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FEATURED ARTICLE
View Our 2022 Medicare Annual Enrollment Guide
The experts at TogetherHealth have developed a 2022 AEP Readiness Guide to help you prepare for the Medicare Annual Enrollment Period so you can make an informed choice for your healthcare needs next year.
What is the Medicare Annual Enrollment Period?
The Medicare Annual Enrollment Period (AEP), sometimes called Medicare Open Enrollment or the Medicare Annual Election Period, happens each year from October 15 to December 7. During this time period, you have the option to make changes to your Medicare coverage. Your new coverage would then take effect January 1.
If you're satisfied with your current coverage, you don't have to take any action during Medicare AEP and there are no penalties involved.
Medicare plan details can change annually, though, so it's wise to review your Medicare coverage each year.
What’s the Difference Between Medicare AEP and the Medicare General Enrollment Period?
The Medicare Annual Enrollment Period is sometimes confused with the Medicare General Enrollment period, which is January 1 to March 31 each year. It’s important to understand the differences between the two enrollment periods.
The Medicare General Enrollment Period is for Medicare beneficiaries who didn’t sign up for Medicare Part A) or Part B when they first became eligible and aren’t eligible for a Medicare Part B special enrollment period. The AEP, however, is for beneficiaries who are already enrolled in Medicare and want to change their Medicare coverage.
What Changes Can I Make During the Medicare Annual Enrollment Period?
The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time.
If you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare AEP:
Change from Original Medicare to a Medicare Advantage plan.
Change from one Medicare Advantage plan to another.
Disenroll from your Medicare Advantage plan and go back to Original Medicare.
Change from one prescription drug plan (Medicare Part D) to another.
Enroll in a prescription drug plan.
Cancel your prescription drug coverage.
5 Tips to Prepare for the Medicare Annual Enrollment Period
There are many Medicare insurance carriers and plan options, but there are several steps you can take to be a savvy shopper and choose the right plan for your unique needs.
1. Mark Your Calendar
This may seem like an obvious tip, but it’s worth mentioning: Mark your calendar for October 15 through December 7 if you’d like to make a change to your Medicare plan.
You might even set aside a few hours to research and compare Medicare Advantage plans and Prescription Drug plans ahead of October 15. These plans announce their benefits for the next year starting on October 1.
Writing down these Medicare AEP dates and to-dos will help you to commit to these priorities.
2. Review Your Medicare Annual Notice of Change
You’ll receive lots of information over the next month or so prior to and during AEP, so if you’re currently enrolled in a Medicare Advantage or Prescription Drug Plan, the Annual Notice of Change (ANOC) is one piece of mail you’ll want to read.
Your Medicare plan will mail your Annual Notice of Change letter to you by September 30. The ANOC letter will inform you of most changes to your Medicare health plan, including coverage and benefits that will take effect on January 1, 2022.
Each year, your Medicare health plan sets the amounts it will charge you for premiums, deductibles and other services. Medicare doesn’t set these rates - but your insurance company does. With this in mind, the amounts you pay could change each year.
While evaluating your current Medicare plan, you may want to ask yourself questions like:
Did the plan cover the services I needed?
Did I use out-of-network providers?
Did I spend more out of pocket than I originally anticipated?
Has something changed with my health (new diagnosis, new prescriptions, etc.)?
The ANOC will also provide a side-by-side comparison of your current plan and next year’s plan benefits, costs and other changes (if any).
Moral of the story: Don’t toss this piece of mail aside. Always review your ANOC to ensure your plan continues to meet your needs on an annual basis. And if you don’t receive your ANOC by September 30, contact your Medicare insurance company.
3. Make a List of What’s Important to Your Health
Keeping a list of what’s important to your health is an invaluable way to prepare for the Medicare Annual Enrollment Period.
Start by writing down all of your doctors, preferred health care facilities and hospitals, and prescription drugs, if you take any.
