An estimated 70 billion baby boomers are nearing retirement, and over 10,000 boomers are turning 65 every single day. If you’re new to Medicare, we can help you understand how to sign up for Medicare and answer your questions about coverage, benefits, qualifications, fraud, and privacy.
How to Sign Up for Medicare
If you currently receive Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. However, if you do not receive Social Security benefits, you will need to enroll yourself. You can enroll in Original Medicare (Parts A and B) online, by phone, or by visiting your local Social Security office.
Do you have to sign up for Medicare when you are 65?
The standard age for Medicare eligibility is 65. However, this does not mean you are required to enroll on your 65th birthday.
If you wish to enroll in Medicare when you become eligible, you can enroll anytime during your initial enrollment period. This period begins three months before your 65th birthday and ends three months after. If you choose to postpone enrollment, you may be subject to a late-enrollment penalty. This can result in a 10% Part B premium increase for every year you were eligible but did not enroll. Plus, you will have an additional penalty of 1% the national based Medicare Part D monthly premium for each month you did not enroll in prescription drug coverage.
Medicare Coverage and Benefits
Original Medicare consists of Parts A and B. Part A covers inpatient hospital fees, hospice care, and home health services. Part B covers doctor services, outpatient care, and physical therapy. Most beneficiaries receive Part A for free, but pay a monthly Part B Medicare premium. Beyond Original Medicare, there are Parts C and D, Medicare Advantage and prescription drug plans.
What is Medicare Advantage (Part C)?
Medicare Advantage plans, sometimes referred to as “Part C,” are available through private insurance companies. They cover the same benefits as Original Medicare, but most offer extra benefits like vision, hearing, dental, and even fitness programs like Silver Sneakers.
Medicare Advantage plans have one monthly premium, and you only pay for the services you use rather than paying a higher cost upfront. You may want to enroll in Medicare Advantage instead of Original Medicare alone. If MA is not right for you, consider Medigap.
What is Medigap?
If you are enrolled in Original Medicare, you are eligible to purchase a Medigap plan, otherwise known as Medicare Supplements. These plans help pay some of the costs that Original Medicare does not cover – your copayments, coinsurance, and deductibles. Most Medigap plans do not cover additional benefits like vision, hearing, dental, and prescription drugs. They are sold by private insurance companies. You can search Medicare Supplement Plans here.
What is Medicare Part D?
You may have noticed by now that Original Medicare (Parts A and B) does not include prescription drug coverage. Even though it isn’t included in your initial plan, you will encounter penalty fees if you do not purchase a prescription drug plan during your initial enrollment period.
Part D plans will have a formulary or list of qualifying prescription drugs. The list is usually divided into tiers according to cost. Keep in mind that your out-of-pocket drug costs will vary according to the plan you choose. Costs will also depend on your premium, deductible, copayments, and coinsurance.
How do I compare Part D plans?
The best way to compare Part D plans is to contact a licensed agent in your area. We happen to have thousands of agents across 38 states! Plus, our Medicare Part D Plan Finder Checklist can help make sure your needs and wants regarding Part D coverage are clear. The checklist has six short sections and shouldn’t take long to complete.
Does Medicare offer free preventive services?
Once you’ve had Medicare Part B for at least 12 months, you are eligible for a zero-cost yearly Medicare wellness exam. The purpose of this wellness visit is to work with your doctor to identify any concerns and to develop a plan for staying healthy. In addition to the annual wellness exam, there are a number of additional services, screenings, and vaccinations covered at no cost including:
- Annual flu shot
- Alcohol screening
- Bone mass measurements
- Cardio screening
- Colorectal screening
- Diabetes screening
- Hepatitis screening
- HIV screening
- Lung, prostate, and cervical cancer screenings
Turning 65 is certainly the most common way to qualify for Medicare, but there are a handful of other ways to qualify. You may also qualify for Medicare if you are under 65, have received Social Security Disability Insurance (SSDI) for more than 24 months or if you are diagnosed with either Lou Gehrig’s disease or ESRD.
