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New To Medicare?

Feeling lost? You are not alone.

People who are new to Medicare often have a hard time sorting things out in the beginning. There are all these parts and plans with similar letters, which makes it hard to figure out what is what. The tremendous amount of phone calls and mail that people new to Medicare receive certainly doesn’t help either!  It is very important for everyone New to Medicare to get accurate information about coverage and delivery options, including Original Medicare, Medicare Supplements, Medicare Advantage, and Prescription Drug Coverage.  Attention to these issues will help you avoid serious and costly problems later.

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Medicare as Your Primary Insurance

Leaving employer coverage to transition to Medicare as your primary insurance can be overwhelming because it’s all new to you.  Never fear though; it’s a painless process when you know the proper steps to take. You can find most of the information you need about Medicare planning right here on this website. 

Medicare planning can help you avoid penalties and get the most out of your benefits.

First, you need to know that the only parts of Medicare you will enroll in via the Social Security office is your Original Medicare Parts A & B. All other Parts and supplemental coverage enrollments are done outside of that, through an insurance agent or agency.

Also, if you are already taking Social Security, the government will auto-enroll in both parts of Medicare. Otherwise, you must enroll yourself.

Here is an overview of the steps you will take to get the ball rolling:

Medicare Eligibility

Who is eligible for Medicare? When can you get Medicare? Medicare eligibility begins for most people at age 65. Individuals who have been entitled to Social Security disability for at least 24 months also qualify.

Many people confuse their Medicare Eligibility date with their Social Security retirement age. They are different. A person can apply for full retirement income benefits at around age 67. This is considered their retirement age. However, this does not affect the age at which they qualify for Medicare.

There is no such thing as a Medicare retirement age. The normal Medicare eligibility age for Medicare is age 65, whether you have retired or not. You can qualify for Medicare coverage at age 65 (or older) if you are a U.S citizen or a permanent resident and you’ve lived here continuously for 5 years or more.

You can also qualify for Medicare under these circumstances when you are under age 65:

Eligibility for Medicare Part B

You are eligible for Medicare Part B at age 65 as well. However, you must pay a monthly premium for Part B.  This provides for your outpatient benefits such as doctor visits, lab work, surgery fees, and more. Check out our Part B page for more on what Part B covers.

Some people turning 65 still have health insurance through an employer. They can delay their enrollment into Part B in favor of their group health insurance without fearing a late penalty.

If you delay enrollment into Part B, consult with an insurance agent who specializes in Medicare. He or she can explain the special election periods which you must use later on so that you won’t be subject to a late enrollment penalty.

Eligibility for Medicare Part C

Medicare Part C is another name for the Medicare Advantage program. You can enroll in Part C if you wish to get your benefits through a private insurance company instead of Original Medicare. Usually, these plans have smaller networks than Medicare, but some of them include built-in Part D coverage.

To be eligible for Part C, you must first be enrolled in both Medicare Parts A and B. You must also live in the plan’s service area.

Many people think that if they enroll in a Medicare Advantage plan, they can drop their Part B and escape paying Part B premiums. This is NOT the case. You must have both A and B to even be eligible to enroll in either a Medicare Advantage plan or Medicare supplement plan. You must continue to be enrolled in Parts A and B during the entire time that you are enrolled in a Medicare Advantage plan.

Eligibility for Medicare Part D

You are eligible for Medicare Part D as long as you are actively enrolled in either Part A and/or B. You must also live in the Part D Plans' service area. Though Medicare Part D is voluntary, we strongly recommend it if you have no other drug coverage. Part D provides your insurance against future catastrophic medication costs. It will also help give you lower copays on medications you take now.

Be aware that if you do not enroll in Part D and you have no other creditable coverage, you may incur late penalties when you enroll later on.

Frequently Asked Questions

Is everyone eligible for Medicare?

NO. You must be a U.S. Citizen or a permanent resident who has lived continuously in the United States for at least 5 years.

When do I qualify for Medicare?

If you aging into Medicare, you will qualify at age 65. This is regardless of when you apply for Social Security income benefits.

Who is eligible for Medicare under age 65?

Can a person get Medicare at age 62?

Not unless they qualify under one of the circumstances discussed in the previous question. Your Medicare eligibility date is not the same as your Social Security eligibility date.

At what age can you apply for Medicare?

You can apply when you are age 64, as early as 3 months before your 65th birthday month.

How long do you have to work to be eligible for Medicare?

Your eligibility for Medicare is not based on your work history. However, people with at least 10 years (40 quarters) of paying Medicare payroll taxes will get Part A services without paying premiums once they are eligible.

Is Medicare age changing to 67?

Under the current federal laws, the Medicare age of eligibility is still 65, although some younger people can enroll as discussed above. Congress has discussed changing the age of Medicare eligibility, but as of yet that change has not been voted into law, so standard Medicare age is still 65.

Is it mandatory to sign up for Medicare at age 65?

No, but if you do not have other creditable health coverage, you will face penalties for delaying your Medicare enrollment. You should also know that when you enroll in Social Security income benefits, you will be automatically enrolled in Medicare Part A. You cannot have one without the other.

Who is eligible for Medicare and Medicaid?

Medicare is our national health insurance system for people aged 65 and older and people with certain disabilities. Medicaid is a joint federal and state program to provide benefits for people with low incomes. It is possible to have qualified for both Medicare and Medicaid. In this scenario, Medicare is primary and Medicaid is secondary.

Who is eligible for Medicare part D?

Anyone who is enrolled in either Medicare Part A or Part B (or both) is eligible to enroll in Part D. You must enroll when you are first eligible unless you have other creditable drug coverage. Otherwise, you will be subject to an expensive late penalty for Part D later.

Find out about your Medicare Eligibility

Determining your Medicare eligibility is sometimes tricky. We get many questions about when can you collect Medicare, how to qualify for Medicare, what are the requirements for Medicare, when to enroll in Medicare, and how to set up Medicare supplement insurance.  Though the process may seem overwhelming to you, our Certified Medicare Advisors with these processes every day. We can guide you easily through the process before you reach Medicare age.

You are not alone – let one of our Certified Medicare Advisors assist you in making this entire process easier.

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Medicare Costs for 2020

How much does Medicare cost? Do you have to pay for Medicare? Is Medicare Part B free? What are 2020 Medicare premiums?

These are very common questions about the costs of Medicare. The costs for Medicare Part B and Part D, as well as supplemental coverage, are something that many don’t anticipate. It can surprise you when you turn 65 and learn that Medicare is not free. So do you have to pay for Medicare? Yes, most people do pay Medicare premiums. Fortunately, it’s fairly easy to put together a Medicare cost estimate so that you can plan ahead.

4 Simple Steps to Understanding Medicare

Understanding Medicare is easier said than done. You get a big "Medicare & You" Handbook for 2020 in the mail, full of terms that are difficult to understand. Then there are scores of insurance agents calling you on the phone and sending you tons of mail with a foot-high stack of mail every week.

If your desk is covered in Medicare mailers and you aren’t sure what to keep. You need the 4 Simple Steps to Understand Medicare!

Are you supposed to read all the mail that you receive? Do you have any idea what is important and what's not? How do you know which mail is ok to throw away?

