When Does Eligibility Begin?
The majority of people are eligible for Medicare once they reach age 65. The steps to enroll depend on whether the individual is collecting retirement benefits when beginning the Initial Enrollment Period or IEP. Enrollment for both Part A and B is generally automatic if the person is receiving benefits for Social Security or Railroad Retirement. If neither of these benefits are being received, active enrollment is required.
When eligibility requirements are met for automatic enrollment, the individual should not need to contact anyone. A package should be received in the mail prior to the new coverage starting. This occurs three months in advance. A letter is also sent explaining how the program works and confirming automatic enrollment for Part A and B. For those receiving retirement benefits from Social Security, the SSA or Social Security Administration sends the card and packet. The Railroad Retirement Board sends the package for those with Railroad Retirement benefits.
Part B should not be declined unless the individual receives insurance through the job of their spouse. If the individual declines to accept Part B because they have insurance, signing up for the program in the future may include a premium penalty. If once the individual becomes eligible their insurance pays secondary, the recommendation is to enroll to ensure primary coverage with lower payments. If the person has not reached the age of 65 and does not receive benefits from Railroad Retirement or Social Security, active enrollment is necessary.
How to Sign Up for Medicare
During the Initial Enrollment Period, the person can sign up for Part A or B. This can be accomplished with any of the options below.
- Calling Social Security. The number is (800) 772-1213.
- Going to the local Social Security office.
- Filling out an online application at www.ssa.gov.
- Mailing a dated and signed letter including the date the individual wants their enrollment to begin, their name and Social Security number to Social Security.
- If the individual is eligible for benefits for Railroad Retirement, enrollment can be completed through the local Railroad Retirement Benefits office or by calling the RRB.
When enrolling, the individual can protect themselves by keeping proof to prevent a premium penalty for Part B if the application becomes lost. This includes:
- Write down the date and time of the conversation and the representative’s name
- If enrolling at a Social Security office, request a written receipt
- If enrolling through the mail, a receipt should be requested for certified mail
- If enrolling online, the confirmation page should be printed and saved
Medicare Part A Coverage
Part A is coverage for standard hospital services and visits, skilled nursing services, hospice and specific home health care. If the individual is eligible to receive retirement benefits from Social Security, there is no premium due for Part A. Coverage for Part A also includes skilled nursing facilities and critical access hospitals. Long-term and custodial care is not covered. To receive these benefits, the eligible must meet specific conditions. The majority of people are eligible if they:
- Are a minimum age of 65 and meet the requirements for residency and citizenship
- Receive benefits from disability due to a diagnosis of Lou Gehrig’s disease, also referred to as Amyotrophic Lateral Sclerosis
- Have received benefits for a minimum of 25 months from the Railroad Retirement Board or Social Security.
- Meet specific requirements and have ESRD also referred to as end-stage renal disease
Medicare Part B Coverage
Part B is similar to health insurance and there is a premium according to https://clearmatchmedicare.com/. In 2021, the base rate was $148.50 per month. The premium may increase if the individual is in a higher income bracket. Part B helps with coverage for services considered necessary including the majority of preventative services, outpatient care, doctor visits and some medical services not covered by Part A.
If the individual is receiving veterans’ benefits or has primary coverage through their spouse’s employer, they can decide to keep their existing coverage and opt-out. The person should contact their insurance provider to make certain their coverage is adequate. Their Social Security status will not be affected, but a penalty may be charged resulting in higher premiums if the individual enrolls at a later date.
Medicare Part C Coverage
This coverage is also referred to as Medicare Advantage. This part B alternative comes from a private insurer and the individual is responsible for signing up. Additional information is available in a publication from Social Security, on the official website or by calling direct at (800) 633-4227.
Medicare Part D Coverage
This is coverage for prescription drugs. Any individual qualified for the program can receive Part D. This coverage is provided by private companies. The individual selects the drug plan they prefer. There is a premium for each plan with the drug coverage and cost varying. If the individual does not choose to participate in a drug plan when eligible, does not receive any extra help or is not enrolled in any prescription drug coverage, they will most likely be charged a late penalty for enrollment. This penalty may be applicable for the entire time the individual receives drug coverage under Part D.
Initial Enrollment Period
Enrollment in Part A and B can only be completed during three specific time periods. During the Initial Enrollment Period, the individual can enroll at any time during a period of seven months. This includes the three months prior to, the three months following and the month of the person’s 65th birthday. The date when coverage will start is dependent on when the individual signed up.
- If the person enrolls during the first three months of the Initial Enrollment Period, their coverage will start during the month they first became eligible for the program.
- If the individual waits until the fourth month of the Initial Enrollment Period, coverage starts the month after the enrollment month.
- If the individual enrolls during the fifth month of the Initial Enrollment Period, coverage starts the second month after enrollment.
- If the Initial Enrollment Period is in the sixth or seventh month, coverage starts the third month after enrollment.
If the birthday of the person is on the first of any month, the Initial Period of Enrollment becomes the seven months before the month of birth.
Special Enrollment Period
A Special Enrollment Period is a time period not included in normal enrollment. This can happen due to specific circumstances. Enrollment can be delayed during the Part B Special Enrollment Period with no penalty provided the individual has insurance coverage from their spouse’s job at the time of eligibility. This means the person can enroll in the program with no penalty for a maximum of eight months once their spouse is no longer working or group health coverage is lost, whichever happens first.
Once enrolled, coverage will start during the next month. A good example is an individual signing up in March. Their coverage will start on April 1st. A coverage gap can be avoided if the individual enrolls the month prior to their spouse’s insurance ending.
General Enrollment Period
If the person did not enroll when they first became eligible including both the Initial Enrollment Period and the Special Enrollment Period, they can sign up for Medicare during the General Enrollment Period. The General Enrollment Period takes place every year from January 1st until March 31st. The coverage then starts on July 1st. If the person decides to enroll during the General Enrollment period, they may have coverage gaps in addition to being charged a penalty for late enrollment in Part B.