Three months before your 65th birthday month, you become eligible to enroll in Medicare. If you have already been receiving benefits from Social Security, you will be automatically enrolled. Otherwise, you will need to enroll through your local Social Security office. Your Initial Enrollment Period lasts for seven months in total, extending to three months after the month of your birthday.
During this time, you will be enrolling in Original Medicare, which is Part A and Part B. If you are still working and have coverage through your or your spouse’s employer, you may qualify for a Special Enrollment Period. This would mean you can wait to enroll in Part B with no late enrollment penalty until you lose the health coverage or stop working, whichever comes first. You will have eight months to enroll. It is recommended to enroll in Part A when you first become eligible, as it is usually premium-free. You qualify for premium-free Part A if you or your spouse has worked and paid taxes to Medicare for at least 40 quarters.
What are the parts of Medicare?
Original Medicare encompasses both Part A and Part B. Part A is hospital insurance, which covers inpatient services, skilled nursing facility services, hospice care, and home health care. Part B is medical insurance, which covers wellness visits, laboratory tests, x-rays, medical supplies, durable medical equipment, and ambulance services.
Part C is Medicare Advantage. Medicare Advantage Plans are provided by private Medicare-approved companies that Medicare compensates to handle your Part A and Part B coverage. You receive the same benefits for hospital and medical insurance as with Original Medicare. Additionally, most Part C plans offer prescription drug coverage as well as dental, hearing, and vision options.
Part D is Prescription Drug coverage. Prescription Drug Plans have what are called formularies, which list the drugs covered by the plan into tiers. The tiers determine the amount you owe as a copayment, and this varies depending on if the prescription is generic, name brand, specialty, or non-preferred. Each plan covers at least two drugs for each of the most commonly prescribed categories.
Medicare Supplement Plans, also known as Medigap Plans, are intended to cover not treatment but expenses. They help to pay the expenses of Original Medicare. The ten Medigap Plans each cover a percentage of payments for deductibles, coinsurance, and copayments for Part A and Part B. Six of the plans have coverage for foreign travel.
If you want to add a Medigap Plan to help pay your Medicare expenses, you can first do so during your Medigap Open Enrollment Period, which lasts for six months after you enroll in Part B. You cannot have both a Medigap Plan and a Medicare Advantage Plan. Switching from Original Medicare to a Medicare Advantage Plan can happen during the Open Enrollment Period, which is from October 15 to December 7. If you want to switch back to Medicare, you can do so from January 1 to March 31.