You are not alone, Medicare can feel a little scary when it’s entirely new to us. Most of us spend our lives working for an employer who selects our insurance for us.  We go to an annual benefits meeting and sign up for the plan they’ve chosen for us.

When we reach 65, we are clueless about Medicare and its dozens of plan options.

Perhaps you are new to Medicare, and it will be your primary insurance. Maybe you are working and not even sure if you need Medicare, but you want to make sure you don’t unknowingly get a late enrollment penalty.

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4 Simple Steps to Understanding Medicare

#1 – Understanding Medicare Basics First 

Who can get Medicare? Anyone who is 65 in America, even permanent residents who have lived here at least 5 years. People who have qualified for 24 months of Social Security disability also become eligible. For people aging into Medicare at 65, it doesn’t matter if you are taking Social Security benefits. 

Once you’ve confirmed you qualify for Medicare, we recommend starting with the basics. People get confused when jumping right into figuring out Medicare supplement plans and Medicare Advantage plans before they even understand how their Original Medicare benefits work.

Before you worry about all that, I want you to first familiarize yourself with the Medicare basics. Your Original Medicare consists of Part A and Part B.

These benefits are provided to you by the federal government. You will enroll in these two parts and only these two parts (Part A and Part B) through the Social Security office.

Anything in your mailbox that comes from the Social Security office or the Centers for Medicare & Medicaid Services is mail you want to keep.

The Parts of Medicare

Medicare itself has 4 PARTS (NOT PLANS).

Part A is your Hospital Coverage. This coverage pays for your room and board in the hospital or in a skilled nursing facility.

Part B is your Outpatient Coverage. This includes pretty much everything else: doctor visits, equipment, lab-work, surgeries, durable medical equipment, diagnostic tests, etc.

Part D is your drug coverage. This is a prescription drug benefit that will allow you to purchase your prescriptions at a much lower price than retail. It is insurance you buy for the present AND future medication needs. It’s pretty important to have unless you can afford to pay for all your medications out of pocket. For more about drug coverage, read our post about why you need Part D.

You are eligible for these 3 parts of Medicare on the first day of the month in which you turn 65 (or earlier if you have qualified for Medicare due to disability).

Understanding Medicare just got a little easier! Now that you know these 3 basic parts, keep them in mind as we continue. We’ll refer back to them in the rest of the article to build upon what you have learned so far.

(P. S. - We haven’t forgotten about Part C. We’ll have more on that in Step #4 because that Part is optional.)

#2 – Understanding Medicare Costs for these Parts

Ok, so we know you are eligible for the 3 parts of Medicare at age 65. Now you’ll need to know what you can expect to pay for each of these parts. This is especially important if you are deciding whether to stay working past age 65 for an employer who offers health benefits or whether you will retire and go onto Medicare as your primary insurance.

Costs for Medicare Part A

Medicare Part A is free for most people, as long as you or a spouse have worked at least 10 years in the United States.

Costs for Medicare Part B

Medicare Part B depends on your income. People new to Medicare 2019 have a base rate of $135.50/month. However, people in higher income brackets will pay an “Income Adjustment.” Really that’s just a nifty term for explaining that people who earn higher incomes pay higher costs for Medicare.

Understanding Medicare Costs: Your Part B premium is based on your income from 2 years prior.

Social Security bases your income adjustment on your income as reported on your tax returns. They are usually looking at your income tax return from two years prior to now.

If your income has decreased since then, you can file a reconsideration request. You’ll present proof of your lower-income and ask Social Security to lower your Part B premium. They will reconsider your premium and notify you if it can be lowered.

Once Social Security has determined what you’ll pay based on your income, they will deduct your Part B premiums from your monthly income benefits. If you have delayed enrollment into your Social Security income benefits, then they will invoice you for Part B on a quarterly basis.

Later on, when you file to start your income benefits, they’ll switch over to the monthly deduction from your SS check.

Is Part B Necessary?

Medicare Part B is an absolute must if Medicare will be your primary insurance at age 65. In fact, you can’t buy any supplemental insurance unless you first have both A & B.

However, if you actively work for a large employer with 20+ employees, that will continue to be your primary insurance.  Medicare will be secondary, so you can consider delaying Part B since your group insurance probably includes outpatient benefits already.

Costs for Part D

Understanding Medicare Part D costs are a little tricky because prescription plans have varying premiums. Beneficiaries also might pay more due to their income, just as mentioned above in the Part B costs section.

Most states have 20-30 different Part D plans to choose from. The national average Part D premium is currently around $35/month. That’s a pretty good figure to use if you are just running some estimates today.

Part D plans have different drug formularies, so you’ll choose one that offers your medications at decent prices. The Medicare website has a handy plan finder tool to help you choose one that fits you.

Part D premiums get paid directly to the insurance carrier. However, you can request that Social Security deducts that monthly premium from your SS income check. If you owe an income adjustment for having a high income, this surcharge will be added to the monthly premium of your chosen Part D drug plan.

So we’ve learned that both Part B and Part D have a base premium, and also an income-related additional premium for people in higher income brackets. You can look up your personal estimated costs on the chart on this page.

#3 – Understanding Medicare Parts  – What’s Covered and What’s Not

By this time you are wondering: exactly what am I paying for? What are my benefits?

Medicare covers most of your health care costs, but you are still responsible for your share. This includes things like deductibles and coinsurance and copays.

Understanding Medicare coverage: Know what’s covered by Medicare and what things you need supplemental insurance to cover

It’s very similar to employer coverage you’ve had in the past. You paid your share of the monthly premium via paycheck deductions. That purchased the insurance coverage. Then when you used that insurance, you also paid your share of each medical service, right? You had co-pays at the doctor’s office. You probably also incurred a deductible if you had surgery or a hospital stay. It works the same with Medicare.

What Medicare Pays For:

Part A pays for your first 60 days in the hospital. Your share of that cost is a hospital deductible, which will be $1408 in 2020.  After 60 days of consecutive days in the hospital, Medicare pays a diminishing share of your benefits. You begin paying a larger share in the form of a daily hospital copay. This can be hundreds of dollars per day, so you need supplemental coverage to protect you from those expenses on Part A services.

This can be hundreds of dollars per day, so you need supplemental coverage to protect you from those expenses on Part A services.

Part B pays for your outpatient care. This includes things like doctor visits, lab-work, imaging tests, surgeries, durable medical equipment, and even things like chemotherapy, radiation, and dialysis. After a small deductible that you pay once per year $198 in 2020, Part B will cover 80% of all of these services for you.

Your share is the other 20% of all of these services, with no cap. That can be a lot of money for some of the bigger ticket items like surgeries or cancer treatments. You’ll need supplemental coverage to protect you from high Part B expenses.

Part D helps to pay for retail prescription medications. By that, we mean medications that you yourself pick up at a local pharmacy or via the plan’s mail order.

You do NOT need any supplemental insurance for Part D. It has built-in co-pays for medications so that you don’t get smacked with paying 100% for necessary medications. When the time comes, it’s easy to find the right Part D plan by using Medicare’s Plan Finder Tool.