We also recommend making a list of value-added benefits that may fit your health, lifestyle and budget.
For example, you may be someone who likes to keep active and have social interaction. So a fitness program like SilverSneakers, which gives you access to a network of gyms and other programs, might be a good fit for you. A Medicare Advantage plan may provide these types of fitness or wellness programs.
Another thing to consider is whether or not you have an elective surgery planned for 2022. If so, you’ll want to check your hospital-specific benefits under your current Medicare Advantage plan.
4. Check Your Plan’s Drug Formulary
Your Medicare plan’s drug formulary will not be included in your Annual Notice of Change, so be sure you call your insurance customer service representative to see if your prescription drugs will be covered for the 2022 plan year.
If your prescription drugs aren’t covered, it’s wise to use the Medicare Annual Enrollment Period to find a plan that does cover them.
5. Talk To Your Doctor
Another “Medicare must-do” is to make sure all of your doctors and healthcare facilities will remain in network with your current Medicare plan. If they aren’t, you may want to take advantage of the Medicare Annual Enrollment Period.
So be sure to ask your doctor if he or she plans on changing health plan affiliations over the next year.
What Changes Can I Make During the Medicare Annual Enrollment Period?
The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time.
But if you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare Annual Election Period:
Change from Original Medicare to a Medicare Advantage plan.
Change from one Medicare Advantage plan to another.
Disenroll from your Medicare Advantage plan and go back to Original Medicare.
Change from one prescription drug plan (Medicare Part D) to another.
Enroll in a prescription drug plan.
Cancel your prescription drug coverage.
What Are The Benefits of A Medicare Advantage Plan?
Understanding your Medicare plan options - starting with a Medicare Advantage plan - is a smart first step to take because you can switch, enroll into or dis-enroll from Medicare Advantage plans during AEP.
Medicare Advantage plans, otherwise known as “Medicare Part C” or “MA Plans,” bundle Original Medicare (Parts A and B) services into one plan. While Original Medicare offers you a number of benefits, it may not cover health and medical services you might need.
One major change happening for the 2021 plan year is that people with End Stage Renal Disease (ESRD), also known as kidney failure, will now have the option to enroll in a Medicare Advantage plan. The Centers for Medicare & Medicaid Services (CMS) estimates that more than 80,000 people living with ESRD will enroll in a Medicare Advantage plan by 2026 - a significant increase of 63%.
What Are Medicare Advantage Special Needs Plans?
Medicare beneficiaries also have access to Medicare Advantage plans designed for unique needs. These are called Special Needs Plans (SNPs). Like other types of Medicare Advantage plans, SNPs vary based on location.
You may be able to switch to a Special Needs Plan during the Medicare Annual Enrollment Period if one of these situations apply:
You’ve been diagnosed with a serious medical condition by a doctor. There are SNPs for certain chronic conditions, such as kidney and heart failure, diabetes and dementia. Services are tailored to the specific condition the plan covers.
You need or have received skilled nursing care for at least 90 days at your home or at an institution, such as a nursing home or long-term care facility.
You qualify for both Medicare and Medicaid. Medicaid eligibility is based on your income and assets. If you qualify, Medicaid will pay most of the costs for your Medicare Special Needs Plan.
Special Needs Plans include all the same benefits as regular Medicare Advantage plans, plus some expanded coverage.
For example, all Special Needs Plans must include prescription drug coverage, which is usually tailored to the specific condition the plan covers. Although most regular Medicare Advantage plans include prescription drugs, some do not.
Some SNPs also provide a care coordinator to help you stay on track with your doctor appointments and treatment plan.
Changes in Income Due to Coronavirus (Covid19)?
The coronavirus crisis has affected the financial well-being of many Americans, including those on Medicare. If you’ve experienced a decrease to your income or assets, the Medicare AEP 2020 season is a great time to switch to a more affordable plan.
