How It All Began
In 1965, Congress passed Medicare legislation to create a national health-care plan for all citizens 65 years of age. In addition, citizens under 65 who are disabled or afflicted with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) are also covered.
Medicare is the nation’s largest health insurance program, with a current enrollment of over 61 million.
Original Medicare, as it was first created, only included Parts A and B. In the years since, the program has been expanded to include Parts C and D.
Am I Eligible for Medicare?
You are eligible to enroll if you are at least 65 years of age and have been a legal resident of the United States for at least five years.
In addition, if you are under 65, you may be eligible if you have received Social Security Disability Insurance (SSDI) for twenty-four months. After enrollment, your coverage will begin on month thirty.
There are also some special circumstances that provide an enrollment opportunity. If you have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, your benefits begin the month your social security disability benefits begin. If you have End Stage Renal Disease (ESRD), your eligibility would begin on the first day of the fourth month of your dialysis treatments
How Do I Apply for Medicare?
If you are receiving Social Security or Railroad Retirement benefit payments at least three months prior to your 65th birthday, your enrollment will be automatic. Within those three months before your 65th birthday, your new Medicare card will arrive in the mail.
WARNING: Your card comes in a white 6 x 9 envelope that looks like all the solicitation mail you will be receiving as you approach your 65th birthday. Check your mail carefully to be sure you don’t accidentally discard your new card. You can print a new card by creating an account at mymedicare.gov
If you have not begun your Social Security or Railroad Retirement benefit payments prior to turning 65, the Social Security Administration recommends that you apply three months before your birth month.
- You don’t have to be retired to enroll.
- If you’re NOT receiving Social Security or Railroad Retirement benefit payments, you must initiate your enrollment; it does not happen automatically.
- Contact the Social Security Administration to enroll online.
- To enroll at a local Social Security office, phone 800-772-1213 to set up an appointment.
When Do I Apply for Medicare?
Your Initial Enrollment Period (IEP) is 7 months long. It begins three months before your birth month, includes your birth month, and continues for three months following your birth month.
For example, if your birth month is April , your enrollment period would begin on January 1 and end on July 31.[glossary
The Social Security Administration recommends that you enroll as early as possible. If you enroll at any time during the three months prior to your birth month, your coverage will begin on the first day of the month you turn 65. (If you are born on the first of the month, however, your coverage will begin on the first day of the prior month.)
If you wait to enroll during your birth month, your coverage will begin the first of the following month. But if you wait until the month after you turn 65, your coverage will be pushed out two months. Put off enrolling until the second month after your birth month and your coverage won’t begin for another three months.
What if I Plan to Continue Working?
If you plan to continue working and will be covered by an employer group health plan from an employer with more than 20 employees, you may not need to sign up for Medicare Part B. You will want to check with your company’s HR department to see if the group health plan requires that you enroll in Part B. This isn’t usually the case. If not, you can delay enrollment until you leave that active employment.
You could enroll in Part A, which, in most cases, has no premium and may offer additional coverage.
Take note of the word, active. To be creditable coverage, which allows you to delay your enrollment into Medicare Part B, the coverage must be provided by an employer for whom you are actively working. Retiree group health coverage is not creditable and neither is COBRA except possibly in the case of drug coverage which may be creditable, depending on the plan.
If you plan to continue working and will be covered by an employer group health plan from an employer with fewer than 20 employees, you must sign up for Medicare because Medicare will be primary.
We had a client come to us who was in this very situation. Bob didn’t know that his employer group coverage was secondary to Medicare due to the fact that he worked for a firm with fewer than 20 employees. It wasn’t until Bob had a medical emergency that he found he had no coverage, even though he was enrolled in a group plan through his employer. Because he wasn’t enrolled in Medicare, which would have been primary, his group plan wasn’t obligated to take care of his medical bills. A plan which has secondary status can not pay if there’s no plan in place to be secondary to.