By now you’ve absorbed a lot of information, and we’ve got one step to still go over. If you feel overwhelmed, just click here to request help from one of our Certified Medicare Advisors. We will explain this to you. There’s no cost to you for our help.

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#4 — Understand Your Supplemental Coverage Options

Which Medicare plan is right for you? Now that we’ve explained what Medicare pays for, and what your share is, you have probably discovered that some sort of supplemental insurance is necessary for you. This is MOST of what’s been filling up your mailbox: solicitations for Medicare supplements and Medicare Advantage.

Once you decide between the two main types of coverage we are about to discuss, you’ll be able to toss out most of that stack of mail. There’s no need to keep mailers about Medicare Advantage plans if you determine that Medigap plans are a better fit for you, and vice versa.

One of the great things about Medicare insurance options is that there are plans available for any budget. So next up, let’s do a quick overview of those 2 choices, with links to additional reading for you.

Some of you reading this will not need supplemental coverage yet because you have other coverage. 

Medicare Supplement Plans

Medicare supplements pay AFTER Medicare. They pay for the things that are normally your share. For example, all Medigap plans cover the 20% that we mentioned above. So Medicare will pay 80%, and your Medigap plan will then pay the other 20% of your Part B outpatient expenses (thank goodness)! Some Medigap plans also cover your Part A and B deductibles. You can choose your own Part D drug plan to go alongside this coverage.

Medicare supplement plans also allow you freedom of choice in your medical care. You can see any physician or healthcare provider that participates in Medicare. These plans cost more than Advantage plans because they are more comprehensive. They also give you more freedom in choosing your providers.

Medicare Advantage Plans (also called Part C)

Understanding Medicare Advantage plans can be more confusing because the Medicare Advantage program is also called Part C of Medicare.

Medicare Advantage plans pay INSTEAD OF Medicare. These plans are optional. They were created to give a low-cost alternative to Medigap.

Advantage plans are private insurance plans with their own local network of providers, generally an HMO or PPO style plan. When you join an Advantage plan, you’ll see these providers in order to get the lowest copays.

You will pay co-pays for doctor visits, hospital stays, and any other Medicare-approved services. Medicare Advantage plans generally have lower premiums than Medigap plans. That’s because you agree to share in the costs by paying co-pays for services as you obtain them. (Whereas with a Medigap plan, you often will have NO copay, depending on the plan you choose.)

Most Medicare Advantage plans also include a rolled-in Part D drug benefit. This can be a benefit or a hindrance, depending on whether that rolled-in benefit includes the specific medications you need. Each type of plan has its advantages and disadvantages. You’ll want to be thinking about what things are most important to you.

In my local presentations and webinars for hospital groups and employers, I tell attendees to ask themselves filtering questions. Would a local network plan work for me or do I need wider access because I travel? Which plan would give me the most peace of mind? Am I okay with paying co-pays as I go along in order to get lower premiums upfront?

So…what to do with all the phone calls and tons of mail, here are my best tips:

However, you can sidestep all the agents calling you on the phone and all the tons of mail solicitations and instead get everything you need from one place. We have been helping people new to Medicare for more than 40 years. We’ve already learned what’s important and what isn’t. There is no cost to you for our services.

We’ll guide you through the next steps to enroll in the right parts of Medicare. We’ll also help you find the most suitable supplemental coverage and a cost-effective drug plan. We can help you avoid any unnecessary coverage.

Understanding Medicare Conclusion

So, was Medicare explained or what?

While there is no truly simple explanation of Medicare, we hope we’ve helped you get the basics down. There’s no need for you to do this alone. Get someone on your side when it comes to understanding Medicare today! There’s absolutely no cost to you for our help. We have helped tens of thousands of Medicare beneficiaries understand their benefits since 1980.

Call one of Certified Medicare Advisors, we’re here to help! Our Medicare Advisors know more about Medicare than you can imagine.

We’ve put together a New to Medicare checklist and 6-Day Email Mini-course for people who will have Medicare as primary insurance. It includes a bonus worksheet for you to calculate your potential costs for Medicare. You can register for that here right here on this page.

Several months before turning 65 you should begin to learn more about Medicare and how it relates to your circumstances.  For example:

When and How to Enroll in Medicare

Automatic Enrollment

If you are already receiving Social Security benefits, Railroad Retirement benefits, or Federal Retiree benefits, your enrollment in Medicare is automatic. Your Medicare card should arrive in the mail shortly before your 65th birthday. Check the card when you receive it to verify that you are entitled to both Medicare Parts A and B.

Initial Enrollment Period

If you are not eligible for Automatic Enrollment, contact the Social Security Administration at 800-772-1213 or enroll online at www.socialsecurity.gov, or visit the nearest Social Security office to enroll in Medicare Part A and Medicare Part B. You have a seven-month window in which to enroll in Medicare without incurring a penalty. If you’re not automatically enrolled in premium-free Part A, you can sign up for it once your Initial Enrollment Period starts. Your Part A coverage will start six months back from the date you apply for Medicare, but no earlier than the first month you were eligible for Medicare. However, you can only sign up for Part B (or Part A if you have to buy it) during the seven-month time window listed below:

Three months before 65th birthday

Enroll during this time and your Medicare is effective the first day of your birth month.

Birthday month

Enroll during this time and your Medicare effective date will be delayed until the first day of the month following the month you actually enrolled.

The first month after 65th birthday

Enroll during this time and your Medicare effective date will be delayed until the first day of the second month following the month you actually enrolled.

Two to three months after 65th birthday

Enroll during this time and your Medicare effective date will be delayed until the first day of the third month following the month you actually enrolled.

During this Initial Enrollment Period, you will also have the option to enroll in a Medicare Prescription Drug Plan (PDP) available under Medicare Part D. Enrollment in a Medicare PDP is strictly voluntary. These plans are offered by private insurance companies approved by Medicare. Information about PDPs can be found on the SHIIP website. If you fail to enroll in a Medicare PDP during your Initial Enrollment Period and you do not have equal or better coverage through an EGHP, you will incur a one percent penalty for each month that you are late enrolling, and you will only be allowed to enroll during the annual Open Enrollment Period of October 15 through December 7 for Medicare Advantage and Medicare Part D.

General Enrollment Period 

If you do not enroll in Medicare Parts A and B during your seven-month window of eligibility, you cannot enroll until the General Enrollment Period, which is January 1 through March 31 each year (unless you are entitled to Special Enrollment). Your Medicare eligibility will not begin until the following July 1. Your monthly Medicare Part B premium will increase to include a permanent ten percent penalty for each year of delayed enrollment (unless you are eligible for Special Enrollment):

January 1 through March 31

Enroll during this time

April 1 through June 30

No Medicare coverage during this time

July 1

Medicare coverage begins with a penalty

Working Past Age 65 (Special Enrollment)

If you or your spouse are actively working at age 65, are covered by an Employer’s Group Health Plan (EGHP) and the company has 20 or more employees, you may be able to delay Medicare Part B coverage without penalty. You will still be eligible for Part A without paying a premium (as long as you or your spouse has 40 credits of work).