If you have limited income, you might qualify for extra savings on Medicare costs through these programs:
Medicare Savings Programs. These programs help pay for some of your Medicare Part A and Part B out-of-pocket costs, such as copays, deductibles and premiums. Most programs are for Medicare beneficiaries who also qualify for Medicaid. And as mentioned, Medicaid covers the majority of your costs when you join a Medicare Advantage Special Needs Plan. You can check if you qualify through your local Medicaid office.
Medicare Extra Help. Extra Help reduces your Medicare prescription drug plan costs. You should contact Social Security to check your eligibility for Extra Help if you have an existing Medicare drug plan or you join one during AEP.
How To Enroll During the Medicare Annual Enrollment Period
To enroll in an eligible plan during the Medicare Annual Enrollment Period, you can visit our comparison tool. Or, you call (855) 651-5094 to talk to a licensed insurance agent to get help enrolling in Medicare.
Whatever option you choose, be sure to have 3 items handy before you enroll in a plan or make changes to your current plan during AEP:
Your Medicare card
Your list of doctors, prescriptions and what is important to your health
Pen and paper to take notes
How To Find A Medicare Advantage or Prescription Drug Plan Before AEP
You don’t have to go it alone when choosing a Medicare Advantage plan or Prescription Drug Plan. We’re here to help you navigate the Medicare Annual Enrollment Period through a number of ways, including:
Our Medicare plan comparison tool
Our online Medicare resources
You can also call 800-620-4519 to speak to a licensed insurance agent about your options.
You can also read through some of our articles to learn more about Medicare.
Medicare 101 Guide
What is Medigap
Understanding Original Medicare vs. Medicare Advantage
If you choose to have Original Medicare with Medicare Part D added, you’ll receive prescription drug coverage through Medicare Part D. However, there can sometimes be a gap in the coverage of your prescriptions.
This gap is known as the “donut hole,” and it’s a period of time where you pay out-of-pocket for your medications. However, you don’t pay the full amount, and once your out-of-pocket costs hit a specific level Medicare will resume coverage.
What is the Medicare donut hole? This page will help you understand the donut hole and how to navigate it.
How Does the Donut Hole Work in Medicare?
The Medicare donut hole is a period of time where you’ve reached the limit of your Medicare Part D coverage, but haven’t hit the “catastrophic coverage” level where Medicare resumes assisting you with your prescription drug coverage.
With Medicare Part D, the first portion of the year you’ll be paying toward your deductible. The deductible varies but can be up to $445 in 2021. Once you reach your deductible, your drug plan will kick in and you’ll pay your copayment or coinsurance for your medication.
If the amount you and your plan pay toward prescription drugs reaches a certain level, you’ll enter the donut hole. Keep in mind that not everyone gets to the prescription donut hole — the gap was designed to encourage Medicare recipients to seek out lower-cost drugs and generics. The Medicare donut hole in 2021 starts at $4,130.
When Does the Medicare Donut Hole End?
The coverage gap ends when you reach the catastrophic coverage limit for the year. In 2021, this amount is $6,550.
The good news is that the donut hole essentially closed in 2020, so that even when you hit the coverage gap, you won’t pay more than 25% of the cost of prescription drugs. However, around 95% of the cost will count toward moving you out of the hole.
Do Medicare Advantage Plans Cover the Donut Hole?
Medicare drug coverage — Part D — works the same in a Medicare Advantage plan as it does with a "Stand-alone” Part D plan. However, some Medicare Advantage plans offer more generous benefits during the donut hole than a stand-alone Part D plan does.
Understanding your prescription drug coverage is essential so that you know if you’re likely to approach a coverage gap based on the price of your medication. If so, make sure you know what the costs will be during the donut hole period.
Medicare Part D Plans Without the Donut Hole
There are no Medicare Part D plans — including Medicare Advantage plans — without a coverage gap. However, some prescription plans have additional coverage options during the donut hole.
For instance, your Medicare Advantage plan might include coverage for some generic medications even in the gap. Or, they may offer some drugs at a lower cost than 25%. It all depends on your plan and provider.
