Orlando Harmon
Medicare is the United States' federal health insurance program for people aged 65 or older. It is also available for those under 65 who have permanent kidney failure, receive disability benefits, or have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). To sign up, you must first determine whether you need to enroll in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) or just Part B. If you are 65 or older, you can enroll online, while those under 65 must apply for benefits and choose whether they want Part B. Additionally, if you live in Puerto Rico or outside the U.S., you will need to sign up for Part B as you will receive Part A automatically. Once you have enrolled in Part A and/or Part B, you can consider supplemental insurance, known as Medigap, to help cover out-of-pocket costs. Medigap policies are sold by private insurance companies and can be purchased during your Medigap Open Enrollment Period, which lasts for six months from the start of your Medicare Part B coverage when you turn 65 or older.
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What You'll Learn
Enrolling in Medicare Parts A and B
Medicare is the health insurance program for people aged 65 or older in the United States. It is also available to those with certain disabilities or permanent kidney failure.
Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) are available to US citizens or lawfully admitted aliens who have been residing in the country for at least five continuous years. Most people get Part A for free, but some have to pay a premium. If you pay a premium for Part A, you can choose to drop it, but you cannot drop Part A if you receive it for free.
Individuals who are already receiving Social Security or Railroad Retirement Board (RRB) benefits at least four months before becoming eligible for Medicare are automatically enrolled in premium-free Part A and Part B. People who are automatically enrolled can choose whether they want to keep or refuse Part B coverage. Those who are not automatically enrolled must contact the Social Security Administration to file an application to enroll.
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 are already covered through an employer's group health plan. If you already have Part A and did not previously sign up for Part B, you can sign up for Part B only.
To sign up for Part A or Part B, you will need to contact the Social Security Administration (SSA). You will need to provide your Medicare Number and your Part A and/or Part B coverage start dates, which can be found on your Medicare card. You can also apply online at Social Security, which is the fastest way to sign up and get any financial help you may qualify for.
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Signing up for Part B if you live outside the US
If you live outside the US, you may want to get Medicare Part B if you plan to return to the US to get health care services. You can get help signing up for Part B if you live in a foreign country. You will receive a welcome package with your Medicare card, which has your Medicare Number. You will need your Medicare Number to create your secure Medicare account on Medicare.gov, join a plan, or buy supplemental insurance.
To sign up for Part B, fill out the Application for Enrollment in Medicare Part B (CMS-40B) and send the completed form to your local Social Security office by fax or mail. If you or your spouse worked for a railroad, visit RRB.gov, or call the Railroad Retirement Board at 1-877-772-5772. TTY users can call 1-312-751-4701.
If you live overseas and don't qualify for free Part A, and you sign up for Medicare later than age 65, you get a three-month window once you move back to the US to enroll, without late penalties. If you plan to travel back and forth between the US and your home abroad, it can make sense to be enrolled in Medicare if you would otherwise have no coverage.
In certain situations, Medicare offers different enrollment periods for a limited time, allowing you to sign up without penalties during these windows. You can see if you qualify for a Special Enrollment Period on Medicare.gov. You can also call the Medicare helpline at 1-800-MEDICARE (1-800-633-4227) for assistance.
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Understanding Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance, also known as Medigap, is extra insurance that can be purchased from a private health insurance company. It helps to cover out-of-pocket costs in Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance). It's important to note that Medigap is only available to those with Original Medicare, and you must have Part A and Part B before you can buy a Medigap policy.
During the "Medigap Open Enrollment" period, which lasts for 6 months starting from the first month you have Medicare Part B and are 65 or older, you can enrol in any Medigap policy without being denied coverage due to pre-existing health conditions. This is a one-time opportunity, so it's important to carefully consider your options before making a decision. After this period, purchasing a Medigap policy may be more difficult or expensive.
There are 10 different types of Medigap plans offered in most states, labelled as Plan A through D, F, G, and K through N. The specific benefits and coverage can vary between plans, but all Medigap policies with the same letter offer the same basic benefits, regardless of the insurance company or your location. Price is typically the only difference between plans with the same letter sold by different companies. Some Medigap policies also offer additional benefits not covered by Original Medicare, such as coverage for travel outside the U.S. However, Medigap generally does not cover long-term care, vision, dental, hearing aids, private-duty nursing, or prescription drugs.
