Overview

Medicare is a health insurance program from the federal government mainly for individuals 65 and older, but also for some younger individuals with disabilities or specific conditions like ALS or end-stage renal disease. The Centers for Medicare & Medicaid Services (CMS) runs it, helping cover various healthcare needs—though it doesn’t cover everything, like all medical costs or long-term care.

How to Sign Up:

You can enroll online, over the phone, or in person at a Social Security office. There’s a 7-month window to sign up, starting 3 months before you turn 65, your birthday month, and ending 3 months after. If you’re still working and have insurance through your job, you might qualify for a Special Enrollment Period (SEP) to sign up later without a penalty.

Who Can Get It?

If you’re hitting age 65 soon, you’re likely eligible. If you’re already getting benefits from Social Security or the Railroad Retirement Board, you’ll be signed up automatically. If not, especially if you don’t have health insurance through work, you’ll need to sign up around your 65th birthday. People with certain disabilities might qualify earlier, so it’s a good idea to talk to the Social Security office to find out.

What’s the Cost?

Medicare Part A (hospital coverage) is usually free if you or your spouse paid Medicare taxes for 10 years. Part B (doctor visits and medical services) has a monthly cost (premium). Prices change year to year, so knowing what each part covers and any fees is key.

Medicare Costs

– Part A: Generally free, but includes deductibles and copayments.

– Part B: Monthly premium of $174.70 in 2024 (may be higher based on income), plus deductible and coinsurance.

– Medicare Advantage (Part C): Average premium of $18.50 per month in 2024, with varying deductibles, coinsurance, and copayments.

– Part D: Monthly premium of $48 (projected in 2024), plus a deductible of $545, with possible income-based surcharges.

– Medicare Supplement (Plans A-N): Premiums vary by plan. The most popular Plan G has an average monthly premium of $148.

Next Steps

As you approach 65, ensure you understand Medicare eligibility and enrollment processes. Enroll online, by phone, or at a Social Security office within your 7-month Initial Enrollment Period to avoid penalties. If you have job-based insurance, check if you qualify for a Special Enrollment Period. Review the costs and coverage of Medicare Parts A and B, and consider additional benefits through Medicare Advantage (Part C) and Prescription Drug Plans (Part D). Taking these steps will help secure your health coverage effectively.

Medicare Resources

Understanding Medicare

Medicare does not cover all healthcare expenses, leaving you responsible for certain out-of-pocket costs and services like long-term care.

To manage these gaps, you have several options:

– Original Medicare: Includes Part A (Hospital Insurance) and Part B (Medical Insurance)

– Medicare Supplement: Also known as Medigap, this insurance helps cover the costs not included in Original Medicare

– Medicare Advantage (Part C): An all-in-one plan that may include additional benefits

– Part D: Prescription drug coverage provided by independent insurers.

Medicare Plan Options

– Original Medicare Part A: Covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care.

– Original Medicare Part B: Covers doctor services, outpatient care, durable medical equipment, and preventive services.

– Medicare Advantage (Part C): Offers an alternative to Original Medicare with potential additional benefits and access to HMO or PPO networks.

– Part D: Helps with the cost of prescription drugs and some recommended vaccines.

– Medicare Supplement (Medigap): Plans A-N fill gaps in Original Medicare coverage, such as deductibles, copayments, and coinsurance.

How to Enroll in Medicare

How/when do I enroll in Medicare?  

Most people should apply for Medicare during their Initial Enrollment Period (IEP), which spans seven months around your 65th birthday. The fall Open Enrollment Period runs from October 15 through December 7 each year for making changes to your Medicare coverage. If you miss your initial enrollment period and don’t qualify for an exception, you can enroll during the General Enrollment Period (GEP) from January 1 to March 31 each year. Keep in mind, that this may incur higher premiums.

How do I switch Medicare plans?  

You can switch Medicare plans during the Open Enrollment Period or Special Enrollment Periods if you qualify. This is also when you can switch between Original Medicare and Medicare Advantage or add Part D coverage.

When is the deadline to enroll into Medicare?  

The Initial Enrollment Period is your main opportunity to enroll in Medicare without penalties. For changes or new enrollments outside this period, be aware of the Open Enrollment Period from October 15 to December 7, and the General Enrollment Period from January 1 to March 31.