Signing Up for Medicare

Christina Bach, MBE, MSW, LCSW, OSW-C
Last Modified: February 12, 2018

You are eligible for Medicare! That is great. But, did you know that having insurance coverage under all the different parts of Medicare is NOT automatic? You need to do some work to be sure you have all the coverage you need and are eligible for. 

You are eligible for Medicare when:

  • You turn 65.
  • You are under 65 and have been receiving Social Security Disability/Railroad Disability for 2 years.
  • You have been diagnosed with kidney disease and need dialysis and/or a kidney transplant.
  • You have been diagnosed with ALS (Lou Gehrig’s disease).

Part A: Covers care you receive while you are in the hospital or skilled nursing facility (SNF).

Part B: Covers most outpatient care, including visits with your healthcare providers, lab tests, x-rays and scans, and chemotherapy given outside of the hospital.  It is best to sign up for Medicare Part B when you are first eligible for Medicare.

How do I get enrolled?

This depends on how you became eligible for Medicare. 

How did you become eligible?

How do I get part A?

How do I get part B?

I was receiving Social Security or Railroad Retirement Board benefits for at least four months before I turned 65.

 

You will automatically be signed up.

You will automatically be signed up.

I turned 65, or I was receiving Social Security or Railroad Retirement Board benefits for less than 4 months before I was 65.

You will need to sign up for Part A with the Social Security Administration.

You will need to sign up for Part B with the Social Security Administration.

 

I am under 65 and have a disability.

You will automatically be signed up for Part A.

You will be automatically signed up for Part B.

I have kidney disease (ESRF).

You need to sign up for Medicare. Coverage usually does not begin until the first day of the fourth month of your dialysis treatments.

You will need to sign up for Part B with the Social Security Administration.

I have ALS (Lou Gehrig’s Disease)

You will automatically be signed up the month your disability benefits begin.

You will automatically be signed up the month your disability benefits begin.

When can I sign up?

  • Your initial sign up period begins 3 months before you turn 65, includes the month you turn 65 and ends three months after you turn 65.
  • In most cases, if you don’t sign up for Part B during your initial sign up period, you will have to pay a penalty. You also may not have access to all the healthcare you need, as many services are not covered by Part A.

But remember!!

  • You don’t HAVE to get Medicare Part B. There is a monthly premium (what you pay for Medicare Part B coverage each month) that is taken out of your social security payments.
  • You should think very carefully before deciding NOT to get Part B. It may seem like you are saving money, but in reality you could have very limited access to the medical care you need because you are “underinsured”.
  • If you have other coverage, for example, you or your spouse is working and you are still covered under the employer’s plan, you can skip Part B sign up---for now.
    • But, when you or your spouse stops working, its important that you contact Social Security as soon as possible to sign up and not have late sign up penalties.
    • There are some exceptions to the late sign up penalty that make you eligible for a Special Enrollment Period.

Learn more about Medicare A and B in our health insurance webinar series

Part D

Don’t forget there is also a Part D to Medicare. Part D is prescription drug (medicine) coverage. Part D is elective, meaning you must choose to have it and sign up. If you don’t have prescription drug coverage (through Part D or another prescription plan), you will have to pay for all of the costs of your medications.

Like Part B, it is best to sign up for Part D coverage when you are first allowed (this period begins 3 months before you turn 65, and ends three months after the month you turn 65- a total of 7 months to sign up).

You can join a prescription plan in several different ways, and there can be many plans to choose from. Start with the Medicare Plan Finder (link). This online tool will help you find prescription plans in your area, as well tell you how to sign up for these plans. You can also call the plan directly to enroll or call Medicare (1-800-Medicare) for more help. 

If you have decided to have your insurance coverage through a Medicare Advantage plan, this plan may offer part D coverage as part of its package. Contact your plan directly to check if you have Part D coverage.

Be sure when you are picking a plan that you compare things, such as:

  • Premium: This is what you pay every month for the plan.
  • Deductible: This is what you pay every year before the plan starts to pay for any of your medications.
  • Co-Pay: This is what you pay for each prescription. The copay is different for every medication. It depends on the cost group (called a “tier”) the medication is in with that particular plan.

Learn more about Part D coverage in our health insurance webinar series

Its important to pay attention to deadlines for signing up. Penalties for late sign up can be large and last for your lifetime. Ask your healthcare team, social worker, or navigator for help if you are having trouble understanding your options or signing up.

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