WebMD Medical Reference
Enrolling in Medicare is simple and often automatic. Follow these three steps to learn what you should do.
Medicare is for people age 65 or older, and for those who are disabled or are on renal dialysis. Medicare has two parts. Medicare Part A covers hospital stays and other inpatient services. Part B covers physician and other outpatient services.
If you currently get Social Security or Railroad Retirement payments:
- You will be enrolled in Medicare Part A & B automatically on the first day of the month of your 65th birthday. (If you turn 65 on May 15, you are enrolled on May 1.)
- Your Medicare card should come in the mail three months prior to your 65th birthday. If you do not receive your card, call the Social Security Administration at 1-800-772-1213, or visit www.ssa.gov.
If you do not draw Social Security or Railroad Retirement payments:
- You must sign up to get Medicare benefits.
- To sign up, call Social Security at 1-800-772-1213.
- You can also apply in person at your local Social Security office.
- You cannot apply online for Medicare alone.
To sign up for both Medicare and Social Security retirement benefits:
- You can apply online here.
- Or call 1-800-772-1213.
- Or visit your local Social Security office.
If you qualify for Social Security benefits, you do not pay for Medicare Part A coverage. Therefore, you should definitely sign up for Part A.
For Medicare Part B insurance everyone pays a monthly fee, which is usually taken out of your Social Security payment. In 2005, this fee is $88.50, although it may be higher if you didn't sign up for Part B when you first became eligible. You may choose not to participate in Medicare Part B insurance, which covers doctor visits and other outpatient medical services.
If you are still working and you are covered under your union or employer's health insurance -- or if you are covered under your spouse's employee health insurance -- Medicare Part B is not necessary. However, if you have retiree health insurance, you will need Medicare Part B. If you do not want Part B, you must opt out.
If you were enrolled in Medicare automatically:
- A form that comes in the mail with your Medicare card allows you to opt out of Part B.
- Indicate that you do not want Part B coverage on the form.
If you are enrolling yourself in Medicare:
- Indicate that you do not want Part B when you enroll by phone, by Internet, or in person.
If you opt out of Part B when you are enrolled, you may pay higher premiums if you decide you want it later. The premium goes up 10% every year that you could have had Part B.
There are some exceptions. You will not pay more for signing up later:
- If you are covered by another group health plan when you turn 65.
- If you sign up for Part B within eight months after the other group health plan no longer covers you.
If you decline Part B at first, and do not sign up within eight months after your other health coverage ends, you can only sign up during Medicare's "general enrollment" period: January 1 to March 31 of each year, and your coverage will not begin until July of that year.
Before opting out of Medicare Part B, it would be a good idea to talk to the group benefits administrator with your other health insurance plan. In some cases Medicare Part B would be your main insurance even if you have other coverage.
Your retiree health insurance plan may pay for some of the deductibles or co-payments that you have to pay with Medicare coverage. If you don't have retiree health benefits, you can decide to participate in a Medicare Advantage plan that often covers some of the gaps in Medicare. Or you can buy specially designed health insurance that supplements Medicare called Medigap insurance.Medigap
Medigap plans are sold by private companies to seniors on Medicare. These plans are meant to fill in the "gaps" in Medicare. They help pay for things that Medicare does not pay for.
If you are going to buy a Medigap plan, you should do so within six months of taking Medicare Part B. During this six-month window, insurers:
- Can't deny you coverage.
- Can't delay the start of your coverage.
- Can't charge you more based on pre-existing health problems.
If you try to buy a Medigap policy after your six-month enrollment period has ended, there is no guarantee that you will be given coverage.
To learn about Medigap plans offered in your area, you can use the online Medicare Personal Plan Finder.Medicare Advantage (formerly Medicare + Choice)
These are managed care plans sold by private insurers as alternatives to the traditional Medicare Plan. To join, you must already have Medicare Part A and Part B. Your Medicare Advantage plan may also require a monthly fee for some of the plan's extra benefits.
If you are in a Medicare Advantage Plan, you don't need a Medigap policy. Medicare Advantage plans usually cover the same benefits that a Medigap plan offers.
In 2005, you can enroll or disenroll from a Medicare Advantage plan at any time.
- You must contact the insurance company and tell them you wish to cancel.
- Usually, your coverage will end the first day of the month after you request to leave.
- You will then have 60 days prior to that date, and 63 days after that date to buy a Medigap plan.
*But in 2006, you will only be able to change or cancel your Medicare Advantage plan once a year.
Medicare for People With Disabilities
If you are under age 65, you are eligible for Medicare if:
- You are disabled and are getting Social Security disability payments.
- You have Lou Gehrig's disease (ALS).
- You have kidney failure (end-stage renal disease) and you need dialysis or a kidney transplant.
You can enroll in Medicare by calling or visiting your local Social Security Office or by calling Social Security at 1-800-772-1213.
Reviewed by Cynthia Haines, MD, August 2005.
SOURCES: Centers for Medicare and Medicaid Services. Medicare.gov web site. National Council on the Aging web site.
© 2005 WebMD Inc. All rights reserved.
For additional Medicare information, please read the following articles:
- New Benefits At-a-Glance
- Medicare Coverage
- Drug Discount Cards
- Drug Benefits in 2006
- Retiree Benefits
- Long-Term Benefits
- Medicare for People with Disabilities
- Decisions: What's The Right Coverage for You?
- Filing a Medicare Claim
- Getting More Information
- Get The Most From Medicare
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