The best way to avoid the donut hole is to work with your doctor to keep the cost of your medication low. If that’s not possible, the fact that you will pay no more than 25% of the full cost even in the coverage gap will help ease your mind.
How Do I Get Out of the Medicare Donut Hole?
If you’re in the Medicare Part D donut hole, the only way to get out is to spend enough to reach the catastrophic coverage threshold. The good news is that while you’re paying no more than 25% of the cost of the medication, close to 95% of the cost of the drugs is going toward your spending total.
One way to manage the coverage gap “donut hole” is to work with your doctor to find effective low-cost and generic medications that will help you maintain your physical health.
Here are some tips that can help:
Use a generic or find a similar drug that has a generic
Talk to your doctor about drug costs and whether specific prescriptions are really needed
Shop around — different pharmacies offer different drug prices
Compare Medicare plans each year to make sure you have affordable drug coverage
Learn More About Medicare Costs and Plans
Medicare costs can be confusing, especially when there is the possibility of a coverage gap in the middle of the year. Fortunately, even during the Medicare donut hole, you don’t have to pay more than 25% of a prescription drug price, and you may even pay less.
If you’re interested in comparing Medicare plans to make sure your drug coverage meets your needs, talking to a licensed insurance agent can help. Learn more about your options and compare Medicare plans today!
Everyone can enroll in Medicare in the seven-month period around their 65th birthday through the Medicare Initial Enrollment Period (IEP). It starts three months before your birth month, includes your birth month, and ends three months afterward. If you don’t enroll in Medicare (either Medicare Part A or Part B) during your IEP, you can enroll enroll in either during the General Enrollment Period that occurs annual from January 1 through March 31 of each year.
After you enroll in Medicare when can you change your Medicare coverage options?
There are three main enrollment periods that allow you to make changes to your coverage. Everyone with Medicare can make changes during the annual enrollment period (AEP). If you have certain qualifying events happen in your life, you may also have a special enrollment period (SEP) to allow changes. And if you are enrolled in a Medicare Advantage (MA) plan, you will also have an opportunity to make changes during the MA open enrollment period (OEP) that happens at the beginning of the year. .
This article will cover these enrollment periods in more detail so you know exactly when you can make changes to your Medicare plan.
Special Enrollment Period SEP for those enrolled in Medicare Advantage or Prescription Drug Plans
If you have special circumstances in your life, , you may qualify for a Medicare SEP to change your Medicare Advantage or Part D plan coverage. The special enrollment period options and length will be different for each circumstance.
For example, you could qualify for an SEP if you:
Retire from a job after age 65
Move
Become eligible for Medicaid
Have your Medicare plan terminated by the insurer
Lose other medical or drug coverage
To learn more about Medicare SEPs, check out our guide on special enrollment periods.
Medicare Advantage Open Enrollment (MA OEP) vs. Annual Enrollment (AEP)
Both Medicare annual enrollment period (AEP) and Medicare Advantage Open Enrollment period (MA OEP) happen each year. However, there are some important differences. This will help you understand Medicare AEP vs Medicare Advantage OEP.
The Medicare annual enrollment period is between October 15th and December 7th of each year. During this time everyone with Medicare can join, switch, or drop any Medicare Advantage or Prescription Drug plan (“Part D). Your coverage will begin on January 1st, as long as you make your choice by December 7th.
The Medicare Advantage open enrollment period applies only to those enrolled in Medicare Advantage plans. From January 1st to March 31st each year, you can switch to a different Medicare Advantage plan, or switch from Medicare Advantage to Original Medicare and join a separate drug plan.
