Jane Dotson
Medicare is the United States' federal health insurance program for people aged 65 or older. People under 65 may be eligible for Medicare if they have permanent kidney failure, end-stage renal disease, or receive disability benefits. Signing up for Medicare for the first time depends on whether you start receiving retirement or disability benefits from Social Security before turning 65. If you are 65 or older, you can enroll online for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you live in Puerto Rico or outside the U.S., you will need to sign up for Part B, as it is not provided automatically.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicare? | People aged 65 or older. People under 65 may be eligible if they have permanent kidney failure, a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's disease). |
| When to enroll | During the Initial Enrollment Period, which begins 3 months before turning 65 and ends 3 months after the month you turn 65. |
| How to enroll | Enroll online for Parts A and B, or Part A only. If you already have Part A, you can sign up for Part B only. |
| Enrollment considerations | If you live in Puerto Rico or outside the U.S., you need to sign up for Part B. You get Part A automatically. If you don't sign up for Part B within 3 months of turning 65, you may have to pay a late enrollment penalty. |
| Additional considerations | If you have other health insurance or drug coverage, consult your benefits administrator before switching. If you live in another state for part of the year, check if your plan covers you there. |
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What You'll Learn
Understanding Medicare Parts A and B
Medicare is health insurance for people aged 65 or older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig's disease). Some people get Medicare automatically, while others have to sign up for it—it depends on whether you start receiving retirement or disability benefits from Social Security before turning 65.
Medicare Part A and Part B are often referred to as "Original Medicare". Part A is hospital insurance, which covers inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. You get Part A automatically once you start receiving benefits from Social Security or the Railroad Retirement Board.
Part B is medical insurance. Unlike Part A, you need to sign up for Part B. If you don't sign up within 3 months of turning 65 or within 3 months after your Part A starts, you might have to wait and pay a monthly late enrollment penalty. You can only sign up for Part B at certain times. You'll get Part B automatically after receiving disability benefits for 24 months.
You can sign up for Part A and Part B through Social Security, either online or by mail. This allows you to make both retirement and Medicare choices and withhold any premiums from your benefit payments. You can also choose to delay Part B if you're already covered through an employer group health plan.
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Eligibility and enrolment periods
Eligibility and Enrollment Periods
Medicare is a health insurance program for people aged 65 or older. If you are under 65, you may still be eligible for Medicare if you have permanent kidney failure, End-Stage Renal Disease (ESRD), receive disability benefits, or have Lou Gehrig's disease (ALS). If you have a spouse, your eligibility may also depend on their insurance coverage.
If you are 65 or older, you can enroll in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) through Social Security. You can enroll online or by contacting your Social Security Office. The Initial Enrollment Period begins 3 months before you turn 65 and ends 3 months after the month you turn 65. If you miss this 7-month window, you may have to pay a late enrollment penalty.
If you are not yet ready to receive Social Security benefits at 65 because you are still working, you can still apply online for Medicare only. You may also be able to wait until you retire and sign up during a Special Enrollment Period.
If you have health insurance through your job or your spouse's job, you can sign up for Medicare:
- Any time while working and covered by the group health plan.
- Within 8 months of stopping work or the group health plan ending, whichever comes first.
This is the General Enrollment Period, and there may be a lifelong penalty for signing up during this time.
If you have Medicare Part A and Part B, you can only join, switch, or drop a Medicare Advantage Plan (Part C), other Medicare health plan, or Medicare drug plan (Part D) at certain times, known as enrollment periods. For example, if you join a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan or switch back to Original Medicare within the first 3 months of having Parts A and B.
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Medicare Advantage Plans (Part C)
Medicare Advantage Plans, also known as Part C or MA Plans, are offered by private companies approved by Medicare. These plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.
Medicare Advantage Plans may offer extra benefits, such as vision, hearing, dental, and health and wellness programs. Most include Medicare prescription drug coverage (Part D). These plans can be HMOs, PPOs, Regional PPOs, or Private Fee-for-Service plans.
Medicare pays a fixed amount every month to the companies offering Medicare Advantage Plans. However, you may still have to pay a separate monthly insurance premium for your Medicare Advantage Plan, in addition to your Part B premium. These plans may also have different out-of-pocket costs and rules for how you access services. For example, you may need a referral to see a specialist.
