Medicare Enrollment & Changing Your Medicare Plan – What You Need To Know
Medicare is a program run by the federal government that is designed to provide people who are 65 years of age or older, certain younger people who suffer from disabilities and people who suffer from End Stage Renal Disease with health insurance coverage. There are different types of Medicare coverage, and the coverage type that an individual qualifies for depends upon his or her individual circumstances.
Types of Medicare coverage
There are four primary types of Medicare coverage, each of which is designed for different groups of people.
- Medicare Part A – Medicare Part A is coverage that is referred to as the hospital insurance coverage Medicare. It covers services such as inpatient hospital stays, hospice care, nursing facility care and some types of home healthcare.
- Medicare Part B – Medicare Part B is coverage that is known as the medical insurance coverage Medicare. This type of coverage covers some types of doctors’ services, medical supplies, outpatient care and preventive services.
- Medicare Part C – Medicare Part C plans are Medicare Advantage (or MA) plans offered by private companies that have contracted with Medicare to provide individuals with all of their Medicare Part A and Part B benefits. Types of organizations that cover Medicare Advantage plans include preferred provider organizations, private fee-for-service plans and health maintenance organizations.
- Medicare Part D – Medicare Part D is the type of Medicare that pays for an individual’s prescriptions. This type of Medicare is also offered by private insurance companies and other private companies approved by Medicare. This coverage adds prescription drug coverage to certain types of Medicare plans, including original Medicare plans, Medicare Cost Plans and Medicare Fee-for-Service plans.
When to apply for Medicare
Generally, the basic rule for when individuals should apply for Medicare is when they turn 65 years of age. An open enrollment period for Medicare begins three months prior to the month that individuals turn 65; that enrollment period ends three months after the month that they turn 65.
Essentially, individuals have a seven-month open enrollment window during which they can apply for Medicare. The manner in which individuals apply is influenced by their individual circumstances, however.
- People already receiving Social Security benefits or benefits from the Railroad Retirement Board can expect to be automatically enrolled in Medicare on the first day of the month that they turn 65. They can expect their Medicare cards to be mailed to them three months before the day that they turn 65.
- People with End Stage Renal Disease will also qualify for Medicare benefits, but will have to apply for coverage.
- People who are receiving disability benefits from the Social Security Administration (SSA), due to some other qualifying disease, will first become eligible for Medicare benefits on the first anniversary of receiving disability checks. They can begin to enroll on the 25th month.
Although certain people will automatically be enrolled in Medicare, they still have some enrollment decisions to make, just like the rest of the newly eligible Medicare recipients. For instance, they don’t necessarily have to enroll in Medicare Part B, which is the type of Medicare that requires them to pay a monthly premium. However, those who don’t enroll in Medicare Part B when they are first eligible, but choose to enroll at a later time, may have to pay a higher monthly premium down the road for their coverage.
An additional decision that a Medicare recipient should make is whether they want to take on Medicare Part D, or prescription drug coverage, which also may require a monthly premium cost. Or, they may prefer to forgo Original Medicare coverage (Part A and B) for a Medicare Advantage (Medicare Part C) plan through a private carrier.
- People who aren’t already receiving Social Security benefits will not have their enrollment happen automatically. Rather, they have to take the initiative and sign up for Medicare Part A on their own. It is in their best interest to do so, even if they are still covered under a group health plan, but aren’t working.
- For people who are over 65 and didn’t sign up for Medicare during their initial enrollment window, there is an open enrollment window each year, from January 1 to March 31. During this time, they may apply for benefits. If granted benefits, they will begin on July 1.
- If a person wishes to drop their Original Medicare coverage to enroll in a Medicare Advantage plan, they can do so during the open enrollment period, which runs from October 15 to December 7 of each year.
- If a person does not enroll in Medicare Part D when first eligible, they can enroll during the open enrollment period, which also runs from October 15 to December 7 of each year.
People who get Medicare automatically
The following people can expect to receive their Medicare coverage automatically and don’t have to worry about applying:
- People who already receive Social Security benefits or Railroad Retirement Board (RRB) benefits
- People under 65 who have a disability
- People who have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
- People who live in Puerto Rico and receive benefits from the SSA or the RRB.
People who have to sign up for Medicare
The following types of people can expect to have to sign up for the Medicare benefits, since they won’t be enrolled automatically:
- People who are still working and don’t receive SSA or RRB benefits
- People who have End Stage Renal Disease
- People who live in Puerto Rico and want to sign up for Part B after they’ve automatically received Part A.
Ways to sign up for Medicare
There are numerous ways to sign up for Medicare, including the following:
- Apply online. An increasing number of people are beginning to apply for their Medicare benefits online. It takes approximately 10 minutes to apply for Medicare online, and once the application is submitted electronically, that’s all there is to it. There aren’t any forms to sign, and either the SSA (if applying for Original Medicare) or the private insurance carrier (if applying for an MA plan) will contact individuals if they require additional information. Applicants may also save their applications and finish filling them out at a later date if they wish. They can check the status of their applications online when they apply online. You can apply directly for a Medicare Advantage plan by using this website.
- Visit a local Social Security office to enroll in Original Medicare. People who require assistance with their applications might prefer to visit their local Social Security offices and fill out their applications that way.
- Call the Social Security Administration at (800) 772-1213. For people who worked at a railroad, call (877) 772-5772.
How to discontinue Medicare Part B
Sometimes, when individuals are automatically enrolled in Medicare, they are automatically signed up for Medicare Part A and Medicare Part B. Medicare Part B is the one that requires individuals to pay a premium, and not every person may want Medicare Part B coverage. Those who don’t need it or simply don’t want to have to pay the premiums can discontinue their automatic Medicare Part B coverage. They can simply follow the instructions that came with the Medicare Part B cards that they received in the mail upon their automatic enrollment.
The provided instructions advise individuals on how to send their cards back and discontinue their Medicare Part B coverage. Individuals who keep the cards will end up being charged for Medicare Part B premiums. They must pay those premiums every month for as long as they are signed up for Medicare Part B, no matter whether they use that coverage or not. People who were enrolled for Medicare Part B at a Social Security office and want to end their coverage can contact their Social Security Administration offices for instructions on how to submit a signed request. Then, their Medicare Part B coverage will end on the first day of the month after the Social Security Administration got their requests.
Applying for Medicare coverage can seem confusing to those who’ve never done it before. However, by knowing the different types of coverage, as well as whether or not they will be automatically enrolled or not, the process is made simpler. Those who do have to manually apply for their Medicare coverage have several different application methods to choose from, including applying online or in person at their local Social Security Administration offices.