To summarize the Medicare annual enrollment period vs Medicare Advantage open enrollment period:
Dates: Oct 15 - Dec 7 for AEP, Jan 1 - March 31 for Medicare Advantage OEP
Costs: None beyond your plan’s monthly premiums
Eligibility to Enroll: AEP — any Medicare beneficiary; OEP — Medicare Advantage enrollees only
Form of Medicare Available: AEP — any; MA OEP — Change Medicare Advantage plans or Medicare Advantage to Original Medicare
Medicare Enrollment Periods Chart
This chart can help you understand Medicare open enrollment vs annual enrollment, along with special enrollment periods.
Medicare Annual Enrollment (AEP)
Medicare Advantage Open Enrollment (OEP)
Medicare Advantage & Part D Special Enrollment (SEP)
Start Date
October 15th
January 1st
When a qualifying even occurs
End Date
December 7th
March 31st
Varies
Notes
Any Medicare beneficiary can make any changes
Medicare Advantage enrollees only, limited changes
Details depend on the qualifying event
Learn More About Medicare Enrollment Periods
Now that you understand the different enrollment periods, you might decide you want to make a change. Making the right choice for your needs is easier when you talk to a licensed insurance agent. Contact us today for any questions about enrollment periods or comparing Medicare plans!
Medicare Part D offers important prescription drug coverage and is part of both Original Medicare and Medicare Advantage. As a result, it’s important to understand the Medicare Part D phases that occur each year.
There are four Medicare Part D stages. Depending on your drug costs, you may not reach all four in a given year. However, it’s still vital to know what to expect in case your prescription drug needs increase over time.
Here’s what you need to know.
What are the 4 Stages of Medicare Part D?
What are the Medicare Part D stages of coverage? As we mentioned, there are four of them. They start with the deductible period, then initial coverage, followed by the donut hole, and then catastrophic coverage. We’ll go in-depth into each stage so that you can fully understand how they work for you.
Deductible Period
During the deductible period, you pay the full price of your prescription drugs until you meet your Medicare Part D deductible. The deductible may vary from one plan to another, but Medicare does set a maximum limit.
Medicare Part D Deductible 2021
In 2021 the deductible limit for Medicare Part D is $445.
Some plans have a $0 deductible, meaning that you skip the first of the Medicare Part D payment stages and move straight into initial coverage.
Other plans have a deductible that only applies to certain tiers of medications, while other medications are covered right away. For instance, generic medications may be covered immediately while name-brand medications have a deductible.
Make sure you review the Medicare Part D deductible when you compare plans each year so you can choose the plan that’s best for your needs.
Initial Coverage
Once your deductible is met, you move into initial coverage. This is where your Medicare Part D plan covers your medication, and you only pay a copayment or coinsurance each time. Each plan will have a different list of covered medications and different out-of-pocket costs, so be sure to carefully review the details of your plan.
The initial coverage period lasts until you hit $4,130 in total drug costs, which includes both the amount you have paid during the year and the amount your plan paid. Depending on your medical needs, you may not hit the limit, but if you do, you enter the coverage gap known as the Medicare donut hole.
Medicare Part D Donut Hole
Once you hit the Medicare Part D initial coverage limit, you enter a gap in coverage known as the donut hole. In the past, you had to pay a significant amount of your drug costs during this gap. The coverage gap for all drugs essentially closed in 2020, meaning your share of costs in the “donut hole” is limited to 25% of the drug cost (both brand-name and generic).
This percentage will replace the copayment or coinsurance you were paying during the initial coverage period. S For a generic drug that costs $100, you would pay $25 for that drug during the donut hole. For brand-name drugs, even though you only pay 25% of the cost, around 95% of the cost will count toward your out-of-pocket total to move you out of the coverage gap.
Once you have paid $6,550 in out-of-pocket costs for prescription drugs, you’ll exit the donut hole and enter catastrophic coverage.
Medicare Part D Catastrophic Coverage
The final stage of Medicare Part D is catastrophic coverage. What is catastrophic coverage in Medicare Part D? It’s a phase designed to help those who have especially high prescription drug costs.