Supplemental Coverage

Medicare is a major federally-funded medical plan that provides a basic foundation of benefits. However, it does not pay 100 percent of all medical bills. Medicare beneficiaries are responsible for premiums, deductibles, and coinsurance. These amounts can be significant. Because of these costs, most beneficiaries need some kind of plan, policy or program to fill in the “gaps.”

Medicare Supplement Insurance

Medicare supplement plans are one health insurance option for people with Original Medicare. There are standardized Medicare supplement insurance plans available that are designed to fill the gaps left by Original Medicare (Parts A and B). These are sold by private insurance companies as individual insurance policies and are regulated by the Department of Insurance. After age 65 and for the first six months of eligibility for Medicare Part B, beneficiaries have an Open Enrollment Period and are guaranteed the ability to buy any of these plans from any company that sells them. Companies cannot deny coverage or charge more for current or past health problems. If you fail to apply for a Medicare supplement within your Open Enrollment Period, you may lose the right to purchase a Medicare supplement policy without regard to your health. 

Medicare Prescription Drug Coverage (Medicare Part D)

Medicare Prescription Drug Plans (PDPs) are sold by private insurance companies approved by Medicare. All people new to Medicare have a seven-month window to enroll in a PDP – three months before, the month of and three months after their Medicare becomes effective. The month you enroll affects the PDP’s effective date. All people with Medicare are eligible to enroll in a PDP; however, unless you are new to Medicare or are entitled to a Special Enrollment Period, you must enroll or change plans during the Open Enrollment Period for Medicare Advantage and Medicare Part D, Oct. 15 through Dec. 7. There is a monthly premium for these plans. 

Employer or Miltary Retiree Coverage

If you or your spouse has an Employer Group Health Plan (EGHP) as retiree health coverage from an employer or the military (TRICARE for Life), you may not need additional insurance. Review the EGHP’s costs and benefits and contact your employer benefits representative to learn how your coverage works with Medicare.

Medicare beneficiaries with limited income or very high medical costs may be eligible to receive assistance from the Medicaid program. There are also Medicare Savings Programs for other limited-income beneficiaries that may help pay for Medicare premiums, deductibles, and coinsurance. There are specified income and resources limits for both programs. Contact your local county Department of Social Services to apply for one of these programs.

Medicaid or Medicare Savings Programs

Medicare beneficiaries with limited income or very high medical costs may be eligible to receive assistance from the Medicaid program. There are also Medicare Savings Programs for other limited-income beneficiaries that may help pay for Medicare premiums, deductibles, and coinsurance. There are specified income and resources limits for both programs. Contact your local county Department of Social Services to apply for one of these programs.

Other Medicare Insurance Options

Medicare Advantage Plans (Medicare Part C)

Medicare Advantage plans are another health insurance option for Medicare beneficiaries. Medicare Advantage plans (HMOs, PPOs, SNPs and/or PFFS) are available in our state and provide all Medicare Part A and Part B benefits and possibly some extra benefits. Members may be required to utilize a network or group of preferred providers. Check with your health care providers to see if they accept the insurance plan you are considering. All plan options may not be available in the county in which you reside. If you join a Medicare Advantage Plan, you are still in the Medicare Program but you receive your Medicare benefits from the private carrier and are no longer enrolled in Original Medicare.You may enroll in a Medicare Advantage plan during your Initial Enrollment Period or during the Open Enrollment Period for Medicare Advantage and Medicare Part D from October 15 through December 7.

Turning 65 FAQ

It is very important for everyone Turning 65 to get accurate information about coverage and delivery options, including Original Medicare, Medicare Supplements, Medicare Advantage, and Prescription Drug Coverage.  Attention to these issues will help you avoid serious and costly problems later.  

When can I get Medicare benefits?

Unless you're disabled, the answer is 65 years old. A common misconception among Americans is that you can get Medicare as soon as you claim Social Security benefits, which can be as early as age 62. Unfortunately, even if you retire early and claim your Social Security benefit early, you'll have to wait until 65 before you'll be covered for Medicare.

How do I apply for Medicare?

You may not have to. If you're already receiving Social Security retirement benefits when you turn 65, you'll be enrolled in Medicare automatically. If this is the case, you'll be automatically enrolled in Parts A and B of Medicare (more on the parts in a bit), and you can expect to receive your Medicare benefits card about three months before you turn 65.

If you aren't receiving your Social Security retirement benefit when you turn 65, you'll have to apply for Medicare, which you can do quite easily on the Social Security Administration's website. Your initial enrollment period begins three months before the month of your 65th birthday and extends for three months after.

How much does Medicare cost?

Medicare Part A is free for the vast majority of American seniors but has a deductible of $1,408 per benefit period in 2020. 

Medicare Part B has a monthly premium. For 2020, the standard monthly premium is $144.50, but high-income seniors pay significantly more than this. At the high end, seniors with incomes over $362,000 (joint tax return) or $163,000 (individual) have to pay $462.50 per month.

In addition, Medicare Part B has an annual deductible of $198 for 2020. For the 61st through 90th days of hospitalization, beneficiaries will pay $352 per day, up from $341 in 2019, and then $704 per day for lifetime reserve days, up from $682 in 2019.

Part D, prescription drug coverage plans, come with an average monthly premium of $30.

I have health insurance already through an employer. Do I have to enroll in (and pay for) Medicare at age 65?

It depends on what kind of health insurance you have. If you have insurance through your employer or your spouse's employer and the primary insured is still working, you may not be required to enroll in Medicare as long as the company sponsoring your coverage has at least 20 employees. In this case, you'll have a special enrollment period after you (or your spouse) retire or leave that employer.

On the other hand, if your insurance is through an employer you've already retired from, you still have to sign up at 65. If you are required to sign up for Medicare Part B and don't, you'll face a permanent penalty of 10% of the Medicare Part B premium for every year you were supposed to enroll but didn't.

It's also worth noting that since Medicare Part A is free, it generally doesn't make sense to delay signing up for it, even if you're not required to. Your employer's insurance will be your primary coverage, and Medicare will be secondary. However, since Part B comes with a premium, it does make sense to wait if you're still covered by your employer's plan.

What should I do before I reach age 65?

Six months before turning 65 you should begin to learn more about Medicare and how it relates to your specific circumstances.  For example:

If you or your spouse have paid into the Social Security System for 10 or more years, you are eligible for premium-free Medicare Part A (Hospital Insurance) at age 65.  If you have paid in fewer than 10 years, you can buy Medicare Part A coverage.  Everyone pays a premium for Medicare Part B (Medical Insurance). If you have been on Medicare due to disability, you have a brand new six month Open Enrollment Period for purchasing Medicare supplemental insurance when you turn 65.

Talk to your employer's benefits officer and ask for any information about company health insurance after age 65.  If you have an Employer Group Health Plan (EGHP) that will continue to pay secondary after you become eligible for Medicare, study the benefits booklet to find out the cost and benefits of the plan.  You will then need to decide if you should keep your EGHP as secondary to Medicare or if you need to drop your EGHP and purchase a Medicare supplement or join a Medicare Advantage Plan.  If your EGHP has drug benefits, make sure they are as good as or better than Medicare Part D. If you will not be covered by an EGHP plan that will pay secondary to Original Medicare, begin to investigate your health insurance options - either an individual Medicare Supplement Policy or a Medicare Advantage Plan. 