Medicare Advantage Plans can change their monthly premiums and benefits each year, so it's important to review the plan's details carefully before enrolling. To find out more about the specific terms and premiums for Medicare Advantage Plans in your area, you can contact your local insurance providers or Medicare directly.
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Prescription medication coverage (Part D)
Medicare is health insurance for people aged 65 or older. You may be eligible for Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig's disease). Some people get Medicare automatically, while others have to sign up for it.
If you are enrolling in Medicare for the first time, you will need to sign up for Part A (Hospital Insurance) and Part B (Medical Insurance). You will get Part A automatically once you start receiving benefits. You will need to sign up for Part B within 3 months of turning 65 or within 3 months after your Part A starts to avoid a monthly late enrollment penalty.
Now, let's focus on prescription medication coverage, also known as Medicare Part D:
Medicare Part D is private insurance that covers most prescription drugs. Original Medicare does not offer drug coverage, so you will need to join a separate plan that includes prescription medication coverage. There are two main ways to get Medicare drug coverage:
- Medicare Advantage Plan (Part C): This is a single plan that includes Part A, Part B, and Medicare drug coverage (Part D). You must have Part A and Part B to join a Medicare Advantage Plan, and you will typically get your drug coverage through this plan.
- Standalone Prescription Drug Plan (PDP): This is a separate plan that you can add to Original Medicare (Part A and Part B), a Medicare Supplement (Medigap) insurance plan, or a Medicare Advantage Plan without drug coverage.
When choosing a Medicare prescription drug plan, it is important to consider your specific needs. Build a list of the medications you take, and then estimate your drug costs for a particular plan based on your list. Some plans may offer different coverage levels, premiums, deductibles, and copayments. For example, during the Initial Coverage stage, you may pay a copay or coinsurance, while in the Catastrophic Coverage stage, the plan pays the full amount for Part D-covered drugs, with a $0 cost share.
You can also look for plans that offer cost savings when using preferred pharmacies or home delivery services, which may provide additional benefits and lower costs for your prescriptions.
Remember, Medicare prescription drug plans (Part D) cover drugs on the plan's drug list or formulary, as well as vaccines not covered by Medicare Part B and drugs commonly prescribed for Medicare beneficiaries. However, Part D plans generally do not cover drugs prescribed for anorexia, weight loss or gain, fertility, erectile dysfunction, cosmetic purposes, or hair growth.
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Medicare costs and penalties
Medicare is health insurance for people aged 65 or older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig's disease).
Some people get Medicare automatically, while others have to actively sign up. If you want Part B, you need to sign up for it within 3 months of turning 65 or within 3 months after your Part A starts. If you don't, you might have to wait to sign up and pay a monthly late enrollment penalty. The late enrollment penalty for Part B is an extra 10% premium for each year you waited.
If you delay signing up for Medicare, you may need to pay extra. These added costs are called late enrollment penalties. For Part A, most people don't pay any premium. However, if you have to buy Part A because you don't qualify for premium-free Part A, and you don't buy it when you're first eligible for Medicare, your monthly premium may go up by 10%. You'll have to pay the penalty for twice the number of years you didn't sign up.
For Part D, which covers drug costs, there is also a late enrollment penalty if you sign up late. The penalty amount is calculated by multiplying 1% of the "national base beneficiary premium" by the number of full, uncovered months you were eligible but didn't join a Medicare drug plan or have creditable prescription drug coverage. This penalty amount is added to your monthly premium and may change each year.
If you have limited income and resources, you may qualify for a program called Extra Help, which assists with Medicare Part D costs, including late enrollment penalties.
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Frequently asked questions
Medicare is health insurance for people aged 65 or older. You may be eligible for Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's disease).
You can enroll in Medicare for the first time through Social Security. If you are 65 or older, you can enroll online for Parts A and B, or Part A only. You can delay Part B if you're already covered through an employer's group health plan. If you live in Puerto Rico or outside the U.S., you will need to sign up for Part B.
The Initial Enrollment Period to sign up for Medicare begins 3 months before you turn 65 and ends 3 months after the month you turn 65. You may have to pay a penalty if you miss your Initial Enrollment Period.
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