During catastrophic coverage, you’ll pay significantly lower copayments or coinsurance for your remaining prescriptions for the year. For Medicare Part D catastrophic coverage in 2021, you’ll pay 5% of the cost of drugs, and the plan pays for the remainder.
Does Medicare Part D Have an Out-of-Pocket Maximum?
There is no out-of-pocket maximum for Medicare Part D, but once you hit catastrophic coverage, your out-of-pocket costs drop significantly. Generally, you’ll pay a a minimum of $9.20 for brand-name medication and $3.70 for generic drugs, or 5% of retail costs, whichever is higher.
Learn More About Medicare Part D Coverage Stages
Medicare Part D is important coverage for many Medicare beneficiaries. That’s why it’s vital to understand the various Part D phases and whether you will enter them in a specific year. Comparing plans is easier with a licensed insurance agent by your side. Contact us to learn more or use our plan comparison tool to learn about plans in your area.
Not all Medicare beneficiaries can afford to pay their premiums, copayments, and coinsurance. If you have a lower income, it’s possible that you’ll qualify for a Medicare Savings Program to help with your out-of-pocket expenses.
Are you asking, “Do I qualify for a Medicare Savings Program?” If so, this article will help. This page is designed to help you understand the Medicare Savings Program income limits and other requirements.
Read on to find out if you qualify.
What Does the Medicare Savings Program Cover?
There are four different Medicare Savings Programs that you may qualify for. Each one has different requirements and benefits. In general, there are income limits and resource limits to qualify for each program, and they may help pay your premiums, deductibles, copayments, and coinsurance.
Qualified Medicare Beneficiary
The first program is known as the “Qualified Medicare Beneficiary” program. If your income is 100% of the Federal Poverty Level or below and you are below the resources threshold, you can qualify for assistance with Part A premiums (if applicable), Part B premiums, deductibles, copayments, and coinsurance. Providers are not allowed to bill you for services or items covered by Medicare, and you pay very little for prescription drugs as well.
Specified Low-Income Medicare Beneficiary
You may be eligible for the Specified Low-Income Medicare Beneficiary (SLMB) program if you make less than 120% of the Federal Poverty Level and are below the resources threshold for the program.
This program covers your Part B premium but does not cover any other out-of-pocket expenses from Medicare. You will still be responsible for your deductible, copayments, and coinsurance.
However, you will qualify for Extra Help with prescription drugs under Medicare Part D automatically, which will help you save money on needed medication.
Qualified Individual Program
The Qualified Individual (QI) program is state-based and helps pay Part B Medicare premiums for those with Medicare Part A and limited resources. This limited program is available on a first-come, first-serve basis and has limited spots each year. You also need to reapply each year.
You can qualify for the QI program if you make 135% or less of the Federal Poverty Level income and are below the resources limit for the program.
Qualified Disabled Working Individual
If you qualified for Medicare due to a disability but recently returned to work, you may no longer be able to get Medicare Part A premium-free. You can qualify for this assistance if you make as much as 400% of the Federal Poverty Limit if your income is from working.
The Qualified Disabled Working Individual (QDWI) program may help you if the following apply:
You’re a disabled working person under 65
You lost Social Security benefits and premium-free Medicare Part A due to returning to work
You’re not getting medical assistance from your state through Medicaid
You meet the income and resource requirements set by the state
QDWI will help pay your Medicare Part A premiums.
Who Qualifies for the Medicare Savings Program?
There are two qualifications for the Medicare Savings Programs. One is based on your income, and the other is your resources. The requirements may vary depending on the state you live in, and whether any of your income comes from working. Let’s take a deeper look.
What is the Income Limit for the Medicare Savings Program?
The Medicare Savings Program income limit varies by location; most states base it on a percentage of the Federal Poverty Limit, which shifts slightly each year.
In 2021, here are the monthly income limits for each program. Limits for Hawaii and Alaska are slightly higher.