What are my two Medicare Choices?

You have two Medicare choices for receiving your Medicare coverage. You can get your Medicare coverage through Original Medicare OR Medicare Advantage. Understanding the differences between Original Medicare and Medicare Advantage is the first step in getting the coverage that is right for you and protecting your healthcare now and in the future. Currently, 51 million beneficiaries are enrolled in the Medicare program. Enrollment is expected to rise to over 80 million by 2030. In 2018, 8 in 10 Medicare beneficiaries enrolled in Original Medicare had some type of supplemental insurance, including Medicare supplemental insurance, employer-sponsored insurance, and Medicaid. Also, in 2018, 3 in 10 Medicare beneficiaries enrolled in a Medicare Advantage plan. Great Video on My Two Medicare Choices

  1. Original Medicare is a health insurance program run by the federal government. Under Original Medicare, the government pays healthcare providers directly for the services you receive. With Original Medicare, there are no network restrictions. That means you have the freedom to choose any doctor, specialist or hospital anywhere in the USA when you need care.  When enrolled in Original Medicare you do not need to get prior approval, referral or permission from Medicare or from your primary care doctor when you need care.
  2. Medicare Advantage is a health insurance program run by private insurance companies contracted by Medicare. If you enroll in a Medicare Advantage Plan you will automatically be dis-enrolled from Original Medicare and you will NOT be able to use your red, white, and blue Medicare card. If you enroll in a Medicare Advantage Plan, there are network restrictions. This means you are required to see the healthcare providers in the Medicare Advantage network; plus, in most cases, you will need to get prior approval when you need care, except in case of an emergency. 

Due Diligence: Again, to make good decisions, you need good information. We want to make sure YOU do your "due diligence" on Medicare Advantage and Original Medicare so YOU can determine the right fit for you. Medicare Advantage Plans are health care options provided under Medicare Part C of the Medicare program. Although some individuals may benefit from a Medicare Advantage, we want YOU to know many Medicare Experts and Consumer Advocates don't like  Medicare Advantage Plans. 

Beware of Medicare insurance agents who tell you ONLY the good and NOT the BAD 

Beware of former football players and coaches on TV with sales pitches for enrolling in Medicare Advantage-related insurance. It happens every year during Medicare open enrollment: Older Americans’ mailboxes and TV screens fill up with sales pitches for enrolling in Medicare Advantage-related insurance. If you call the number on the ad, you’ll likely end up talking to a licensed insurance agent. The bad news is that if the person works exclusively for one insurer, you could be stuck for a whole year with a policy that’s inappropriate for you. Now, the really bad news, - not only being stuck with a bad policy for a whole year that's inappropriate but also you may NOT be eligible to switch to a Medicare Supplement policy the following year if you have developed health issues.

There are many Medicare insurance agents who can sell you a Medicare Advantage policy with a "0" premium. The insurance company and agents make a lot of commission. An agent makes more than twice the commission on a new Medicare Advantage enrollee as they do with a Medicare Supplement.  You may be stuck with a Medicare Advantage for your entire life because the ONLY time you can enroll in a Medicare supplement policy without answering medical questions is when you're turning 65 or enrolling in Medicare Part B for the first time.

As you grow older, a "0" premium plan may not provide you the protection you really want and need when it really counts - at claim time.  You should carefully get accurate information about coverage and delivery options offered by the "0" premium plans. Don't be fooled or mislead by the "extra benefits" offered by Medicare Advantage plans.

IMPORTANT: If you enrolled in a Medicare Advantage Plan and would like to switch back to Original Medicare, we can help you. 

Judy Gray, the former Outreach Coordinator for the Department of Insurance, said "some Medicare insurance agents are providing bad financial advice and misleading seniors into buying Medicare Advantage plans that are not accepted by many doctors and hospitals. Also, seniors don't realize doctors and hospitals can opt-out of a Medicare Advantage plan at any time during the year". A few years ago, UnitedHealthcare dismissed thousands of physicians from their Medicare Advantage networks, sometimes telling their patients before telling their physicians. Good Morning America - Beware of Medicare Advantage Plans

Ralph Nader, a consumer advocate, lawyer, and author, said "Medical Disadvantage would be a more accurate name for the programs, as insurance companies push to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion. The advertisements for Medical Disadvantage stress that you can sometimes get perks—gym memberships, hearing aids, eyeglasses, and home-delivered meals as enticements, but they avoid telling you they are not so ready to cover serious needs like skilled nursing care for critically ill patients or even less serious need like a broken back. Elderly people enrolled in a Medicare Advantage will experience its often merciless denials when they get sick."See Good Morning America - Beware of Medicare Advantage Plans 

"AARP reportedly receives a commission for new enrollees on top of the premiums seniors pay for a Medicare policy from United Healthcare," writes Nader. "This money—about seven hundred million dollars a year—is a significant portion of AARP’s overall budget." 

Eleanor Laise, the senior editor of Kiplinger’s Retirement Report, said: “the evidence on health care access and quality decidedly favors Original Medicare over Medicare Advantage, according to a Kaiser Family Foundation review of 40 studies published between 2000 and 2014.” Good Morning America - Beware of Medicare Advantage Plans

Joseph Kelly, the former President of the America Senior Citizens Association, said "we have received an increasing number of calls from Medicare beneficiaries who enrolled in a Medicare Advantage plan without fully understanding the impact of their decision. These plans promise big savings and better benefits but there are some really serious concerns. There are network restrictions, prior approval requirements, and you are automatically dis-enrolled from Original Medicare. Plus, you can NOT use your red, white, and blue Medicare card". See Good Morning America - Beware of Medicare Advantage Plans 

Chris Cuomo, with ABC News, said "these plans are available in every state; however, Medicare Advantage plans are not the best fit for many Medicare beneficiaries, though that is how they are often presented by insurance agents. Don't be fooled or mislead. Get the facts. See Good Morning America - Beware of Medicare Advantage Plans  

Who offers Medicare Supplement Insurance? 

Medicare supplement insurance is offered by private insurance companies. It covers some of the gaps not paid by Original Medicare Parts A and B. With Original Medicare and a Medicare supplement, you are protecting the quality of your healthcare NOW and in the FUTURE. Medicare supplement insurance provides choice, control, freedom, flexibility, and great value for your healthcare needs. When you enroll with one of our Certified Medicare Advisors, you get value-added benefits such as help with your Medicare prescription drug plan; dental and vision protection; free consultation with an elder law attorney, senior financial specialist and long-term care specialist; also, free help to access nursing home and home healthcare referral service; plus, we provide you expert help at claim time – when it really counts. We consistently hear from our senior friends that our Medicare Advisors are the first people they have spoken with that have finally helped them make some sense out of Medicare. See What Our Senior Friends are Saying

What are the four parts of Medicare?

Medicare Part A is your hospital insurance and helps cover medical expenses while you are staying in a hospital setting. Your exposure with Medicare Part A includes deductibles, coinsurance and co-pay expenses that can become pretty significant if you do not have supplemental coverage to Medicare. You will automatically be entitled to, and enrolled in, Part A at age 65 if you worked 40 quarters in the United States. You can also qualify for coverage through a spouse that worked 40 quarters. 