Don’t put yourself in Bob’s situation, where some Medicare regulation you don’t know about can come come back to hurt you. A consultation with our expert agents can alleviate the worry of an unpleasant, unexpected surprise.
If you don’t enroll in Medicare when first eligible, your next opportunity would come during the General Enrollment Period (GEP) which runs from January 1 through March 31. Even then, your coverage would not begin until July 1.
For every 12 months that you delay enrollment absent creditable coverage, a 10% penalty would be applied to your Part B premium. And this penalty would continue as long as you are enrolled in Medicare.
The Parts of Medicare
It's an Alphabet Soup of Coverage
Part A is your medical coverage. Think of it as your room and board. Part A covers a semi-private room, meals, nursing care, and some medications administered in the hospital. Part A also covers skilled nursing care in a hospital or rehabilitation facility, some in-home healthcare, and hospice.
If you have worked at least 40 quarters (10 years), your Part A benefit comes to you with no monthly premium. You have already pre-paid the premium through your Medicare payroll deductions.
Part B is outpatient coverage and covers doctors visits, surgeries, lab tests, blood work, x-rays and radiation, medications given by infusion in a doctor’s office or hospital setting (chemotherapy, for instance), and flu and pneumonia inoculations. There is a premium for Part B.
Medicare parts A and B, Original Medicare, only pay a portion of your expenses. In addition to the Part B premium, both parts require the payment of deductibles and copayments. And the bad news is that Original Medicare has no maximum out-of-pocket limit. As long as you continue to access care and the bills continue to arrive, Medicare will pay it’s ever-increasing portion, and your obligation to the deductibles and copayments will continue as well.
Part C is the designation for Medicare Advantage, which works as a replacement of Parts A and B.
Medicare Advantage is offered by “for-profit” medical providers that the government pays to take over your health care. These providers are required to cover all the benefits you would have received under Medicare Parts A and B. In addition, they may also add ancillary benefits not found in Original Medicare such as routine dental, vision, and hearing coverage.
Medicare Advantage is Managed Care and is usually provided through a network of providers in an HMO or PPO setting.
Medicare Advantage plans contract with the government in one-year contracts. Each year during the Annual Election Period from October 15 to December 7 you have the opportunity to change plans.
We can help you choose the plan that includes all your doctors, has all your medications on its formulary, and offers the best additional benefits.
Part D is prescription drug coverage. Medicare Part D is available as a stand-alone plan that can be paired with a Medigap policy. It can also be included as part of a Medicare Advantage plan.
It's all so confusing!
How do I decide?
Don’t worry, we’re here to help. This is what we do.
Medicare is a huge program comprised of an absolute ocean of information. Over the years since it was first signed into law in 1965, policy after policy and regulation upon regulation have been added until it’s enough to make your head spin.
You can try to learn it all, but there’s always the fear that the one thing you don’t know may come back to penalize you.
Or, you can leave it to us. The reality is that out of this ocean of information, only a small portion applies to any one person. In a brief consultation, we can determine what you need to know and educate you on just that much of the program. Then, based on the information you provide, we can recommend a way forward.
We’ll keep you out of the penalty box and help you access the best healthcare you’ve ever enjoyed
And all this assistance comes at no cost. There’s never a charge for our services!
So let me answer the question most of our clients wonder but are too polite to ask.
“How do we get paid?”
Well, if we’re able to assist you with a plan, the insurance carrier will pay us a small commission.
Having said that, let me be clear. Our help is never contingent on getting you into a plan. There are occasions where we help folks who, because of a government, union, or teaching affiliation, must go through that entity’s designated agency to obtain their coverage. We’re still happy to educate those individuals and to help them determine what their best Medicare options would be.
And once you select us to be your agent, we’re paired for life. Year after year we’ll do the heavy lifting. There’s no need for you to investigate plans each year to determine your best option. We do that so you can enjoy your retirement without the stress of managing your Medicare coverage options on an annual basis.
Questions? Feel free to give us a call or send a request for a consultation.