Medicare Checklist — for those who are turning 65 or eligible
Each phase of life offers different challenges and new opportunities. When you are approaching age 65 you may or may not want to retire just yet. If you are still working and have your health insurance offered through your job, then you may delay enrolling in Medicare and postpone retirement. However, if you are turning 65 years young and are not enrolled in group health insurance through your job, it is important to get all your ducks in a row and plan your Medicare enrollment accordingly. I put together a series of videos and a simple process that will help you understand what to do and when to enroll in Medicare and avoid costly mistakes and penalties, how much it’s going to cost, and what to know if you’re still working. So if you’re turning 65 in the next few years and you want a quick overview, please keep reading!
Firstly, let’s see what is Medicare?
Medicare is a federal program that offers health insurance to American citizens and other eligible individuals based on age, disability, or a qualifying medical condition. Medicare is individual insurance and doesn’t cover spouses or dependents. Medicare is not Medicaid. Medicaid is a program that helps pay health care costs for people with limited income and resources. You can get both Medicare and Medicaid if you are eligible.
Who can get Medicare?
Generally, you’re eligible for Original Medicare (Parts A and B) if you’re a U.S. citizen or you’ve been a legal permanent resident for at least 5 continuous years, and one of the following applies to you:
· You’re 65 or older and eligible for Social Security
· You’re under 65, permanently disabled and you’re receiving disability benefits from Social Security or the Railroad Retirement Board
· You have end-stage renal disease (ESRD)
· You have ALS (Amyotrophic Lateral Sclerosis), also known as Lou Gehrig’s Disease
How to enroll in Medicare?
STEP 1
The first step is enrolling in Original Medicare, Medicare Parts A, and B. If you are receiving Social Security or Railroad Retirement Board benefits when you become eligible you will be automatically enrolled in Medicare Parts A and B. You’ll receive your Medicare card in the mail.
If you’re not receiving benefits, you need to sign up for Medicare at least 3 months before your 65th birthday. Here is how to do it:
- Visit your local Social Security Office
- Apply Online: https://www.ssa.gov/benefits/medicare/
- Call Social Security at 1–800–772–1213 (TTY: 1–800–325–0778).
- If you already have Part A and want to sign up for Part B, complete an Application for Enrollment in Part B (CMS-40B).
When to enroll in Medicare?
Your Initial Enrollment Period (IEP) is your first chance to enroll in Medicare. It is 7 months long — it includes your birthday month or the 25th month of getting disability benefits plus the 3 months before and 3 months after.
You may qualify to delay Medicare enrollment if you have creditable coverage through your employer or your spouse’s employer. If you like your health plan and it’s affordable, you can keep the employer-sponsored plan and wait to receive Medicare benefits until you retire. When you do retire, you will likely be eligible for a Special Enrollment Period. The 8-month Special Enrollment Period (SEP) begins either when you lose the employer coverage or leave your job, whichever occurs first.
Additional things to note when working past 65:
• If your employer has 20+ employees, you may be able to delay without penalty. But if your employer has less than 20 employees, you will likely need to enroll in Medicare.
• If you have a health savings account (HSA), be aware that once you enroll in any part of Medicare you can’t continue to make contributions to your HSA.
• If you delay, you will need to provide written proof of your creditable drug coverage to avoid Part D penalties.
You may be able to enroll or make changes at other times
• Medicare offers a General Enrollment Period (GEP) every year from January 1 — March 31 for those who have missed their Initial Enrollment Period. During this time you can enroll in Part A, Part B, or both, with coverage beginning July 1.
Keep in mind, if you enroll after your Initial Enrollment Period or Special Enrollment Period, you could face late penalties for Medicare Part A, Part B or Part D.
STEP 2: Choose Your Medicare Path — Enroll in a Health and Prescription Plan
Once you enroll in Original Medicare and receive your Medicare Card, you have to make a very important decision — What health and drug plans to add to your Original Medicare?
See, Original Medicare Parts A and B don’t cover everything. In addition, you are required by law to enroll in a prescription plan (either a standalone Part D or via a Medicare Advantage plan that covers medications).
Let’s see what options we have:
You have two options for more coverage.
• Option 1 is to add Medicare supplement insurance and/or a Part D prescription drug plan to Original Medicare. Medicare supplement insurance will help pay some of the out-of[1]pocket costs not paid by Medicare Part A and B. Part D will cover prescription drugs.
• Option 2 is to choose a Medicare Advantage plan (Part C). Most Medicare Advantage plans include drug coverage and additional benefits such as dental and vision coverage.
I will not go over in detail to explain these options. I have so many articles and videos specifically on this topic. I have a recent video where I compare side by side Option 1 and Option 2 where I discuss the advantages and disadvantages of both, so please check this out!
STEP 3: Do not forget about Part D- Prescription Plan
A Medicare Prescription Drug Plan (Part D) will help cover the cost of your prescription medication. There might be a penalty if you don’t sign up for the Part D plan on time.
If you decide to go with Option 2 and enroll in a Medicare Advantage Plan (part C), check if the plan you are considering has prescription coverage. This is very important! Most of the Medicare Advantage plans have this benefit included but some don’t and you can not enroll separately in a Medicare Advantage and Part D- it has to be an MAPD, which means the plan covers both the medical and the prescription coverage.
Now, if you decide to go with Option 1, and enroll in Medicare Supplement Insurance, you will have to add a separate stand-alone Part D prescription plan!
Here are some important facts related to stand-alone Part D plans:
• Must be enrolled in Part A, Part B or both
• You may be required to use a pharmacy network
• Coverage and costs vary by plan and may change each year
• There is a Part D premium penalty for late enrollment
STEP 4: Enroll in a plan.
