For most of your life, people didn’t have to apply for Medicare. They were automatically enrolled when they turned 65 and became eligible for Social Security. That all changed in 1983, when President Reagan signed legislation to raise the retirement age, with changes beginning in 2003.
Retirement age has increased 2 months per year since then. However, Medicare eligibility is still tied to your 65th birthday. This means that, unless you’re already receiving Social Security benefits before you turn 65, you must apply for Medicare benefits. This post tells you how.
Who Has to Apply for Medicare?
Anyone receiving Social Security benefits at least three months before they turn 65 is enrolled in Medicare Parts A and B automatically. You also get automatic Medicare enrollment if you receive Railroad Retirement Board benefits or have been on Social Security Disability for 24 months.
If none of these situations apply to you, you must sign up for Medicare.
How to Apply for Medicare
There are three ways to apply for Medicare, all of them through Social Security.
The fastest, easiest way is by applying online here. You need the following information:
- Place of birth
- Medicaid number, if you have one
- Permanent Resident Card number, if you aren’t a U.S. citizen
- Employment information if you currently have group coverage through an employer (yours or your spouse’s)
- Group plan information if applicable
The online application process takes around 10 minutes.
You may also sign up for Medicare by calling Social Security at 800-772-1213. Please note that Social Security prioritizes calls based on need, which could result in long hold times. Finally, you may visit your local Social Security office to enroll in Medicare. However, in response to the COVID-19 pandemic, the Social Security Administration closed local offices on March 17, 2020. They are expected to remain closed at least through April.
When Can You Apply for Medicare?
Your Initial Enrollment Period (IEP) begins three months before your 65th birthday. It lasts a full seven months, ending three months after your birth month.
Failure to sign up for Medicare during your IEP may result in lifelong penalties if you do not qualify for a Special Enrollment Period (SEP). The most common qualifying reason to delay enrollment is having creditable coverage through an employer-sponsored group health plan.
Surely Someone Notifies You When You Become Eligible, Right?
Unless you’re receiving Social Security before you turn 65, nobody notifies you that you have to sign up for Medicare. This seems like a major disconnect, since you face lifelong penalties for failing to enroll, but it’s true. The only people who receive notification that they’re eligible for Medicare are those who began collecting Social Security benefits at least 3 months before their 65th birthday.
All Communication Is Via U.S. Mail
Both Social Security and Medicare only communicate with beneficiaries via U.S. mail. The only time you’ll receive a phone call from one of them is if you requested a phone call.
If you ever receive a call from someone claiming to be from Medicare or Social Security, hang up. It is almost definitely someone looking to steal your identity, your money, or both. If you’re worried the call was legitimate, just call the appropriate entity:
- Medicare: 1-800-MEDICARE (633-4227)
- Social Security: 1-800-772-1213
Describe the call you received and ask if there’s any action you need to take.
Should You Apply for Medicare Part A and Part B?
To avoid late fees and coverage gaps, you should enroll in both Medicare Part A and Part B (Original Medicare). We also recommend adding a Medicare Part D prescription drug plan.
Medicare Part A is also known as hospital insurance. It covers in-patient care for approved services. Medicare Part B is also known as medical insurance. It covers outpatient care, durable medical equipment, and a variety of other services.
Medicare Part D covers prescription medications. Any time you go 63 days or more without creditable drug coverage, you risk lifelong penalties, so choose a Part D plan when you first enroll in Medicare.
If you currently have coverage through an employer, talk to your benefits administrator to make sure it’s considered creditable coverage. The main criteria is number of employees. If there are fewer than 20, your current coverage is not considered creditable. That means you won’t qualify for a Special Enrollment Period.
Supplementing Your Medicare Coverage
Many Medicare beneficiaries choose to supplement their coverage with either a Medigap or Medicare Advantage (MA) plan.
What You Get with Medigap
Medicare covers a wide array of services, but it doesn’t pay 100 percent of the costs. Medicare Supplement Insurance, more commonly referred to as Medigap, covers some of these out-of-pocket costs.
Private insurers sell Medigap policies. However, although premiums vary according to the provider, the plans themselves are standardized. That means that every Medigap Plan G (or Plan A, B, F, etc.) offers the exact same coverage.
If you choose Original Medicare, it’s a good idea to apply for a Medicare Supplement Insurance plan when you first enroll. This is known as your Medigap Initial Enrollment Period and it’s the only time your application doesn’t have to go through medical underwriting.
Medical underwriting basically tells the insurer how likely you are to make claims. The more likely you are to make a claim, the more expensive your premiums. In fact, insurers may decide not to sell you a plan at all. However, during your Medigap IEP, you cannot be denied a Medigap plan or charged more for it.
For full details about Medigap, check out our post, Medigap Plans A to N.
What You Get with a Medicare Advantage Plan
Every Medicare Advantage plan must offer at least the same coverage as Original Medicare. However, providers may also offer additional benefits. For example, the majority of MA plans include prescription drug coverage. Other popular add-ons include coverage for routine dental and vision care, hearing tests, and fitness programs like SilverSneakers.
Thanks to these robust offerings, over one-third of beneficiaries have made the switch to a Medicare Advantage plan.
Which Is Better, Medigap + Original Medicare or Medicare Advantage?
Choosing between Medigap and Medicare Advantage can be difficult. Each option has pros and cons.
Medigap is only available to people enrolled in Original Medicare, which remains the top choice for most beneficiaries. That’s because there aren’t any network restrictions as there are with most Medicare Advantage plans. With Original Medicare, you can visit any provider who accepts assignment, including labs, specialists, and hospitals.
Freedom from provider networks is especially important if you travel a lot or split your time between two states.
Enrolling in a Medicare Advantage plan does not exempt you from Medicare Part B premiums. However, you may still pay less for an MA plan, particularly if it includes prescription drug coverage. Look carefully at the full costs of both options, not just the monthly premiums. This includes deductibles, co-pays, and co-insurance.
There are two main benefits to having a Medicare Advantage plan. The first is any additional coverage the plan offers. Second is that MA plans have a yearly out-of-pocket maximum, something that Original Medicare does not have. In 2020, this is $6,700, although many plans set their yearly max below that. If you expect to spend a significant amount on healthcare, that yearly max may provide substantial savings.
How to Make the Most of Your Medicare Coverage
The following tips help ensure you get the best Medicare coverage for your unique needs and budget.
- Creating a myMedicare.gov account makes it easy to manage premiums, claims, personal health information, and more.
- The Welcome to Medicare preventive screening helps acclimate you to the program and it’s free for all Part B beneficiaries. It also creates a baseline for your primary care provider to monitor your overall health and wellness.
- Completing the Authorization Form lets you decide who can see your personal health information, which may be important if you ever become incapacitated.
- Compare your Medicare plan options carefully. The licensed agents at Medicare Solutions can help. Just call 855-350-8101 to begin comparing your options
If you’re nearing age 65, don’t wait for someone to tell you that you qualify for Medicare. Unless you already collect Social Security, you’ll be waiting forever. Apply for Medicare now to avoid late fees and coverage gaps.