How to Apply for Medicare: A Step-by-Step Guide

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.

Understand Medicare and Its Parts

Before applying, it’s crucial to understand the different parts of Medicare
and what they cover:

Medicare Part A (Hospital Insurance)

• Helps pay for inpatient care you get in hospitals, critical access hospitals,
  and skilled nursing facilities. It also helps cover hospice care and some
  home health care.

Medicare Part B (Medical Insurance)

• Covers medically necessary services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition.
• Covers preventive services to prevent illness (like the flu) or detect it early when treatment is likely to work best. You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.

Medicare Part C (Medicare Advantage)

• Offered by private insurance companies as an alternative to Original Medicare.
• Includes Parts A and B, and often additional benefits like dental, vision, and hearing.

Medicare Part D (Prescription Drug Coverage)

• Covers prescription medications.
• Available through private insurers and requires an additional premium.

Medigap (Supplemental Insurance)

• Helps cover out-of-pocket costs like copayments, coinsurance, and deductibles.

WHAT Medicare DOES NOT COVER

Original Medicare doesn’t cover everything. Here are some of the items
and services NOT covered:

• Eye exams (for prescription eyeglasses)
• Long-term care
• Cosmetic surgery  
• Massage therapy
• Routine physical exams
• Hearing aids and exams for fitting them
• Concierge care (also called concierge medicine, retainer-based medicine,
  boutique medicine, platinum practice, or direct care)
• Covered items or services you get from a doctor or other provider that has opted out of participating in Medicare (except in the case of an emergency or urgent need)
• Most dental care:  In most cases, Original Medicare doesn’t cover dental services like routine cleanings, filings, tooth extractions, or items like dentures. However, in some cases, Original Medicare may pay for some dental services closely related to certain services like:
  • A heart valve repair or replacement
  • An organ transplant
  • Cancer-related treatments

Determine Your Eligibility

Eligibility depends on age, disability, or medical condition:

Age 65 or Older
You qualify if you are a U.S. citizen or legal permanent resident for
at least five continuous years.

Disabilities
Individuals under 65 may qualify after receiving Social Security
Disability Insurance (SSDI) for 24 months.

Specific Medical Conditions
Those with End-Stage Renal Disease (ESRD)
or Amyotrophic Lateral Sclerosis (ALS) qualify automatically.

key enrollment periods

Initial Enrollment Period (IEP)

A 7-month window beginning 3 months before your 65th birthday month,
including the month you turn 65, and ending 3 months after.

Special Enrollment Period (SEP)

If you delayed enrollment because you had employer-based health insurance,
you can enroll without penalties during this period, which lasts up to 8 months
after losing your coverage.

General Enrollment Period (GEP)

Runs from January 1 to March 31 each year, with coverage beginning July 1.

This option is for those who missed their IEP and don’t qualify for an SEP.

Annual Enrollment Period (AEP)

From October 15 to December 7, you can make changes to your
Medicare Advantage or Part D plans.

Medicare Advantage Open Enrollment Period

From January 1 to March 31, you can switch Medicare Advantage plans or
revert to Original Medicare.

BEFORE 65? AFTER 65?

Before you turn 65

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.

After you turn 65

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.

THE PROCESS FOR APPLYING for Medicare

There are several ways to apply for Medicare. Choose the one that works best for you:

Online

Visit the Social Security Administration (SSA) website at www.ssa.gov.

Follow the instructions to apply for Medicare Parts A and B.

By Phone

Call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778).

In-Person

Visit your local Social Security office. You can find the nearest office
using the SSA’s office locator tool.

Automatic Enrollment

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.

Gather Required Documents

To apply, you’ll need to provide certain documents and information:

• Social Security Number
• Birth Certificate
• Proof of U.S. Citizenship or Legal Residency
• Current Health Insurance Information (if applicable)
• Tax Returns or Income Information (for those applying for financial
  assistance or programs like Medicare Savings Programs)

Tips for a Smooth Application Process

Apply Early

Start the process three months before your 65th birthday to ensure timely coverage.

Double-Check Information

Ensure all information is accurate to avoid delays or errors in your application.

Consider Automatic Enrollment

If you’re eligible for automatic enrollment, review your coverage to confirm
it meets your needs.

Explore Your Options

Compare Original Medicare, Medicare Advantage, and Part D plans
to choose the best coverage.

Understand Costs

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.

Check Financial Assistance

Low-income individuals may qualify for programs like Medicaid,
Extra Help (for prescription costs), or Medicare Savings Programs.

Managing Changes and Updates

Once enrolled, you can make changes to your coverage during specific periods:

Review Plans Annually
Compare costs, coverage, and provider networks each year to ensure
your plan still meets your needs.

Report Life Changes
Notify Medicare of changes like a new address, marital status, or employment status.

Avoiding Penalties

To avoid unnecessary penalties, make sure to:

• Enroll in Part B during your Initial Enrollment Period
  unless you have qualifying coverage.
• Sign up for Part D to avoid a lifelong late enrollment
  penalty unless you have creditable drug coverage.

Seek Help if Needed

If you’re unsure about any aspect of Medicare:

• Contact SHIP (State Health Insurance Assistance Program)
  for free, unbiased counseling.
• Speak to a Licensed Insurance Agent – they can explain Medicare
  plans and help you choose one.

IT CAN FEEL OVERWHELMING

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