Once you decide on your coverage, you’re ready to enroll. So let’s explore the different enrollment periods.
We already discussed when to enroll in Original Medicare and typically the best times to add a Medigap with Part D or a Medicare Advantage plan is ideally at the same time when you enroll in Original Medicare Part A and Part B.
However, if you would like to change your options later on you will have to mark your calendar and do so only during certain times of the year.
Whatever you decide, make sure to plan accordingly and research all the options and consequences. It’s important to pay attention to the timing of your enrollment to avoid late penalties.
This table shows in a concise way all of the enrollment periods that you need to be aware if you are transitioning to Medicare. Make sure you keep a copy of it as this will help you with timing and planning your enrollment in Medicare.
There are many options to enroll in a plan. I would suggest you work with a licensed independent insurance agent in your area. Agents don’t charge for their services and are a great resource! If you don’t have an agent, feel free to reach out to us! We are licensed in California and have contracts with the major insurance companies in the state, which allows us to compare various options and allow you to choose a plan that best fits your needs.
www.InsuranceCenterHelpline.com
STEP 5: Add dental or vision to your plan if you need one!
So by now, you already are aware that Original Medicare does not cover everything and you can greatly benefit and fill in the gaps by enrolling in a Medicare Supplement and Part D or a Medicare Advantage Plans. Those are great options, but even these plans won’t cover dental and vision benefits. Long-term care benefits are also not covered by Medicare, so consider looking into this coverage as well. The earlier you start planning for these benefits, the better for you!
You can schedule your free, personalized plan comparison with us. We will review all health coverage options available to you, and help you determine which Medicare Insurance Plan provides the right amount of coverage, at the right price. Whether you enroll in plan coverage on your own, or with our assistance, plan pricing is the same.
If you have found this information useful, please feel free to share it with someone who may benefit! Also, consider exploring other videos on this topic on our YouTube channel.
here is the video version of the above information:
Disclaimer: Medicare has neither reviewed nor endorsed this information.
Not connected with or endorsed by the United States government or the federal Medicare program
questions
This is a list of the most asked questions. We will attempt to answer all of these questions on our website or blog or you can also explore the educational videos available on our Youtube channel at no extra cost! If you have a specific question, please contact us and we will be glad to answer it. We usually don’t charge for answering questions!
- What is Medicare?
What is Medicare Part A?
What is the Premium for Part A?
Who should not enroll in Part A?
What is Medicare Part B?
Should I enroll in Medicare Part B?
When should I enroll in Medicare Part B?
What is the premium for Part B?
What is Medicare Part C?
What is Medicare Part D prescription drug?
Are there any zero premium Medicare Plans?
Am I required to enroll in Part D?
How much does Part D cost?
When can I enroll in Medicare?
What is Medicare Open Enrollment?
What does Medicare cover?
What is not covered by Medicare?
What is Original Medicare?
Who is eligible to enroll in Medicare?
Is long term care covered by Medicare?
Is dental covered by Medicare?
Is acupuncture covered by Medicare?
Is cosmetic surgery covered by Medicare?
Are hearing aids covered by Medicare?
What is initial enrollment period?
What is general enrollment period?
What is a special enrollment period?
What is the late enrollment penalty for Part A?
What is the late enrollment penalty for Part B?
What is the late enrollment penalty for Part D?
What is HMO (Health Maintenance Organizations)?
What is PPO (preferred Provider Organization)?
What is PFFS (private fee for service plans)?
What is Special Needs Plans (SNP)?
What is HMO Point of Service plans (HMOPOS)?
What is Medical Savings Account (MSA) plans?
When can I join a Medicare plan?
When can I switch Medicare plans?
When can I drop a Medicare plan?
What is Medicare Supplement Insurance?
What is Medigap?
What does Medigap cover?
When can I buy a Medicare Supplement Plan?
Is Medicare provided by Covered California?
What is the difference between Medicare and Medi-Cal?
Is Medicare free?
What is Share of Cost?
What is the “coverage gap”?
What is “catastrophic coverage”?
Which prescription drugs are covered by Part D?
What is the Coordinated Care Initiative?
What does “dual eligibility” mean?
If I am enrolled in employer-sponsored health insurance do I have to enroll in Medicare?
Who pays out of pocket costs?
What is the difference between Medicare Advantage and Medicare Supplement Plan?
Are prescription drugs covered by Medicare Supplement plans?
Can I buy a Medicare Advantage and a Supplement plan at the same time?
How much does a Medicare Supplement (Medigap) plan cost?
How much Medicare supplement insurance coverage do I need?
How can I find a Medicare Part D plan?
How can I find a Medicare Supplement Plan?
How can I find a Medicare Advantage Plan?
How to enroll in Medicare?
When is a good time to enroll in a standardized Medicare supplement insurance plan?
Can I qualify for Medicare if I am younger than 65 years old?
Can I have employer-sponsored insurance and Medicare at the same time?
What is Medi Medi?
How many programs does Medicare have?
How many parts Medicare has?
How can I get help paying for medical cost?
Am I automatically enrolled in Part A and Part B?
Does Medicare cover international emergencies?
What is a “Medicare Summary Notice”?
What does “assignment” mean?
What is the Medicare Part D “donut hole”?
How can I get extra help to pay my medication?
How do I get a Medicare Card?
Can I enroll in Medigap if I don’t have Medicare?
What is a “Guarantee Issue Period”?
What is Final Expense?
Is Obama-Care like Medicare?
How to find and compare Medicare Part D prescription drug plans? How to find Medicare Supplements ?
