As you approach your 65th birthday, the topic of Medicare may begin popping up more and more often. For those who are new to it, Medicare can seem to be overwhelming and complicated, both to understand and to enroll in.
Although many people may be first eligible for Medicare at age 65, some may choose not to enroll at that time. If you or your spouse are currently employed and covered by a group health plan at work, it may be to your advantage to apply for Medicare when your employment ends. This may be particularly applicable if your employer has 20 or more workers. If you believe this situation may apply to you, we encourage you to contact your human resources department.
For those who are approaching, or even helping others who are approaching, the age of eligibility for Medicare enrollment we hope that the following will help you begin to understand the broad strokes of Medicare and Medicare enrollment.
What are the key components that make up Medicare Coverage? / Know Your Players
Part A
Medicare Part A, is the component of your medical coverage which primarily focuses on hospital care. Generally, this will include services such as: inpatient hospital stays, some skilled nursing care (following a hospital visit), hospice care and some home health care services[i]. This also does not necessarily cover the entire cost of these services and you will likely still have to pay some co-insurance, co-payments and/or deductible.
Part B
Medicare Part B, is the component which you will likely utilize more often. Put generally, it covers medical services. More specifically it is responsible for providing coverage for services such as: doctor visits, other health care provider services, outpatient care, home health care, durable medical equipment, laboratory tests and some preventative services[ii].
Part C
Medicare Part C, more commonly Medicare Advantage, at its most basic provides the coverage of Parts A and B, in one plan and is substitute rather than supplement to those parts. Medicare Advantage will allow you to elect one plan from a third-party provider which will provide you the coverage for hospital and medical services, and may have options for additional prescription drug, dental, vision and/or hearing coverage[iii]. While Medicare Advantage may run up higher premiums than original Medicare Parts A/B/D, it offers the option to customize certain aspects of your insurance coverage that may be more particular to your needs.
Part D
Part D is an optional coverage that is specifically for your prescription drugs and is not available unless you have already enrolled in Part A and/or Part B coverage[iv]. Depending on any pre-existing conditions and regular medications you take, this optional feature may play a very important role in your coverage. When considering whether to enroll in Part D, you may wish to visit the Medicare website to review what plans are available even if you intend on enrolling over the phone. By entering your zip code, selecting your pharmacy, and entering in your prescriptions Medicare will provide you will a list of eligible prescription drug plans and allow you to view monthly and annual estimated costs for the plan, and the medications at your selected pharmacy[v].
Medigap
Medigap is another optional coverage, also known as a Supplemental Plan to help cover the costs of healthcare[vi]. In a majority of cases Medicare Insurance will not cover the entirety of your health expenses, which is where your Medigap coverage comes to play. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like co-payments, co-insurance and deductibles. Medigap must be purchased directly from the providers andis separate from Medicare and your Medicare coverage. If you are enrolled in a Medicare Advantage plan, you may not need a Medigap plan. vii
When do you enroll in Medicare? / Know Your Timing
If you are already receiving Social Security Income or Benefits, you may be enrolled automatically for Medicare, Parts A and B, but for everyone else reaching 65, this is an important opportunity for you to enroll.
NOTE: It is important to know that delays in enrollment may result in penalties paid out in premiums, and/or a loss of health insurance from another provider.
Initial Enrollment Period
Your first opportunity to enroll in Medicare occurs three calendar months prior to your 65th birthday and ends three calendar months afterwards (e.g. if your date of birth is 01/2020, then you may begin enrolling 10/2019 until 04/2020). This seven-month time period is known as an Initial Enrollment Period (IEP). This occurs only the one time when you turn 65.
During your initial enrollment period, you can enroll in Medicare Parts A, B, C and D. viii Once again, please note that not enrolling in Parts A, B and D at this time may result in higher premiums when you enroll later. It may also be in your benefit to use this time to sign up for a supplemental, or Medigap, plan as well.viii
General Enrollment Period for Parts A and B
If you do not enroll in Medicare Parts A or B during your Initial Enrollment Period, then your next available opportunity to enroll may occur with the General Medicare Enrollment Period (GEP) which runs from January 1st to March 31st, annually. Enrolling during a GEP may cause a gap in coverage, as your coverage will only start on July 1st of the year that you enroll.ix You may enroll for Part D or Medicare Advantage April through June after you have signed up for Parts A and B during the GEP.x Note: if you are eligible for free Part A, as many people are, you may enroll for Part A any time during or after your initial enrollment period.
