Q: My 65th birthday is approaching and I’m ready to apply for Medicare. What do I need to know before signing up?
A: Medicare offers affordable health care coverage to older Americans, but the application process and the various options can be confusing. We have answers to all your questions.
What is Medicare?
It is a federally funded program that provides health care coverage to Americans over age 65. It is generally also available to younger people with disabilities and people with end-stage renal disease.
What are the different kinds of coverage?
There are two government-funded parts:
- Part A – Hospital Insurance. This coverage pays for inpatient hospital costs, is usually premium-free, and is available to anyone age 65 or older who has worked — or whose spouse has worked — and paid Medicare taxes for a minimum of 10 years.
- Part B – Medical Insurance. This offers coverage for services from doctors and other health care providers, outpatient hospital care, home health care, medical equipment, and some preventive services. Part B is not free. Premiums vary by income level but are generally affordable. The standard monthly premium for Part B in 2023 is $164.90.
There are also two privately obtained parts:
- Part C – Medicare Advantage. Private insurance companies provide a plan that provides extra coverage over Parts A and B.
- Part D – Prescription Drug Coverage. Also purchased through a private insurer, Part D offers full or partial coverage for prescription drugs.
Both Part C and Part D have monthly premiums, which vary in cost with each provider. There may be an annual deductible as well. Some people love the low costs and robust coverage of these plans, but others find that they only cover a limited number of providers and are not worth the cost.
How do I apply for Medicare?
If you’re ready to sign up, you can apply online or in person at the nearest Social Security office. Applicants will need to provide their birth certificate or other proof of birth and proof of United States citizenship or legal residency.
What do I need to know before I apply?
Before signing up for coverage, it’s best to learn these important facts:
- You have a seven-month window to enroll. Eligibility begins at age 65, but applicants can sign up three months before the month of their 65th birthday, and up to three months after their birth month. Benefits are retroactive dating back to the applicant’s 65th birthday.
- It pays to enroll on time. Signing up during the initial enrollment window is crucial. It ensures the applicant has coverage in place should the need for it arise, and it helps the applicant avoid lifelong surcharges on Part B premiums. Otherwise, applicants face a 10% increase in these premiums for each year-long period they were eligible for but did not enroll.
What if I missed my Initial Enrollment Period (IEP)?
If an applicant has missed their IEP, they’ll need to enroll during the General Enrollment Period, which runs from Jan. 1 through March 31 each year. Applicants can also make changes to their general coverage during this time.
Can I make changes to my plan?
If you’d like to make changes to your Medicare Advantage or Prescription Drug Plan, you can do so during the annual open enrollment period.
Can I sign up for Medicare if I already have health coverage?
Many employees stay on at their jobs past their 65th birthday and will continue to enjoy the health coverage provided by their employer. These employees do not need to sign up as soon as they hit 65 — they’ll be given a special enrollment period later on that will allow them to avoid the surcharges of late enrollment.
If an employee wants to keep their employer’s health coverage and also get coverage through Medicare, they can do that. In this scenario, Medicare would be used as secondary insurance and the applicant would sign up for Part A since that coverage is free and will be used to fill in the gaps in the employer’s insurance plan.
Your Turn: Have you recently applied for Medicare? Share your best tips with us in the comments.
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