Initial Enrollment Information for Medicare

If you do not have experience with Medicare, understanding all the “alphabet soup” — that is different lettered plans and options — can be overwhelming. Luckily, once you decide to enroll in Medicare, the process is rather straightforward. Better yet, if you find you do not like the plan you have selected, you are not stuck with it forever. Like other forms of insurance, you have the ability to review your Medicare plan each year and make changes. This is especially important over the long-term as your health care needs change.

What is Medicare?

In a nutshell, Medicare is a form of government-sponsored health insurance that ensures you have access to hospitals, doctors and other medical services after retirement, a disability or after being diagnosed with a serious health condition such as ALS or end-stage renal disease.

Who Qualifies for Medicare?

Because Medicare is predominately meant for people who have retired, you generally must be at least 65-years-old to claim benefits. But there are times when you may not need to be close to retirement age, such as if you have been diagnosed with end-stage kidney failure or are legally disabled and receiving Social Security Disability benefits. Below are the eligibility requirements requirements:

1) You must be a United States citizen or permanent legal resident
2) You must have worked for at least 10 years or have a spouse who worked that length of time and paid taxes through your paycheck — this is how you contributed to the Social Security fund that covers many of your Medicare costs
3) If you have not paid into Social Security, you must have paid into Medicare payroll during your time of employment; this may be common for former government employees
4) You are age 65 or older

If you are under age 65, you may still qualify if:

• You have been receiving Social Security disability benefits for 24 months
• You receive a disability pension from the Railroad Retirement Board
• You have Lou Gehrig’s disease or renal failure that can only be treated through dialysis or a transplant

What Kind of Medicare is Available to Me?

Medicare comes in two general forms: Original Medicare, with or without a Medicare Supplement and Part D Prescription Drug Plan, and Medicare Advantage. Original Medicare consists of Parts A and B, which provide hospital and medical coverage. Part D coverage is also available, which offers insurance for prescription drugs. Medicare also offers another alternative — Medicare Advantage. This combines Parts A, B and oftentimes D into one plan, but is provided by private insurance companies that sometimes give additional benefits such as vision and dental coverage. You can choose either form of Medicare and still have benefits that allow you to be admitted into the hospital or visit a doctor’s office. A licensed insurance agent at PolicyZip can help you in determining which type of coverage is most appropriate for your needs. Call us at (844) 205-7510 or fill out the form below.

When to Begin Enrolling for Medicare Benefits

There are two different kinds of Medicare enrollment: automatic enrollment and manual enrollment. As these names imply, automatic enrollment is when you are automatically signed up for Medicare health coverage. Manual enrollment requires you to complete the process yourself within a certain time period.

Automatic Enrollment

In some cases, you may be automatically enrolled in Medicare Part A, the basic level of Medicare hospital coverage. This frequently happens if you are already drawing Social Security or Railroad Retirement Benefits. If you have received disability benefits for 24 months, you’ll be automatically enrolled in Medicare Part A in your 25th month. In addition, people diagnosed with ALS (Lou Gehrig’s disease) are automatically signed up for Medicare at the same time they begin receiving disability benefits. While you are technically enrolled in Medicare, you may want to consider your other health coverage options, such as voluntarily signing up for Medicare Part B, Part D or switching to a Medicare Advantage plan.

Manual Enrollment

Having to manually enroll in Medicare is common, and you will get a notice about needing to do so as you approach age 65. If you are not already receiving Social Security benefits, you will have to manually enroll. Manual enrollment is also required for people of any age who were diagnosed with end-stage renal disease (ESRD). At this time, you will have to decide how you want to handle Medicare coverage in addition to any other insurance benefits you have, such as health insurance through an employer.

If your 65th birthday is approaching, you can begin the Medicare enrollment process as soon as three months before. This is called your Initial Enrollment Period (IEP) and it lasts until three months after your birthday. The sooner you enroll the better; every month past your birthday leads to a month delay in the start of your benefits. And, if you happen to miss your Initial Enrollment Period altogether, you may face penalties when you do finally signup for Medicare.