Annual Enrollment Period for Part D and Medicare Advantage Plans
Extending from October 15th to December 7th, annually this is a time primarily to make changes to your Medicare Part D and/or Part C Medicare Advantage plans if you would like to do so. You may change Medicare Advantage Plans or switch from original Medicare to a Medicare Advantage Plan or vice versa. Similarly, you may choose to enroll in a Part D prescription drug plan if you have not done so already. You may also make changes to other aspects of your current plan to add, remove or substitute coverage.xi
Medicare Advantage Open Enrollment Period
This is another opportunity to enroll in or switch Medicare Advantages Plans. If you missed the annual enrollment period or want to redo your selection, you may enroll during the Medicare Advantage Open Enrollment Period which runs from January 1st to March 31st. You may also switch Medicare Advantage Plans or drop Medicare Advantage and change to original Medicare. However, you may not switch from original Medicare to a Medicare Advantage Plan.xii
Special Enrollment Period for Certain Individuals
This enrollment period can be used If you did not enroll in Medicare Part B when you were first eligible because you were covered by your own or your spouse’s current employer or union group health plan. If you qualify for a special enrollment period, you have up to eight months from the date your coverage ends to enroll in Part B without paying a late enrollment penalty.xiii
Creating Your Enrollment Game Plan
As you can imagine, enrolling for Medicare may not be as simple and straightforward as one would hope.
Very likely you will need to do a bit of research (sometimes more than a bit) and seek out help and advice from your healthcare provider, or an advisor, possibly both.
For this reason, it may be in your best interest to familiarize yourself with the process to enroll, your options and what you plan to enroll in prior to even the beginning of your IEP. Seven months may seem like a long time, but not knowing what to expect may cause delays in addition to those delays inherent to the process. Starting early will allow you to be prepared when the time finally comes to enroll so you don’t miss any deadlines and will help make the process less stressful.
Here are some tips we hope will be helpful:
- Start earlier than early – You may not be able to enroll until your IEP starts, but that doesn’t mean you can’t look. Familiarize yourself with your options and the steps involved so you don’t get surprised later.
- Calendar in Important Dates – Time flies! Make sure to put important dates such as the start and end time for your Initial Enrollment Period, General Enrollment Period (even if you don’t anticipate using it), and Annual Enrollment Period. If you qualify for a Special Enrollment Period, add this date to your calendar. If you use multiple calendars, make sure to put it in all of them; you don’t want to miss an important deadline because you checked the calendar on your fridge instead of the one on your phone that day.
- Speak with your Healthcare Provider and/or Advisor – The options may seem overwhelming and you may be tempted to cut costs by delaying enrollment in certain or all parts of Medicare. Speaking with health, or other advisors, who are familiar with your situation may lend some insight about certain pitfalls or likelihoods that you may not anticipate on your own. You may also want to use this opportunity with your healthcare provider to inquire about what Medicare plans they accept if you plan on retaining them after you enroll.
- Contact us – Upon request we can provide some resources and assistance that can help to guide you through the process of enrolling including links to the pages to enroll online, numbers to call to enroll over the phone, resources who can assist you in determining what plans to enroll in, and guidance so you know what to expect.
Enrolling in Medicare is a complicated decision. It is a minefield for mistakes. Many people have ended up paying more than is necessary, or even worse, not having essential health coverage when it may be needed. We encourage you to seek advice before you make your decisions. If you have questions about Medicare and Medicare enrollment, or would like to know more about the rules and process for enrollment, please do not hesitate to contact our office. Remember, we are here to help!
CRN-3627882-061021
[i] https://www.ssa.gov/benefits/medicare/
[ii] ibid
[iii] ibid
[iv] https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage
[v] https://www.medicare.gov/plan-compare/#/?lang=en&year=2021
[vi] https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
viii https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods and https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan
ixhttps://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods
xhttps://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan
xi ibid
xii ibid
xiii https://www.ssa.gov/benefits/medicare/