Qualified Medicare Beneficiary: Individual $1,094 and Married Couple $1,472
Specified Low-Income Medicare Beneficiary: Individual $1,308 and Married Couple $1,762
Qualified Individual: Individual $1,469 and Married Couple $1,980
Qualified Disabled Working Individual: Individual $4,379 and Married Couple $5,892
There are also resource limits for each program. Counted resources include stocks, bonds, and money in your checking or savings account. The resource limit for the QMB, SLMB, and QI programs is $7,970 for an individual and $11,960 for a married couple.
For the QDWI program, the resource limit is $4,000 for an individual and $6,000 for a married couple.
What Counts as Income for Medicare Savings Program?
When looking at your income, how do you know what counts? The good news is that if you are working, around half of your working income is excluded. Worker’s compensation and disability benefits are also excluded.
If your income, after these adjustments, is close to the limit, it’s worth applying for the program. If approved, you could save a considerable amount of money on out-of-pocket expenses. Contact your state’s Medicaid office if you have questions about your eligibility.
Medicare Savings Program vs. Medicaid
The Medicare Savings Program is administered by each state, often through the Medicaid office. However, it is not the same as Medicaid.
Medicaid is specifically designed for low-income families and individuals and covers medical care with little to no out-of-pocket expenses. There is no monthly premium to be on Medicaid, you qualify based on your income and assets.
The Medicare Savings Program is designed to help Medicare beneficiaries, who are disabled or over 65, pay for their out-of-pocket costs with Medicare. This may include your Part B premium, your Part A premium (if any), and other costs.
It is possible to be eligible for both Medicare and Medicaid at the same time. These folks are known as “Dual Eligible,” and generally qualify for a Medicare Savings Program automatically, along with Extra Help for prescription drugs.
Learn More About the Medicare Savings Program
If you’re ready to learn more about Medicare and the Medicare Savings Program, it’s helpful to talk to a licensed insurance agent. Contact us to learn more and compare plans to find the one that’s right for you.
For most Americans, enrollment in Medicare is automatic around the time you turn 65. If you’re already receiving retirement benefits from Social Security or the Railroad Retirement Board, you will automatically start receiving Medicare benefits on the first day of the month you turn 65.
But what if you’re still working, or you don’t want to sign up for Medicare right away? Is it mandatory to go on Medicare when you turn 65? This page will help you understand your options.
Do You Automatically Get Medicare When You Turn 65?
If you are already receiving Social Security retirement benefits, you will automatically get Medicare at age 65 if you qualify for premium-free Medicare Part A. If you have to buy Medicare Part A, you will need to sign up manually online or by contacting your local Social Security office.
You’ll know if you were automatically enrolled because you’ll receive a “Welcome to Medicare” package in the mail. This package includes details about Medicare Part A and Part B, along with your Medicare card. It will also help you answer the question, “How much will I have to pay for Medicare when I turn 65?” If you are uncertain or have questions about your Medicare eligility, you can contact Social Security direction, either via phone, online or visiting a local SSA office.
You have the option to reject Medicare Part B if you don’t want it. However, if you change your mind and enroll later, you may have to pay a late enrollment penalty.
What Happens If You Don't Sign Up For Medicare At 65?
Do you have to sign up for Medicare when you turn 65? Unless you are covered by an employer group or union health insurance plan, if you don’t and enroll later, you will have to pay higher premiums. So while you don’t “have” to sign up, it will likely cost you more if you delay.
If you’re not automatically enrolled and you also decide not to enroll for Medicare during your initial enrollment period near your 65th birthday, you won’t have coverage. If you change your mind, you will need to manually enroll in Medicare Part A and Part B by contacting your local Social Security office. And you may have to pay higher premiums if you didn’t enroll when you were first eligible. Again, unless you were covered by your employer or union group coverage.