What are the different Medicare enrollment periods?
Initial Enrollment Period
Every Medicare beneficiary will have an IEP, or Initial Enrollment Period, during which they are eligible to enroll in Medicare. Your IEP will begin three months before you turn 65 and will end three months after, giving you a total of a seven-month enrollment period. For example, if your birthday is April 1, your IEP will last from January 1 through August 1.
General Enrollment Period
The General Enrollment Period runs from January 1 to March 31 every year. This is when, if you missed your IEP, you can enroll in Medicare for the first time. Your coverage will begin in July. If you decide that you would like to enroll in a Medicare Advantage or prescription drug plan, you can do so from April 1 through June 30. The reason for that time gap is that you cannot enroll in Medicare Advantage or Part D until you have Original Medicare.
Annual Enrollment Period
AEP occurs from October 15 through December 7 of each year. This is when you have the ability to review and change your existing Medicare Advantage Plan or Medicare Part D Plan.
Special Enrollment Period
You can either have a SEP for a set period of time, or you can have a lifelong SEP. A SEP allows you to enroll in a new Medicare plan or make changes to your current coverage outside of the normal enrollment periods. If you qualify for a SEP, you should take advantage of your ability to get yourself into a better plan. To see if you qualify for SEP, click here.
Open Enrollment Period
Medicare Open Enrollment 2019 will run from January 1 through March 31. During this time, you can switch between:
- One Medicare Advantage plan to another Medicare Advantage plan
- A Medicare Advantage plan with prescription drug coverage to Original Medicare with Part D prescription drug coverage
- Medicare Advantage to Original Medicare only, with the option to add a prescription drug plan
Do I qualify for Medicare’s Extra Help Program?
The LIS, or Low-Income Subsidy program, is a federal prescription drug plan discount program often called “Medicare Extra Help.” LIS helps Medicare beneficiaries who do not qualify for Medicaid but still need help paying for prescription drugs. Plus, those with LIS have a special enrollment period and can change plans at any time!
To have LIS, you must have a Part D or Medicare Advantage plan. LIS can help cover late enrollment penalty fees if you enroll in Part D or Medicare Advantage too late. It also helps with coverage issues if you enter the Medicare donut hole.
LIS qualifications are based on income and assets. The limits change every year, but a licensed agent can help you with eligibility information. Thousands of seniors & Medicare eligibles out there don’t even know that they are eligible! We can help. Click here to get in contact with an agent.
Medicare Fraud and Privacy
It’s important to keep your personal information protected. Your Medicare number is just as valuable as your bank account and social security number. It’s important to understand the appropriate steps to replace a lost Medicare card and to watch out for common Medicare scams.
How do I replace a lost Medicare card?
If you need to replace a lost Medicare card, visit Social Security’s website, call Social Security at 1-800-772-1213, or visit your local Social Security office. Please note, it can take up to 30 days for your card to be mailed to you. If you have moved or have a different address, you need to report this information to Social Security before they can send you a new card.
What are common Medicare scams?
Some people will call and act like they are a relative of yours. They will claim to be injured or in trouble. Try to call that relative first rather than believing the random caller.
Real telemarketers will not ask for your Medicare number. Plus, they cannot call without your permission.
Some telemarketers may lie and say they are from a charity and ask for money. Never give out your financial information over the phone.
“Can you hear me?”
If you answer the phone and someone asks if you can hear them, hang up immediately. This is a common scam where your response is used to make it sound as though you were agreeing to something.
Who can help answer other Medicare questions?
If you have any other questions or concerns about Medicare and related coverage options, please do not hesitate to contact us. Our licensed agents are contracted with the major carriers in your state and can answer these questions with an unbiased and honest approach. To get in contact, fill out this form, or call us at 833-438-3676.