Medicare Part B is coverage for outpatient medical services. You are exposed to a deductible, coinsurance, co-pays and excess charges if you don’t have a supplement for Medicare. This coverage is elective but most Medicare recipients take it. You will pay a monthly premium for Medicare Part B that will be based on your income level. 

Medicare Part C  is a privatized plan that is also known as Medicare Advantage. You can choose to take this plan offered by private health insurers instead of Original Medicare. Although there are some benefits to this plan in that it is required to cover you as well as or better than Original Medicare, you will typically find that fewer doctors and hospitals accept this type of policy. Additionally, there isn’t a reliable way to supplement coverage for the out-of-pocket expenses in this plan. You will still have to pay your Medicare Part B premiums to own this type of policy and may pay anywhere from $0 additional to over $100/month for this type of plan. If you have a Medicare Advantage Plan, you will not be able to buy a Medicare Supplemental Insurance plan as Medicare Supplements are not intended to cover the gaps in Medicare Advantage plans.

Medicare Part D was introduced in 2006 as a component of the Medicare Modernization Act of 2003. It provides coverage for prescription drug costs and is elective coverage. If you don’t take it when you are initially eligible and decide to enroll later, you can face some fairly stiff penalties. These plans have minimal standardization when it comes to important things like premiums, co-pays, coinsurance, deductibles and which drugs they’ll cover (known as formularies). Some may also be more restrictive than others in requiring step-therapy or limiting the amount you can order each month. The best way to determine which drug plan to enroll in is to go to the Medicare website at Medicare.gov and use the Prescription Drug Plan Finder Tool. 

What is Medicare Part A? What is Medicare Part A 2020 Premium and Deductible?

Original Medicare Part A inpatient hospital deductible that beneficiaries will pay when admitted to the hospital will be $1,408 in 2020, an increase of $44 from $1,364 in 2019. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2020, beneficiaries must pay a coinsurance amount of $352 per day for the 61st through 90th day of a hospitalization ($341 in 2019) in a benefit period and $704 per day for lifetime reserve days ($682 in 2019). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $176 in 2020 ($170.50 in 2019).

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to voluntarily enroll in Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $252 in 2020, a $12 increase from 2019. Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $458 a month in 2020, a $21 increase from 2019.

What is Medicare Part B? What is Medicare Part B 2020 Premium & Deductible?

Original Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.  

The standard monthly premium for Medicare Part B enrollees will be $144.60 for 2020, an increase of $9.10 from $135.50 in 2020. While most Medicare recipients will pay the new $144.60 standard monthly premium, some will pay less because of a “hold harmless” provision that limits certain beneficiaries’ increase in their Part B premium to be no greater than the increase in their Social Security benefits.

The annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from the annual deductible $185 in 2020. What’s to blame for the bigger increases this year? Rising spending on physician-administered drugs, according to CMS.

The CMS announcement comes after last month’s Social Security Administration’s COLA announcement: a 1.6% cost of living adjustment for 2020. The average Social Security benefit for a retired worker will rise by $24 a month to $1,503 in 2020. The higher Medicare Part B premium cuts into retirees’ monthly Social Security payments. Part B premiums typically are deducted from monthly Social Security checks. 

This year CMS says 7% of Medicare recipients, up from 5% this year, will have to pay income-related surcharges. The graduated surcharges for high-income seniors kick in for singles with a modified adjusted gross income of more than $87,000 and for couples with a MAGI of more than $174,000. An individual earning more than $87,000, but less than or equal to $109,000, will pay $202.40 in total a month for Part B premiums in 2020.

By comparison, the wealthiest retirees—singles with $500,000 of income or more and couples with $750,000 of income or more—will face total premiums of $491.60 a month per person, including a $347 surcharge, in 2020. (That comes to $11,798.40 a year for a couple.) The 2020 numbers are here. The income-related premium surcharges apply to Part D premiums for drug coverage too.

How to enroll in Original Medicare? (Automatic Enrollment)

If you are already receiving Social Security benefits, Railroad Retirement benefits, or Federal Retiree benefits, your enrollment in Medicare is automatic. If you enroll during this time, your Medicare is effective the first day of your birth month. Your Medicare card should arrive in the mail shortly before your 65th birthday. Check the card when you receive it to verify that you are entitled to both Medicare Parts A and B.

What if I'm not eligible for Automatic Medicare Enrollment? (Initial Enrollment Period)

If you are not eligible for Automatic Enrollment in Original Medicare, you may enroll during the Initial Enrollment Period. You need to contact the Social Security Administration at 800-772-1213 or enroll online at www.socialsecurity.gov or visit the nearest Social Security office to enroll in Original Medicare Part A and Original Medicare Part B.

You have a seven-month window in which to enroll in Medicare without incurring a penalty. If you’re not automatically enrolled in premium-free Part A, you can sign up for it once your Initial Enrollment Period starts. Your Part A coverage will start six months back from the date you apply for Medicare, but no earlier than the first month you were eligible for Medicare. However, you can only sign up for Part B (or Part A if you have to buy it) during a seven-month time window. 

During this Initial Enrollment Period, you will also have the option to enroll in a Medicare Prescription Drug Plan (PDP) available under Medicare Part D. Enrollment in a Medicare PDP is strictly voluntary. These plans are offered by private insurance companies approved by Medicare. If you fail to enroll in a Medicare PDP during your Initial Enrollment Period and you do not have equal or better coverage through an EGHP, you will incur a one percent penalty for each month that you are late enrolling, and you will only be allowed to enroll during the annual Open Enrollment Period of October 15 through December 7 for Medicare Advantage and Medicare Part D.

What happens if I don't enroll in Original Medicare during the Initial Enrollment Period? 

If you do not enroll in Original Medicare Parts A and B during your Initial Enrollment Period (seven-month window of eligibility,) you CAN enroll during the General Enrollment Period, which is January 1 through March 31 each year (unless you are entitled to Special Enrollment). Your Medicare eligibility will not begin until the following July 1. Your monthly Medicare Part B premium will increase to include a permanent ten percent penalty for each year of delayed enrollment (unless you are eligible for Special Enrollment):

What if I am working past age 65? (Special Enrollment Period)

If you or your spouse are actively working at age 65, are covered by an Employer’s Group Health Plan (EGHP) and the company has 20 or more employees, you may be able to delay Medicare Part B coverage without penalty. You will still be eligible for Part A without paying a premium (as long as you or your spouse has 40 credits of work).

Talk to your employer's benefits officer and ask for information about company health insurance options for people who continue working past their 65th birthday.  Ask specifically how many hours you must work to keep your health insurance plan and whether the EGHP will be "primary" or "secondary" coverage to Medicare.  Carefully study the company's current benefit booklet to determine the cost and benefits of the plan.

If your EGHP is primary to Medicare, you do not have to enroll in Medicare Part B at this time.  You will need to enroll in Medicare Part B within eight months of the EGHP's termination of coverage or when it stops being primary.  If your EGHP will be secondary to Medicare despite active employment, you must enroll in Medicare Part B during the seven-month Initial Enrollment Period to avoid future penalties.  If you voluntarily disenroll from your EGHP before terminating your employment, you could lose any EGHP benefits when you retire.