If you qualify for premium-free Medicare Part A, you can enroll in that coverage anytime. However, for Medicare Part B, you can only enroll during specific enrollment periods. The General Enrollment Period (GEP) for Medicare occurs every January - March 31 and is an opportunity for individuals to apply for Medicare Part A or B if not automatically enrolled in Medicare or missed their Initial Enrollment Period. Enrollments during the GEP are effective July 1. If you don’t get Part B when you are first eligible, you could have to pay a late enrollment penalty.
Do You Have To Sign Up For Medicare At 65 If You Are Still Working?
If you have medical coverage under a group health insurance plan offered by an employer or a spouse’s employer, you generally do not have to sign up for Medicare at age 65. You are able to delay your enrollment until your group coverage ends, without paying a penalty. Medicare gives you a special enrollment period that lasts eight months after the group coverage ends. The exception is for employers with less than 20 employees, so check with your employer or Social Security because if you don’t enroll in medicare, your employer might pay less or not at all.
You can also sign up for Medicare Parts A and B while you’re still working, if you choose to. As long as you were previously covered by a group health insurance plan, you won’t have to pay a penalty.
If you have Medicare Part B and return to work after the age of 65, you can drop Part B, as long as you have coverage under your employer’s group plan. When the group plan coverage ends, you can sign up for Part B again without paying a penalty.
Understanding Your Medicare Option
Knowing exactly when to enroll in Medicare can be confusing, especially if you’re still working or not receiving retirement benefits. Also, it’s important to understand all of your options and decide whether Original Medicare is right for you or if you want a different plan.
The best way to find out is to talk to a licensed insurance agent. Contact us to find and compare plans today!
Medicare is important health insurance coverage for many Americans, and it pays to fully understand the coverage you have. When there are a variety of parts, all with different letters, it can be a challenge. What are Parts A and B and which one do you need?
Fortunately, we can help. Medicare Part A and Part B are both elements of Original Medicare. They cover your health costs in different situations. Here’s what you need to know.
What Is Medicare Part A And B?
Medicare Part A
Medicare Part A is known as hospital insurance because it helps cover the costs when you are hospitalized. Part A pays for inpatient care, hospice care, skilled nursing, and some home health care services.
Medicare Part A generally does not cover 100 percent of costs. There is usually a copay or deductible that you are responsible for. Also, in order to qualify for coverage, the services must be deemed medically necessary.
Is Medicare Part A Premium Free?
Medicare Part A can be premium-free for many Americans. In order to qualify for this, you have to be receiving Social Security or the Railroad Retirement Board, and you need to have a qualifying work history. This means that you or your spouse have worked a specific number of quarters while paying FICA taxes.
Medicare Part B
Medicare Part B is medical insurance. It covers services such as doctor’s visits, preventive care, mental health, physical therapy, and other outpatient care. In order to use Medicare Part B, the provider must accept Medicare insurance and the items and services must be medically necessary.
Like Medicare Part A, Part B does not cover 100 percent of costs. If you have Original Medicare, you will be responsible for 20% of the Medicare-approved amount for each service or item. You may also have a deductible.
Is Medicare Part B free?
Medicare Part B is not free. Most Americans have to pay a monthly premium for Part B. If you are lower-income, you may be eligible for programs that help you pay for your Part B premium.
Who Is Eligible For Medicare A And B?
Eligibility for Medicare A and B is generally limited to Americans and permanent residents who are 65 years of age or older. You may also qualify if you are under age 65 and have a qualifying disability or end-stage renal disease.
Many people get Medicare Part A and B automatically when they turn 65, but some people need to sign up. If you are already receiving Social Security benefits when you turn 65, you will automatically get Medicare Parts A and B. However, be sure to check our your eligibility requirements if you have more questions or need for more information.
Learn More About the Differences Between Medicare Part A and B
It’s important to fully understand your Medicare options so that you can choose the right plan for your needs. Medicare Parts A and B are just the beginning. You can also qualify for additional coverage that may lower your out-of-pocket costs.
To learn more about your Medicare options, talk to a licensed insurance agent and compare plans today!
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