When choosing a Medigap policy, it's important to compare plans and review their coverage thoroughly. Check if the plan includes the benefits you need and covers your prescriptions. Additionally, consider the monthly premiums, deductibles, and estimated yearly costs for any medications you require. You can also contact your local State Health Insurance Assistance Program (SHIP) for free, personalized health insurance counselling to make an informed decision.
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Comparing Medigap policies and selecting a plan
When comparing Medigap policies, it's important to know that all Medigap policies are standardized, meaning policies with the same letter offer the same basic benefits regardless of the insurance company or location. The price is the only difference between plans with the same letter sold by different insurance companies. There are 10 different types of Medigap plans offered in most states, named by letters: A-D, F, G, and K-N.
Medicare publishes a booklet each year that includes a Medigap comparison chart, which allows you to compare plans side by side and see exactly which benefits each plan covers. For example, Plans C and F are the most comprehensive but also the most costly. Plans K and L show how much they'll pay for approved services before you meet your out-of-pocket yearly limit and Part B deductible. Plan N, on the other hand, requires copays for doctor and ER visits, resulting in lower premiums.
When selecting a Medigap plan, consider the following:
- Review what Medigap covers and compare plans side by side.
- Check if the plan covers your prescriptions and includes the benefits you need.
- Ask your doctors and pharmacies if they're in the plan's network.
- Review costs like monthly premiums, deductibles, and the estimated yearly costs for drugs you take.
- If you have other health insurance or drug coverage, talk to your benefits administrator before making any changes.
- If you live in another state for part of the year, check if the plan will cover you there.
Remember, you can only buy Medigap if you have Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance). You get a 6-month Medigap Open Enrollment period, starting the first month you have Medicare Part B and are 65 or older. During this time, you can enroll in any Medigap policy, and the insurance company cannot deny you coverage due to pre-existing health conditions. After this period, you may not be able to purchase a Medigap policy, or it may be more expensive.
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Joining a Medicare-approved plan
To join a Medicare-approved plan, you must meet the following requirements:
- Have Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- Live in the service area of the plan you want to join.
- Be a U.S. citizen or lawfully present in the U.S.
- Have your Medicare Number and your Part A and/or Part B coverage start dates (this information can be found on your Medicare card).
It is important to note that you can only join, switch, or drop a Medicare Advantage Plan (Part C) or other Medicare health plan at certain times, known as enrollment periods. If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you have the flexibility to make changes within the first three months of having Medicare Part A and Part B. You can either switch to another Medicare Advantage Plan (optionally with drug coverage) or revert to Original Medicare (with or without a drug plan).
Once you have chosen a plan, you can proceed with the enrollment process. You can either select "Enroll" for the plan you want to join at Medicare.gov/plan-compare, or contact the plan directly. You can reach out to them by phone or visit their website. Alternatively, you can request a paper form to fill out and mail back to the plan before the enrollment period ends.
Medigap policies are standardized, and in most states, they are named by letters, such as Plan G or Plan K. The benefits offered by each lettered plan remain consistent, regardless of the insurance company providing it. The price is the only differentiating factor between policies with the same letter sold by different companies. It is crucial to be vigilant about illegal practices by insurance companies and protect yourself when shopping for a Medigap policy. Review what Medigap covers and compare plans to make an informed decision.
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Frequently asked questions
You can sign up for Medicare Part A and Part B through Social Security. If you live in Puerto Rico or outside the U.S., you need to sign up for Part B. You can enroll online or by calling TTY +1 800-325-0778 if you're deaf or hard of hearing.
Yes, you need to be 65 or older to sign up for Medicare. If you're under 65, you may still be eligible if you have permanent kidney failure, receive disability benefits, or have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig's disease).
Medicare Supplement Insurance, or Medigap, is extra insurance that helps pay your share of out-of-pocket costs in Original Medicare. You can buy it from a private insurance company, but you generally need to have Part A and Part B first.
You can compare the benefits of each lettered plan and select the one that meets your needs. Remember to consider your current and future healthcare needs, as you might not be able to switch policies later. You can buy a Medigap policy from any licensed insurance company in your state that offers your desired plan.
The best time to buy a Medigap policy is during the Medigap Open Enrollment Period, which is a one-time, 6-month period that starts the first month you have Medicare Part B and are 65 or older. During this time, insurance companies cannot deny you coverage due to pre-existing health problems.
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