Give written notice to the company of your intention to continue working past age 65.  When you decide to stop working, notify the Social Security Administration immediately.  It is also advisable to notify the Social Security Administration that you or your spouse is covered under your EGHP, will continue to work beyond age 65.

What is the Medicare "Open Enrollment Period"? 

During the open enrollment period, you do not have to answer any medical questions, have a physical or discuss medications with the Medicare Supplement insurance companies. Your individual Medicare Supplement Open Enrollment period is the period of time in which you can purchase a Medicare Supplement from any insurance company, without having to qualify medically, pay a higher rate due to any current or former health conditions, or wait for coverage. Open Enrollment is federally-mandated, so every company has to abide by it.

This initial enrollment period begins for each individual on the first day of the month in which he is both age 65 or older and enrolled in Medicare Part B. It lasts for a period of six months from that date. For example, if your birthday is April 3 and you enroll in Medicare Part B to start on April 1 of that same year, your Open Enrollment period would begin on April 1 and last through the month of September.

One thing that causes confusion in understanding when the Open Enrollment period falls is the fact that many Medicare Supplement companies also extend a six-month period prior to the start of one's Open Enrollment. During this period, companies allow you to sign up for coverage that is not effective until the actual Part B effective date (often the same as the first day of the month in which you turn 65). So in that case, an individual would have a 12-month period in which he/she could sign up with no medical underwriting. If you have employer group health insurance, it is sometimes wise to delay enrollment in Medicare Part B until you lose or terminate that group coverage. What this does is guarantees you the ability to have an Open Enrollment period at the later time that you do sign up for Medicare Part B.

If I keep my work insurance, do I need to enroll in Medicare?

If you have coverage through a current employer, you are not required to enroll in Original Medicare Part A and B. Below are some things to keep in mind about each part of Original Medicare.

Part A: For most people, Part A does not charge a premium. Typically, Part A pays after your work insurance. Part A doesn’t cost anything to have. For that reason, most Medicare-eligible beneficiaries enroll in Original Medicare Part A at age 65.

Part B: Everyone pays a monthly premium for Part B. Part B typically pays after your work coverage and may not pick up much of the bill. Enrolling in Part B will also start your one-time guarantee to purchase a Medicare Supplement. Once this 6-month time frame starts, it cannot be stopped. For these two reasons, most people wait until their work coverage ends to enroll in Part B.

Part D: Everyone pays a monthly premium for Part D. As long as you have other "creditable coverage," you do not have to enroll in a Part D plan. Creditable coverage means the insurance is as good as, or better than, a standard Part D plan. Check with your HR department to verify if your policy is creditable coverage. Typically, prescription insurance through work (and other sources like VA) offers better coverage than what you can get through Medicare. For this reason, most people wait until their work coverage ends to enroll in Part D.

How do I enroll in a Medicare Supplement Plan?

Medicare Supplement Insurance plans is the best health insurance option for people with Original Medicare. There are standardized Medicare supplement insurance plans available that are designed to fill the gaps left by Original Medicare (Parts A and B). These are sold by private insurance companies as individual insurance policies and are regulated by the Department of Insurance. After age 65 and for the first six months of eligibility for Medicare Part B, beneficiaries have an Open Enrollment Period and are guaranteed the ability to buy any of these plans from any company that sells them. Companies cannot deny coverage or charge more for current or past health problems. If you fail to apply for a Medicare supplement within your Open Enrollment Period, you may lose the right to purchase a Medicare supplement policy without regard to your health. Medicare supplement coverage usually has a higher monthly premium but could result in lower out-of-pocket expenses than Medicare Advantage plans. 

Use our Free Medicare Quote Engine to compare Medicare supplement plans in your area. Compare Medicare Supplement Premium Rates in Your Area

You will not be auto-enrolled into a Medicare Supplement Policy and must make an application to enroll in the plan of your choice. You can enroll online or you may contact one of our Medicare Advisors that represents leading Medicare supplement companies in your area. Our Medicare Advisors have been Certified, Approved, and Authorized by the Association.   

We recommend that you apply at least 5 months before you want the policy to start. If you do not have 5 months, apply as soon as possible. You can lock-in the current premium rate and save on any premium increase that may go in effect before your policy start date with most companies. Medicare Supplement premiums are paid directly to the insurance company and are not deducted from your Social Security payments.

What should I Look for in A Good Medicare Supplement Policy?  

Shopping for a Medicare Supplement policy?  All Medicare Supplement Plan benefits are set by the federal government - the ONLY difference is PRICE. That means there is no difference in the benefits you receive under one company’s plan versus another. However, the prices vary widely among the various insurance companies. The first thing to consider is the price when choosing a good policy. In addition, you should consider the company’s overall reputation, financial rating, household discounts and the number of years the company has been selling Medicare Supplement Plans. Our Medicare Specialists can help you avoid the pitfalls. We can help you compare all the leading companies in your area. We will bring all the numbers to the table and you decide what coverage is best. Compare Medicare Supplement Premium Rates in Your Area

What are the most popular Medicare supplement plans?

A Medicare supplement provides you freedom, choice, and great health protection now and for the future.  By federal law, all Medicare supplements are standardized and offer identical benefits from all companies. That means there is no difference in the benefits you receive under one company’s plan versus another. The ONLY difference is PRICE

Plan G and Plan G High Deductible are two popular Medicare supplement plans. Both Plans cover 100% of the SAME benefits! The ONLY difference is policy DEDUCTIBLE.

Plan G has a policy deductible of $198 (2020) and Plan G High-Deductible has a policy deductible of $2,340 (2020). Both Plans cover 100% of all Medicare-eligible after the deductible is met. The deductible amount represents the out-of-pocket expenses (excluding premiums) that a beneficiary must pay before these policies begin paying benefits. Compare Plan G and Plan G High Deductible in Your Area.

Can I qualify for a 12% Premium Discount?

Yes. You automatically qualify up to a 12% household premium discount with some of the leading insurance companies, if you have a spouse or partner, OR if you have lived with a friend or relative for the past 12 months.  However, some companies, to qualify for a premium discount, your spouse or partner must be a policyholder with the company to qualify for the discount. Compare rates with and without the household discount.

How do I enroll in a Prescription Drug Plan?

The Medicare Prescription Drug Plans (PDPs) are sold by private insurance companies approved by Medicare. All people new to Medicare have a seven-month window to enroll in a PDP – three months before, the month of and three months after their Medicare becomes effective. The month you enroll affects the PDP’s effective date. All people with Medicare are eligible to enroll in a PDP; however, unless you are new to Medicare or are entitled to a Special Enrollment Period, you must enroll or change plans during the Open Enrollment Period for Medicare Advantage and Medicare Part D, Oct. 15 through Dec. 7. There is a monthly premium for these plans.

For assistance with Part D plan comparisons and enrollments, you may log into MyMedicare.gov to shop for prescription drug plans available in your area.

How do I enroll in a Medicare Advantage Plan?

