Medicare Enrollment & Changing Your Medicare Plan – What You Need To Know
Medicare was created for America’s seniors, those over the age of 65. But it’s evolved since then to cover younger people with certain disabilities, too. Wondering how to enroll in Medicare or change your coverage once you’ve got a plan? You’re in the right place.
Here’s what you need to know about Medicare enrollment.
Medicare in Four Parts
Medicare actually comes in four parts: A, B, C and D. Here’s a quick rundown of each part, so you know your options when you’re ready to enroll (or change your coverage):
- Medicare Part A is hospital coverage. It covers inpatient hospital care and skilled nursing facility care. Most people don’t pay a monthly premium for this coverage, but it does include deductibles and coinsurance when you receive care.
- Medicare Part B covers medically necessary care, such as flu shots, doctor’s visits, outpatient surgery, and other types of services. Everyone pays a premium for Part B, along with a 20% coinsurance rate for medical services.
- Medicare Part C is also known as Medicare Advantage. This is the private portion of Medicare, sold by private companies but regulated by the federal government. By law, Advantage plans cover everything that Original does (Parts A and B together). Beyond that, these plans have flexibility in benefits, typically covering extras that Original doesn’t, like prescription drugs, dental and vision benefits, hearing aids and more. Premiums and cost sharing varies.
- Medicare Part D covers prescription drugs. This is also a private portion of Medicare, sold by individual companies. It’s only available to people with Original Medicare. Costs vary with this portion as well.
When to Apply for Medicare
You may not have to actively apply for Medicare depending on your situation. Some people get automatically enrolled into the program. This includes:
- People who already get Social Security or Railroad Retirement Board benefits. Assuming you’ve been getting these benefits for at least 4 months before turning 65, you’ll be auto-enrolled into Medicare the month you turn 65. If your birthday is the first of the month, your benefits actually start the first day of the previous month.
- Those receiving disability benefits from Social Security or the Railroad Retirement Board. If you get disability benefits, then you get automatically enrolled into Medicare after 24 months of disability. That means you’ll be auto-enrolled into Parts A and B on the 25th month of your disability payments.
- People with ALS (Lou Gehrig’s disease). If you have ALS, you’ll be automatically enrolled into Parts A and B the same month you start receiving disability payments.
For everyone else, including people with end-stage renal disease (ESRD), enrollment is not automatic. This means you will need to take action once you’re eligible to sign up for Medicare.
- Age 65+ enrollment. Medicare eligibility starts at age 65. But you actually have 7 months to enroll in Medicare when you’re first eligible: 3 months before the month you turn 65, the month you turn 65, and 3 months after that month. So if your birthday is February 9th, you could enroll anytime from November 1st through June 30th. This is called your Initial Enrollment Period, and it’s important. If you miss it, you may have to pay fees for your Medicare coverage when you sign up later.
- ESRD enrollment. If you’re under 65 with end-stage renal disease, you have to apply for Medicare based on your ESRD diagnosis. And as of 2021, you can also join a private Medicare Advantage plan without any restrictions.
Other Enrollment Periods
The Initial Enrollment Period is the best time to sign up for Medicare when you’re first eligible. You won’t risk paying late fees if you sign up later. But there are other enrollment periods for Medicare:
- General Enrollment Period. Runs from January 1st through March 31st. This is when you can sign up for Medicare Part A and/or Part B if you didn’t enroll when you were first eligible. Coverage takes effect on the first of the month after the month in which you enroll. You may pay a late enrollment penalty for waiting until this period to sign up initially.
- Medicare Open Enrollment Period. Runs from October 15th through December 7th. This is the one time of year when everyone with Medicare (Original or Advantage) can change their coverage for the next year. Coverage takes effect on January 1st.
- Medicare Advantage Open Enrollment Period. Runs from January 1st through March 31st but only for current Advantage members. If you already have an MA plan, you can use this period to make a one-time change to your coverage. That change takes effect on the first of the month after the new plan gets your request for coverage.
You may also qualify for a special enrollment period for various other circumstances, such as when you’re still working at age 65 and opt not to enroll in Part B when you can. If you’ve got specific enrollment questions, reach out to Social Security or Medicare to make sure you’ve got the right info in your case.
How to Sign Up for Medicare
You have options for enrolling in Medicare. You can:
- Apply online. You can use the Social Security website to enroll in Original Medicare (if you aren’t automatically enrolled). But if you want the benefits of a private health plan under Medicare Advantage or a standalone Part D drug plan, you can enroll online using a private marketplace (like ours) or directly through an individual insurance carrier’s website.
- Call an agent. You can call us at 1-800-485-6202 to talk to a licensed insurance agent about your needs, and our agents can help you explore your Medicare options.
- Visit a local Social Security office or call the Social Security Administration. If you need help enrolling in Original Medicare, call the Social Security Administration at (800) 772-1213. Railroad retirees should call (877) 772-5772. You could also make an appointment and visit a local Social Security office in person for specific questions about Original Medicare.