits. If you want Medicare Part D, which covers prescription drug costs, you’ll need to enroll yourself — that’s not automatic. If you’re not receiving Social Security benefits, you’ll sign up through the Social Security Administration website. You typically should do so in the seven-month window around your 65th birthday (which includes the three months before the month you turn 65, your birthday month, and the three months after your birthday month) to avoid permanent penalties. If you want supplemental coverage (Medigap aka Medicare Supplement or Medicare Advantage), you would sign up during the same seven month enrollment period. The private insurers to provide Medigap and Medicare advantage plans are required to take you, if you sign up during that period. Otherwise, they can turn you down.
If you’re not enrolling for the first time, changes can only be made in a 54 day window. This time period begins October 15 and ends on December 7. This is typically when people change supplements or switch from Medicare Advantage to a Medicare Supplement policy.
If you don’t sign up for Part A (if you have to buy it) and/or Part B when you’re first eligible, and you don’t qualify for a Special Enrollment Period, you may have to wait until the Medicare General Enrollment Period (from January – March 31) to enroll and coverage will start July 1 of that year. In most cases, you’ll have to pay a late enrollment penalty for as long as you have Part B if you sign up during the General Enrollment Period.
You don’t have to pay premiums for Medicare Part A if you or your spouse paid Medicare taxes for at least 10 years. (Medicare taxes are part of the payroll taxes deducted from most working people’s paychecks. You can see if you qualify by checking your Social Security statement, which is available through the Social Security website.) Otherwise, eligible people pay monthly premiums for Part A of up to $437 each month. The other parts of Medicare, which cover things like doctor visits and prescription drugs, require monthly premiums.