Enrolling in Medicare isn’t as simple as checking a box. Seniors have a number of options when signing up for Medicare, each with its own set of enrollment requirements. In order to get the right Medicare coverage and avoid any potential penalties, you need to start planning your Medicare coverage before turning 65. Here’s what you need to know about Medicare enrollment so you can make the right coverage decisions for your health.
Medicare Part A covers inpatient hospital care, including lab tests, surgery, and skilled nursing. Part B, meanwhile, covers outpatient medical care and preventive health services. Together, Parts A and B cover many services, but they don’t cover everything.
Seniors collecting Social Security are automatically enrolled in Medicare Part A and B. Otherwise, seniors must enroll during the seven-month Initial Enrollment Period (IEP) that begins three months before the month of their 65thbirthday and ends three months after their birthday month. Seniors who miss the Initial Enrollment Period have to wait until the General Enrollment Period that runs January 1 to March 31 and may be subject to a late enrollment penalty.
Seniors who wait to enroll in Part B due to existing employer-sponsored coverage are eligible for a Special Enrollment Period (SEP).The SEP lasts eight months and begins the month a senior or their spouse stops working or loses employer-sponsored health coverage.
Medicare Part D covers prescription drugs. All Part D plans are held to a standard of coverageset by Medicare; however, specific drugs covered vary from plan to plan. Seniors with specific prescription drug needs should search a plan formulary that includes their medications.
Seniors can enroll in a Medicare Part D plan during their IEP or SEP. Seniors who fail to enroll during these periods must wait until Medicare’s Annual Election Period (AEP), which runs from October 15 to December 7. A late-enrollment penalty applies to seniors who wait to enroll in Part D without creditabledrug coverage from another insurer.
Medicare leaves seniors with significant out-of-pocket costs. In addition to monthly premiums, Medicare Parts A, B, and D are also subject to deductibles and coinsurances. Medigap, formally known as Medicare Supplement Insurance, mitigates these costs. Medigap plans offer varying levels of coverage; the most popular choices are Plan F and Plan G as they provide the most coverage of all Medigap plans. Plan F offers slightly more benefits than Plan G thanks to coverage of Medicare Part B’s annual deductible.
Medigap Open Enrollment Period (MOEP) begins the month a senior enrolls in Medicare Part B if enrolling after their 65thbirthday or their birthday month if enrolling in Part B prior to turning 65. Seniors are exempt from medical underwriting during this period, but those who wait to enroll in Medigap may pay more or be refused a policy. Guaranteed-issue protections let some eligible seniors enroll without medical underwriting past the MOEP.
Like Medigap, Medicare Advantage reduces out-of-pocket spending. However, unlike Medigap, Medicare Advantage replaces Medicare Part A and Part B rather than supplementing it. While Medicare Advantage is required to provide the same coverage as Parts A and B, and many plans include additional benefits, Medicare Advantage is administered by private insurance companies rather than the federal government. As a result, seniors with Medicare Advantage coverage are subject to provider networks and other plan rules.
Seniors can opt for a Medicare Advantage plan during their IEP or AEP or during the Medicare Advantage Open Enrollment Period that runs January 1 through March 31. Adults who receive Medicare coverage due to end-stage renal disease aren’t eligible for Medicare Advantage.
This information covers what seniors need to know to enroll in Medicare. However, if you’re already enrolled in Medicare and want to change policies, additional rules apply. If you need help with Medicare enrollment, contact the Social Security Administration, the Centers for Medicare and Medicaid Services, or a State Health Insurance Assistance Program.
James Hall is a health researcher and the creator of seniorcarefitness.com, a website that aims to provide resources for seniors and their caregivers on how to age gracefully so we can live our best life, even in our golden years.
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