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New to Medicare
Many people who are new to Medicare feel confused. After all, any federal program that serves 60 million people is going to be complex. The sea of mailers insurance companies and brokers send to everyone approaching their 65th birthday can also feel overwhelming. We're here to help you make sense of it all.
When Can You Sign Up for Medicare
Medicare coverage is available to American citizens aged 65 or older. You may also qualify for Medicare before you turn 65 if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease). Most people qualify for Medicare based on their age.
Your Initial Enrollment Period (IEP) lasts for 7 months. It begins 3 months before the month you turn 65 and ends 3 months after your birth month. So, if you turn 65 on May 10, your IEP begins February 1 and ends on August 31.
How to Sign Up for Medicare
If you began collecting Social Security benefits at least 4 months before your 65th birthday, congratulations! You are automatically enrolled in Original Medicare (Parts A and B). Medicare will send your Welcome to Medicare packet 3 months before your birthday.
People who receive benefits from the Railroad Retirement Board (RRB) before they turn 65 are also automatically enrolled in Medicare. For more information, contact your local RRB office.
Everyone else needs to sign up for Medicare through the Social Security Administration (SSA).
Also, please note that if you live in Puerto Rico, you will not be automatically enrolled in Medicare Part B, even if you already collect Social Security benefits. To avoid late penalties, you need to sign up for Part B during your Initial Enrollment Period.
Signing Up for Medicare Through Social Security
Social Security works with the Centers for Medicare & Medicaid Services (CMS) to enroll people in Medicare.
You have three options to enroll in Medicare through Social Security.
Complete the online application: It takes less than 10 minutes and you don't have to worry about crowds, lines, or standard business hours.
Apply over the phone: You may call SSA toll-free at 1-800-772-1213 (TTY 1-800-325-0778). Availability is Monday through Friday from 7 AM to 7 PM.
Visit your local Social Security office: Use the Social Security Office Locator to find your local SSA office. You must call first to schedule an appointment.
Please note that the SSA closed local offices in March of 2020 due to the COVID-19 pandemic. As of November 2020, local offices are still closed. We always recommend calling before visiting your local Social Security office.
Are You New to Medicare and Have Employer Coverage?
Many people already have health insurance when they turn 65, typically thanks to an employer-sponsored group plan. If you have a group health plan through an employer – yours or your spouse's – your Medicare options vary depending on two things.
Is the covered employee actively working?
How many people does the company employ?
Your answers to these questions help determine whether Medicare would be the primary or secondary payer.
The first question may be the more important, because if you are not actively working, then the second question does not matter. Medicare is always considered the primary insurer when your current coverage is through COBRA or retiree insurance.
If you are still actively employed, then the primary vs. secondary question comes down to how many people your company employs. If the answer is "more than 20," then Medicare is the secondary payer. That means you qualify for a Special Enrollment Period (SEP) and may choose to delay Medicare enrollment without incurring late penalties.
If your company employs fewer than 20 people, then Medicare is the primary payer. That means you cannot delay enrollment without risking lifelong late fees. However, you may want to keep your current coverage, particularly if it's the only health insurance your spouse has.
New to Medicare Coverage Options
Once you enroll in Medicare, you need to decide how you want to receive your benefits. You have two options: Original Medicare or a Medicare Advantage (MA) plan, also known as Medicare Part C.
Choosing Original Medicare
The majority of beneficiaries – around two-thirds – choose Original Medicare plus a Part D prescription drug plan (PDP). You may also choose to add a Medigap plan to supplement your Medicare coverage.
Original Medicare includes Part A, hospital insurance, and Part B, medical insurance. It does not provide prescription drug coverage, which is why you need to add a Part D plan if you do not currently have creditable coverage. Part D plans are sold by private insurance companies.
Medicare Supplement Insurance plans, more commonly known as Medigap, help pay some of your out-of-pocket costs under Original Medicare. Coverage varies according to the plan you choose. However, all Medigap plans cover your Part A coinsurance and at least half of your Part B coinsurance, which is typically 20 percent of the Medicare-approved amount for services.
You cannot combine a Medicare Supplement plan with a Medicare Advantage plan.
Choosing a Medicare Advantage Plan
Medicare Advantage plans provide the same level of coverage as Original Medicare. However, most – over 90 percent – provide additional benefits as well. Common extras with an MA plan include:
Prescription drug coverage (known as an MA-PD plan)
Routine eye care
Routine dental care
Even if you sign up for an Advantage plan, you still have to pay your Medicare Part B premium. Despite this, one reason Medicare Advantage has grown so much in popularity is that many beneficiaries see lower out-of-pocket costs with an MA plan.
Compare your Medicare Advantage plan options carefully to be sure you get the best plan for your particular needs and budget. Considerations include:
Out-of-pocket costs: Look beyond the premium to the full cost of the plan, including copayments, coinsurance, and yearly deductible.
Drug formulary: Make sure any MA-PD plan covers your prescription medications.
Provider network: Most MA plans have a provider network that may include doctors, labs, clinics, hospitals, pharmacies, and more. Using an out-of-network provider may leave you shouldering 100 percent of costs.
Our Find a Plan tool makes comparing your Medicare plan options easy. Just enter your location and coverage start date.
The New to Medicare Checklist
Medicare.gov provides a checklist of things you should do during your first year with Medicare.
Complete an Authorization Form to grant Medicare permission to discuss your healthcare needs with someone you trust.
Schedule your Welcome to Medicare Preventive Visit during your first year to get a baseline reading of your current health issues. Your provider will also help explain your Medicare coverage.
Download the What's Covered app to quickly discover whether Medicare covers the test, item, or service your doctor recommends.
Create your MyMedicare.gov account. This gives you quick access to your Medicare information, lets you make payments, print a replacement Medicare card, and more.
You'll find the full New to Medicare checklist here.
New to Medicare Frequently Asked Questions
This FAQ answers new Medicare beneficiaries' most common questions.
What is the Medicare eligibility age?
All American citizens and permanent residents become eligible for Medicare when they turn 65.
Is Medicare mandatory when you turn 65?
No, Medicare enrollment is not mandatory. However, if you delay signing up for Medicare and do not qualify for a Special Enrollment Period, you face lifelong late fees when you do enroll.
When should I sign up for Medicare?
To avoid late penalties, the best time to sign up for Medicare is during your Initial Enrollment Period. You start accruing late enrollment penalties any time you go a full year without Part A or Part B coverage.
How do I sign up for Medicare?
You sign up for Medicare through Social Security.
Do I have to sign up for a Medicare Part D plan?
You don't have to sign up for any part of Medicare if you're willing to pay late fees for the rest of your life once you do enroll. However, while you get a 12-month grace period under Original Medicare, you can only go 63 days without creditable Part D coverage before you earn a late penalty.
What happens if I miss my Initial Enrollment Period?
If you miss your Initial Enrollment Period, you have two options:
Those who have never enrolled in Medicare Part B may sign up during the General Enrollment Period (GEP). This occurs every year from January 1 through March 31. Coverage begins on July 1. Depending on when you first became eligible for Medicare, delaying enrollment until the GEP could result in you paying lifelong late fees.
You may avoid this if you qualify for a Special Enrollment Period. There are literally dozens of ways to qualify, but losing your current coverage is the most common – particularly if you're new to Medicare.
Find the full list of special circumstances that qualify you for an SEP here.
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