What You Need To Know
Decide how to get your Medicare
If you join a Medicare Advantage Plan, you can’t use Medicare Supplement Plan (Medigap) to pay for out-of-pocket costs you have in a Medicare Advantage Plan. If you already have a Medicare Advantage Plan, you can’t be sold a Medigap policy. You can only use a Medigap policy if you disenroll from your Medicare Advantage Plan and return to Original Medicare.
- You may be able to save money or have other choices if you have limited income and resources.
- You may also have other coverage, like employer or union, military, or veterans’ benefits.
You can get personalized health insurance counseling at no cost to you from your local State Health Insurance Assistance Program (SHIP).
Medicare Part A
Coverage for hospital inpatient care
Medicare Part A is hospital insurance that is provided by the government.
Part A (Find more detailed information about Medicare Part A)
- Covers inpatient care in hospitals or a limited stay in a skilled nursing facility
- Covers hospice and home healthcare
Medicare Part B
Coverage for doctors’ services and outpatient care
Medicare Part B is optional medical insurance that is provided by the government.
Part B (Find more detailed information about Medicare Part B)
- Covers doctors’ services, hospital outpatient care, and home healthcare
- Covers some preventive health services
Parts A and B together make up Original Medicare. Parts A and B cover much of the medical care you need, but not all of it. That’s why most people with Medicare carry additional Medicare coverage from a private insurance company – Parts C and D.
Part C- Medicare Advantage Plans
- Include Part A, Part B, and, in many cases, Medicare prescription drug coverage (Part D).
- Plans are run by Medicare-approved private insurance companies, include additional benefits and usually reduce out-of-pocket expenses.
- Out-of-pocket expenses include hospital and medical deductibles and coinsurance.
Part D- Prescription Drug Plans
Part D (Find more detailed information about Medicare Part D)
- Helps cover the cost of prescription drugs.
- Plans run by Medicare-approved private insurance companies and may be purchased as stand-alone Prescription Drug plan (PDP), or as part of Medicare Advantage plan that include prescription drug coverage.
When Can You Enroll?
Some people get Part A & Part B automatically
- You are already getting benefits from Social Security or the Railroad Retirement Board (RRB)
- You are UNDER-65 AND Disabled
- You have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gherig’s disease)
- You live in Puerto Rico and get benefits from Social Security or the RRB
If you get Medicare automatically
If you’re automatically enrolled, you’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability.
Some people need to sign up for Part A & Part B
You need to sign up for Part A and Part B if:
- You aren’t getting Social Security or Railroad Retirement Board benefits (for instance, because you’re still working).
- You qualify for Medicare because you have End-Stage Renal Disease (ESRD).
- You live in Puerto Rico and want to sign up for Part B.
How to sign up for Part A & Part B
- Apply online at Social Security.
- Visit your local Social Security Office.
- Call Social Security at 1-800-772-1213.
- If you worked for a railroad, call the RRB at 1-877-772-5772.
You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans.
Don’t want Part B?
If you don’t want Part B, follow the instructions that come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.
When can you sign up for Part A & Part B?
For example, if you’re eligible when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
2.) Between January 1–March 31 each year (General Enrollment Period)
If you didn’t sign up for Part A and/or Part B when you were first eligible, you can sign up during the General Enrollment Period between January 1–March 31 each year.
Your coverage will start July 1. You may have to pay a higher premium for late enrollment (See below for details)
3.) Special circumstances (Special Enrollment Periods)
If you’re covered under a group health plan based on current employment, you have a Special Enrollment Period to sign up for Part A and/or Part B any time as long as you or your spouse (or family member if you’re disabled) is working, and you’re covered by a group health plan through the employer or union based on that work.
You also have an 8-month Special Enrollment Period to sign up for Part A and/or Part B that starts the month after the employment ends or the group health plan insurance based on current employment ends, whichever happens first.
Usually, you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period.
COBRA and retiree health plans aren’t considered coverage based on current employment. You’re not eligible for a Special Enrollment Period when that coverage ends. This Special Enrollment Period also doesn’t apply to people with End-Stage Renal Disease (ESRD).
You may also qualify for a Special Enrollment Period for Part A and Part B if you’re a volunteer, serving in a foreign country.
Part A late enrollment penalty
If you were eligible for Part A for 2 years but didn’t sign up, you’ll have to pay the higher premium for 4 years. Usually, you don’t have to pay a penalty if you meet certain conditions that allow you to sign up for Part A during a .
Part B late enrollment penalty
If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.
Usually, you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.
If you have limited income and resources, your state may help you pay for Part A, and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.
Your initial enrollment period ended September 30, 2016. You waited to sign up for Part B until the General Enrollment Period in March 2017. Your Part B premium penalty is 20%. (While you waited a total of 30 months to sign up, this included only 2 full 12-month periods.)
Mr. Green’s 65th birthday is July 20, 2016. If he signs up for Medicare in April, May, or June, his coverage will start on July 1, 2016.
If your birthday is on the first day of the month, your coverage starts the first day of the prior month.
Mr. Kim’s 65th birthday is July 1, 2016. If he signs up for Medicare in March, April, or May, his coverage will start on June 1, 2016.
When will your Medicare coverage start?
|If you sign up for Part A/ B in this month:||Your coverage starts:|
|The month you turn 65||1 month after you sign up|
|1 month after you turn 65||2 months after you sign up|
|2 months after you turn 65||3 months after you sign up|
|3 months after you turn 65||3 months after you sign up|
|During the January 1–March 31 General Enrollment Period||July 1|
How To Get Drug Coverage
Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.
To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
2 ways to get drug coverage
- Medicare Prescription Drug Plan (Part D). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
- Medicare Advantage Plan (Part C) (like an HMO or PPO) or otherMedicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance)and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.