Medicare is health insurance for people 65 or older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).
Some people get Medicare automatically, others must actively sign up – it depends if you start getting retirement or disability benefits from Social Security before you turn 65 or after. Understanding how to apply for Medicare is essential to ensure timely coverage and avoid penalties. This guide provides detailed information and tips to help you navigate the application process.
Before applying, it’s crucial to understand the different parts of Medicare
and what they cover:
Original Medicare doesn’t cover everything. Here are some of the items
and services NOT covered:
Eligibility depends on age, disability, or medical condition:
You qualify if you are a U.S. citizen or legal permanent resident for
at least five continuous years.
Individuals under 65 may qualify after receiving Social Security
Disability Insurance (SSDI) for 24 months.
Those with End-Stage Renal Disease (ESRD)
or Amyotrophic Lateral Sclerosis (ALS) qualify automatically.
A 7-month window beginning 3 months before your 65th birthday month,
including the month you turn 65, and ending 3 months after.
If you delayed enrollment because you had employer-based health insurance, you can enroll in Part B without penalties during this period, which lasts up to 8 months after losing your coverage. For Part D drug coverage, the SEP is generally only 2 months after loss of “creditable coverage” – coverage at least as good as standard Medicare drug coverage (often employer or union plans). If you wait longer, you may incur a penalty or go without coverage until the next enrollment period.
Coverage starts the month after you enroll during the GEP.
This option is for those who missed their IEP and don’t qualify for an SEP.
From October 15 to December 7, you can make changes to your
Medicare Advantage or Part D plans.
From January 1 to March 31, you can switch Medicare Advantage plans or
revert to Original Medicare.
If you apply to start getting retirement benefits from Social Security (or the Railroad Retirement Board) at least 4 months before you turn 65, you’ll automatically get Part A (Hospital Insurance) and Part B (Medical Insurance) when you turn 65.
You’ll still need to make important decisions about how you get your coverage, including adding drug coverage. If you want Medicare when you turn 65, but aren’t planning to take retirement benefits at that time, you’ll need to sign up for Medicare.
Automatic Enrollment Timing: If you’re already receiving Social Security benefits, you can expect to get your Medicare card about 3 months before your 65th birthday.
You’ll have to contact Social Security when you’re ready to sign up for Medicare. Depending on your work situation and if you have health coverage through your employer, you may want to wait to sign up for Medicare. Important note: your employer must have 20+ employees for Medicare to be secondary – otherwise you should enroll in Part B immediately to avoid penalties.
Contrary to what many people think, COBRA coverage is NOT considered creditable coverage for delaying Medicare Part B enrollment without incurring penalties. If you’re eligible for Medicare and are on COBRA, you should enroll in Part B when you are first eligible – to avoid late enrollment penalties.
There are several ways to apply for Medicare. Choose the one that works best for you:
Visit the Social Security Administration (SSA) website at www.ssa.gov.
Follow the instructions to apply for Medicare Parts A and B.
Call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778).
Visit your local Social Security office. You can find the nearest office
using the SSA’s office locator tool.
If you’re already receiving Social Security or Railroad Retirement benefits,
you’ll be automatically enrolled in Parts A and B when you turn 65.
To apply, you’ll need to provide certain documents and information:
Start the process three months before your 65th birthday to ensure timely coverage.
Ensure all information is accurate to avoid delays or errors in your application.
If you’re eligible for automatic enrollment, review your coverage to confirm
it meets your needs.
Compare Original Medicare, Medicare Advantage, and Part D plans
to choose the best coverage.
Be aware of premiums, deductibles, copayments, and coinsurance.
For example: Part B has a standard monthly premium (adjusted based on income).
Some Advantage and Part D plans may offer lower out-of-pocket costs.
Low-income individuals may qualify for programs like Medicaid,
Extra Help (for prescription costs), or Medicare Savings Programs.
Once enrolled, you can make changes to your coverage during specific periods:
Compare costs, coverage, and provider networks each year to ensure
your plan still meets your needs.
Notify Medicare of changes like a new address, marital status, or employment status.
To avoid unnecessary penalties, make sure to:
If you’re unsure about any aspect of Medicare:
Applying for Medicare can be a bit daunting, but with the right preparation and guidance, it becomes a straightforward process. Understanding the parts of Medicare, your eligibility, and the application timeline will help you make informed decisions about your healthcare coverage. Be proactive, seek assistance when needed, and ensure you’re fully covered to enjoy the benefits of Medicare.
Sources:
Medicare.gov
Centers for Medicare and Medicaid Services
