New to Medicare

retire circled on calendar

What is Medicare?

Medicare is the federal government program that provides health insurance if:

  • You are 65 or older, or
  • Under 65 and receiving Social Security Disability Insurance (SSDI) for 24 months, or
  • Under 65 and with End-Stage Renal Disease (ESRD) or ALS.

In addition, both of these items describe you:

  • You or your spouse worked and paid Social Security taxes for at least 10 years and
  • You are a permanent resident of the U.S. or a legal citizen who has lived in the U.S. for 5 years in a row.

The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs Medicare. The program is funded by a combination of the Social Security and Medicare taxes you pay on your income, the premiums that people pay for Medicare, and the federal budget.

Enrollment Options & Costs

Medicare has several different parts:

Original Medicare

  • Part A – Inpatient Hospital Coverage
  • Part B – Medical / Outpatient Coverage

Part C – Medicare Advantage Plan

Part D – Prescription Drug Plan

Original Medicare is the traditional fee-for-service program offered directly through the federal government and helps pay for hospital inpatient coverage and medical and outpatient coverage. Neither Part A or B cover prescription drugs. If you want Medicare prescription drug coverage (Part D) with Original Medicare, in most cases you will need to enroll in a stand-alone Medicare private drug plan (PDP).

Part C is known as a Medicare Advantage Plan, a type of private insurance offered by companies that contract with Medicare (the federal government). You still have Medicare if you enroll in a Medicare Advantage Plan. This means that you will still owe a monthly Part B premium (and your Part A premium, if you have one). Each Medicare Advantage Plan must provide all Part A and Part B services covered by Original Medicare, but can do so with different rules, costs, and restrictions that can affect how and when you receive care. Medicare Advantage Plans can also provide Part D coverage.

Enrollment Options

Once you have become Medicare-eligible and enroll, you can choose to get your Medicare benefits from Original Medicare and optionally include a Medicare Supplement (Medigap) plan and a Part D Prescription Drug Plan, or a Part C Medicare Advantage Plan.  Most Medicare Advantage Plans, but not all, incorporate a Prescription Drug Plan.

Original Medicare: Part A and Part B (B is optional):

Option 1 –  Add one or both of the following to Original Medicare:

Medicare Supplement Insurance

Medicare Part D

Option 2 – Choose a Medicare Advantage Plan

It is important to understand your Medicare coverage choices and to pick your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and where you can get your care. For instance, in Original Medicare, you are covered to go to nearly all doctors and hospitals in the country. Medicare Advantage Plans, on the other hand, usually have network restrictions, meaning that you will be more limited in your access to doctors and hospitals. However, Medicare Advantage Plans can also provide additional benefits that Original Medicare does not cover, such as routine vision or dental care.

Costs Associated with Enrolling in Medicare

Part A – Inpatient Hospital Coverage

If you or your spouse worked and paid social security taxes for 10 years, there is no monthly premium for Part A. If you are only enrolled in Original Medicare, Part A has deductibles and copays.

Part B – Medical / Outpatient Coverage

In 2019, Part B has a monthly premium of $135.50.
If you are only enrolled in Original Medicare, Part B covers 80% of Medicare-approved medical expenses, and you are responsible for the remailing 20%

Supplement (Medigap)

These plans work with Original Medicare, and may cover some or all of Part A and Part B deductibles and copays.  Depending on the type of plan the monthly premium range is approximately $90 – $150 at age 65.

Part C – Medicare Advantage Plan (MAPD)

MAPD plans are available for monthly premiums as low as $0. These plans have copays for most services, including inpatient hospital stays, doctor visits, tests, and rehab. If the plan also includes prescription drug coverage, there may be a yearly drug deductible and there are drug copays as well.

Part D – Prescription Drug Plan

Stand-alone Part D plans are available for monthly premiums under $20 and go up in price from there. Part D plans vary not only in price but also in copays and the specific drugs covered in the plan. Work closely with one of our advisors to ensure the plan you enroll in covers your prescriptions.

couple shaking hands with woman

We are here to help!

We understand how confusing this may be, and we are here to help. Schedule a counseling session with one of our trusted advisors. During this session, your advisor will explain how Medicare works, what actions you need to take, costs and more.

Schedule your Session

When to Apply for Medicare

Medicare is separate from your application for Social Security income benefits. People age into Medicare at age 65, regardless of whether they are taking retirement income benefits yet. If you are a citizen age 65 or older and need medical insurance, you are entitled to enroll in Medicare.

However, don’t expect Medicare to notify you of when it’s time to sign up.

If you already taking Social Security income benefits or Railroad Retirement Board benefits at least 4 months before turning 65, you will be automatically enrolled in Medicare Parts A and B at age 65. Your card should arrive 1- 2 months before you turn 65.

If you are NOT yet taking retirement benefits, then you will need to submit a Medicare application yourself. The government expects for you to know when to enroll. The timeline for when and how to register for Medicare is called the Initial Enrollment Period.

 

Initial Enrollment Period

Your Initial Enrollment Period (IEP) for Medicare Parts A, B and D last 7 months. It begins 3 months before your 65th birthday month and runs for 3 months after your birth month. Enrolling in Medicare during your IEP means that you will have no late penalties. There are also no pre-existing condition waiting periods.

How to Apply for Medicare

The only parts of Medicare you will enroll in via the Social Security office are your Original Medicare Part A (hospital) and Part B (medical). Social Security offers several easy options to apply for Medicare. If you are turning 65, you may apply as early as 3 months prior to the month of your 65th birthday. You’ll find that getting started early is a plus so that you’ll have your new Medicare card in hand before your effective date, which is usually the 1st of your birth month.

Applying for Medicare is just your first step. All other Parts and supplemental coverage enrollments are done outside of that, through an insurance agent or agency.

Medicare does not cover all your medical costs. There is significant financial exposure to you in the deductibles and coinsurance that you must pay. Working with an expert insurance agent will help you to identify Medicare supplemental insurance coverage that suits you.

When will I get my Medicare card?

In most cases, you will receive your Medicare card about 3 weeks after you apply. If you are already receiving Social Security benefits when you turn 65, your enrollment into Medicare is automatic. Your card will just show up in your mailbox about 2 months before you turn 65. When you receive it, be sure that you do not forget to enroll in a plan that includes Part D prescription drug coverage.

Everyone who has Medicare receives a red, white, and blue Original Medicare card. If you choose to receive your coverage through Original Medicare, you will show this card when you get services. If you choose to receive your Medicare benefits through a Medicare Advantage Plan, you will still get an Original Medicare card, but you will show your Medicare Advantage Plan card when you get services. No matter how you get your Medicare health benefits, only give your Medicare number to your doctors and health care providers.

Medicare Checklist:

  • If you are already receiving social security, did you receive your red, white and blue Medicare ID card?
  • If you are not yet receiving social security, you will need to submit a Medicare enrollment application yourself.
  • When you receive your red, white and blue Medicare card, verify that the card lists both:
    • Hospital (Part A) Coverage Start Date.
    • Medical (Part B) Coverage Start Date.
  • You absolutely need Part B if Medicare will be your primary coverage.
  • Get someone on your side by working with an independent insurance agency like ours. Our help is free, and we are always available for your questions.
  • Review your coverage annually to make sure you are getting the most appropriate insurance at the right price.

 

Get in Touch