Everything you need to know about Medicare enrollment

Medicare is a health insurance program run by the United States government that helps with the cost of health care. Here’s everything you need to know about it.

Medicare is essential as it significantly reduces healthcare costs; however, the nitty-gritty of enrollment can be challenging. Wading through the different plans can be a little overwhelming, especially if you have no idea where to start. Here are things that will shed some light on Medicare enrollment.

Who can sign up for Medicare?

You can sign up for Medicare if you are 65 years or older. An exception is made for anyone below 65 years if you have a disability or diagnosis such as ALS (Amyotrophic Lateral Sclerosis) or ESRD (End-Stage Renal Disease).

When can you sign up for Medicare?

The best time to join Medicare is three months before turning 65. However, you are still eligible for Medicare if you are 65 or older. The only downside is that you are likely to pay penalties or have a gap in your coverage.

If you have a disability, you can only qualify for Medicare if you have received disability benefits for at least 24 months. The benefits include Railroad Retirement Board benefits or Social Security Administration benefits.

Are there enrollment periods?

The answer is yes. Different enrollment periods serve as chances for you to sign up.

Initial Enrollment Period

It is the first chance you get to join Medicare. This period starts three months before turning 65 and ends three months after turning 65. If you miss the seven-month Initial Enrollment Period, you will likely pay a monthly late enrollment penalty.

General Enrollment Period

It allows you to enrol for Medicare between January 1 and March 31 of each year. Signing up for Medicare during this time may attract penalties at times.

Special Enrollment Period

In some circumstances, you are not penalized for enrolling in Part B and Premium-Part A during the Special Enrollment Period. However, if you miss the time allotted, you will have to hold out until the following General Enrollment Period and may be subject to a monthly late enrollment fee.

For instance, if you’re still employed and have a group health insurance plan, the Special Enrollment Period begins when you lose your job or the coverage expires. The window will only run for eight months before it ends.

Open Enrollment Period

It is between October 15 and December 7 every year. You can join, drop, or switch to another plan during this period.

Medicare Advantage Open Enrollment Period

This period only applies to those having a Medicare Advantage Plan. It is between January 1 and March 31 each year. The period allows you to switch to another Medicare Advantage Plan, join a Medicare drug plan, or drop your Medicare Advantage Plan to join Original Medicare.

Are there costs involved in Medicare enrollment?

For Medicare coverage, you typically pay a monthly fee and a portion of the costs each time you receive a covered service. In Part A, you are eligible for a Part A premium-free plan if you have been paying Medicare payroll taxes for at least ten years. Otherwise, if not, you only qualify for a Part A premium plan.

What are the coverage options?

There are several different parts of Medicare.

Part A

It works as hospital insurance and covers inpatient services and home health services. Part A plan can either be premium free or have a monthly fee. If you or your spouse have already paid payroll taxes for at least ten years, you are eligible for a premium-free plan.

Part B

It covers outpatient services, health care provider services, medical equipment, and preventative services. For Part B coverage, you must make a monthly premium payment. Your yearly income determines the Part B premium amount.

Part D

Several Medicare Advantage plans cover the cost of prescription medications. However, if you do not have prescription drug coverage, you can enroll in Part D separately.

Medicare Supplemental Insurance

Original Medicare, which includes Part A and Part B coverage, has several costs, such as deductibles, coinsurance, copayments, and other out-of-pocket expenses. As a result, most people turn to a supplemental plan (Medigap) offered by private insurance companies. This plan helps fill the Medicare gaps and shares the costs of Original Medicare.

Medicare Advantage

Private insurers provide this coverage, which is a substitute for Original Medicare, and sometimes Part D. Medicare Advantage has lower out-of-pocket costs than Original Medicare and can, at times, offer extra benefits. The only challenge is you can only use doctors in the plan’s network.

What preventative services does Medicare cover?

The preventative service coverage is in the Part B plan of Medicare. These services include:

  • Diabetes, colorectal, cervical, and prostate cancer screening
  • Annual flu shots
  • Annual wellness visits

Can you supplement Medicare with other insurance?

Other insurance plans from private insurers can supplement Medicare to cover gaps in the Medicare plans or reduce out-of-pocket costs associated with Original Medicare.

How can you enroll for Medicare?

Calling Social Security at 800-772-1213 is the best way to enroll for Medicare. Medicare applications can also be submitted online or at a local Social Security office.

Can you change plans?

After enrollment, you can switch, join, or drop a plan during the Open Enrollment Period between October 15 and December 7.

Can you file an appeal?

If you disagree with your Medicare plan or a Medicare payment decision, you can file an appeal. Before appealing, it is essential to gather information from your doctor or health care provider as it will help you with your case.

Choosing the right Medicare plan goes beyond the costs involved and depends on your situation’s specifics. This article helps you make an informed decision during Medicare Enrollment.