Some health insurance agents are misleading seniors into buying Medicare Advantage plans that are not accepted by many doctors and hospitals. It is important to remember to check with your healthcare providers before making any change to your Original Medicare coverage to make sure they will accept Medicare. If you switch to a Medicare Advantage, you will be dis-enrolled from Original Medicare.

Medicare Advantage Plans are health care options provided under Medicare Part C of the Medicare program. These plans are approved by Medicare but sold and serviced by private companies. There are several plan options available under Medicare Advantage Plans such as managed care plans that involve a provider network (HMOs and PPOs) to those that are specially designed for people with certain chronic diseases and other specialized health needs (SNPs) and some that may or may not have a provider network (PFFS) requirement. Most Medicare Advantage plans include Medicare prescription drug coverage.

To enroll in any Medicare Advantage plan option you must have both Medicare Part A and Medicare Part B. Once you enroll in a Medicare Advantage plan, you CAN NOT use your Original Medicare (red, white and blue) card as your Medicare Advantage plan will replace Original Medicare.

Instead, the Medicare Advantage plan will provide you with a member ID card to use when visiting your medical provider. Please note, you will continue to pay the Medicare Part B premium, and you might also have to pay an additional monthly premium charged by the Medicare Advantage plan.

Again, It is important to remember to check with your healthcare providers before making any change to your Original Medicare coverage. Beware. It is also important to know your healthcare providers can opt-out of a Medicare Advantage ANYTIME during the year.

When do I use my Medicare Cards? 

Everyone who enrolls in Original Medicare receives a red, white, and blue Medicare card. This card lists your name and the dates that your Original Medicare hospital insurance (Part A) and medical insurance (Part B) began. It will also show your Medicare number, which serves as an identification number in the Medicare system. (If you get Medicare through the Railroad Retirement Board, your card will say Railroad Retirement Board at the bottom.)

If you have Original Medicare, make sure you always bring this card with you when you visit doctors and hospitals so that they can submit bills to Medicare for payment. If you have a supplemental insurance plan, like a Medicare Supplement Plan, retiree, or union plan, make sure to show that plan’s card to your doctor or hospital, too, so that they can bill the plan for your out-of-pocket costs.

If you are enrolled in a Part D plan (Medicare prescription drug benefit), you will use the Part D plan’s card at the pharmacy.

If you are enrolled in a Medicare Advantage Plan, you CAN NOT use the red, white, and blue card when you go to the doctor or hospital. Instead, you will use your Medicare Advantage Plan card, which you should receive in the mail. You will also use this card at the pharmacy if your plan serves as your Part D coverage. If you have a supplemental insurance plan, like a retiree or union plan, make sure to show that plan’s card to your doctor or hospital, too, so that they can bill the plan for your out-of-pocket costs.

Your Medicare card, Social Security card, and other health insurance cards are very important documents. Make sure to keep a photocopy of your important identification and insurance cards, write down any important numbers (like your Medicare number), and keep everything in a safe place so that you have a record for future reference if anything gets lost. If your card is ever lost, stolen, or damaged, you can get a replacement card by calling 1-800-MEDICARE (633-4227). You can also order or print a card by logging in to your mymedicare.gov account.

Do I need additional insurance coverage when I become eligible for the State Health Plan, Military Plan or from my Employer Health Group Plan (EGHP)?    

If you or your spouse has an Employer Group Health Plan (EGHP) as retiree health coverage from an employer, the military (TRICARE for Life), or the Retired State Health Plan, you may not need additional insurance. With most employee group health plans and TRICARE for LIFE, you are enrolled in Original Medicare.  However, some State Health Plans may require you to dis-enroll from Original Medicare to be eligible for the State Plan Health Plan Medicare Advantage benefits. We strongly recommend you carefully review your options. Many state health plan retirees prefer to remain/enroll in Original Medicare and purchase a Medicare supplement. You should carefully review the costs and benefits to learn how your coverage works with Medicare. 

Does Original Medicare cover the costs of Diabetic Supplies? 

Yes. Original Medicare covers the same supplies for people with diabetes whether or not they use insulin. These supplies include blood sugar self-testing strip, equipment and supplies, insulin pumps, and therapeutic shoes or inserts.  To get Medicare drug coverage, you must join a Medicare prescription drug plan.  These plans typically cover insulin, anti-diabetic drugs, and certain diabetes supplies such as syringes and needles.  The Medicare Coverage of Diabetes Supplies and Services booklet provides a comprehensive look at what diabetes-related services are covered.

Does Original Medicare cover the costs of Durable Medical Equipment?

YES. Medicare does cover durable medical equipment, which is equipment that serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home.  Original Medicare normally pays 80% of the Medicare-approved amount after you meet your Part B deductible and you are responsible for a 20% coinsurance. Medicare only covers durable medical equipment if your provider says it is medically necessary for use in the home.  You must also order the equipment from suppliers who contract with Original Medicare or your Medicare Advantage Plan.  If you have a Medicare Advantage Plan, your plan will have its own cost and coverage rules for durable medical equipment.  For a more comprehensive list of what is covered, please visit the Durable Medical Equipment (DME) section in the Medicare and You handbook.

Where Can I get Expert Medicare Help?

To make good decisions, you need good information. When you are fully informed, you feel more confident about taking action. And taking the right action is the key to protecting the quality of your healthcare in the coming years. Medicare beneficiaries receive a lot of telephone calls from telemarketers all over the country and a lot of information in the mail about Medicare. Medicare options can be difficult to understand, especially if you are turning 65 or enrolling in Medicare for the first time.

Our Medicare Advisors with the Senior Citizens Association can be extremely helpful and can turn a confusing situation into a rather easy process. There are lots of insurance agents who can sell you a policy. But there are almost none offering the extensive back-end support and value-added benefits you will find with our Certified Medicare Advisors. We have been helping seniors for more than 40 years.

We consistently hear from our senior friends that our Medicare specialists are the first people they have spoken with that have finally helped them to make some sense out of Medicare. (See What our Senior Friends have To Say)

We offer you the security of discussing your needs with one of our Medicare Advisors, who have been approved, certified and authorized by the Association. Give us a try – we provide exceptional, straightforward no-hassle service. There is NO COST to you for our services. We are a nonprofit organization. We have been helping Medicare beneficiaries understand Original Medicare and other Medicare choices for more than 40 years. Let us help you. You can Schedule a Phone Call with one of our Certified Medicare Advisor OR Contact Us By Email or Contact Us By Phone. 

Additional Resources

Additional Resources

Medicare Videos

  1. Medicare and You #1
  2. Medicare and You #2
  3. Turning 65: Your Guide To Medicare
  4. Beware of Medicare Advantage Plans
  5. Your Medicare Choices
  6. Medicare's Preventive Benefits
  7. Medicare Advantage from a Doctor’s Perspective

Other Additional Resources

Medicare - Call 800-633-4227 or visit www.medicare.gov

Medicare provides information 24 hours a day, seven days a week about eligibility, enrollment, and coverage

Social Security Administration - Call 800-772-1213 or visit www.socialsecurity.gov

Contact the Social Security Administration to enroll in Medicare or to request a replacement Medicare card.