If you’re getting ready to enroll in Medicare, you may be wondering how or when to enroll, and understandably so! There are many different parts of Medicare and several different options to choose from. Also, if you miss your enrollment period, you may be subject to late penalties!
You will most likely be automatically enrolled in Medicare Parts A & B (Original Medicare). There are also additional options. You can choose Medicare Part C (also known as Medicare Advantage), Medicare Part D (prescription drug coverage) or a Medicare Supplement Plan. There are many different enrollment periods to keep track of! The whole process can be quite confusing, so if you need any help, we recommend that you work with a licensed broker.
When to Enroll in Medicare Part A & Medicare Part B
Medicare Parts A & B are also known as Original Medicare. Medicare Part A is your hospital coverage. Part B is your outpatient insurance. Together, they will cover a large portion of your medical needs including:
- Inpatient and Outpatient Procedures
- Nursing Home Care
- Doctor’s Visits
- And More
Original Medicare will help to cover specific services with doctors and hospitals who accept Medicare (most do). However, it does not cover the entirety of the costs. Original Medicare covers approximately 80% of the costs. This is why many people look to a Medicare Supplement Plan, Medicare Advantage or Medicare Part D. We’ll discuss these momentarily.
If you are receiving social security benefits, you will be automatically enrolled in Original Medicare. However, if you are not automatically enrolled you must do so during:
- Your Individual Open Enrollment Period
- A Special Enrollment Period (if you qualify)
- The General Enrollment Period
Individual Open Enrollment Period
Your Individual Open Enrollment Period is the three months before you turn 65, the month of your 65th birthday and the three months after. If you are not automatically enrolled during this time, you will need to contact your local social security office. You can also call logon to socialsecurity.gov or call 1-800-772-1213 (TTY users 1-800-325-0778)
Special Enrollment Period
Some people will qualify for a special enrollment period. If you maintain creditable coverage elsewhere (perhaps through your employer) and undergo certain qualifying life events (namely moving or loss of coverage), you may be eligible for a special enrollment period. You will have eight months from the date of the qualifying event to enroll in Medicare without penalty.
General Enrollment Period
Additionally, there is the General Enrollment Period. This is every year from January 1-March 31st. Your coverage will begin July 1st. However, it is in your best interest to enroll either during your individual open enrollment period or a special enrollment period if you qualify. If not, you will be charged a late penalty which will be tacked onto your monthly premiums in perpetuity.
When to Enroll in Medicare Part C
Medicare Part C is also known as Medicare Advantage. Some choose to forego Original Medicare in favor of a Medicare Advantage Plan. Advantage Plans encapsulate the benefits of Parts A & B and very often part D as well (that’s your prescription coverage). Additionally, Medicare Advantage helps to bridge the gaps of Original Medicare and limit your out of pocket expenses. Also, very often Medicare Part C covers additional services such as dental, vision, hearing, and even gym memberships.
You can enroll during:
- Your individual open enrollment period
- A special enrollment period
- The annual open enrollment period
Like Original Medicare, your individual enrollment period is the three months prior to, the month of, and the three months after your 65th birthday.
Like Original Medicare, you may qualify for a special enrollment period.
However, the annual open enrollment period is different. For Medicare Advantage, the AEP runs from October 15th to December 7th.
Once you are enrolled in a Medicare Advantage Plan, you are locked into that plan until the next Annual Enrollment Period. So it is very important to do your research and confirm that you are enrolled in the right plan. Because Medicare Part C is offered by private carriers, benefits and prices can vary widely.
When to Enroll in Medicare Part D
Medicare Part D is an important one! Part D is your prescription drug coverage. Without prescription coverage, you could end up paying quite a bit for your prescription drugs.
Additionally, Medicare Part D is arguably one of the most confusing parts of Medicare. Like Medicare Advantage, it is offered by private carriers, so it is important that you shop around. Although there are regulations set by Medicare, some carriers may provide better plans than others for YOU!
The enrollment periods for Medicare Part D are the same as Medicare Part C:
Your Individual Open Enrollment Period is the three months prior to, the month of, and the three months after your65th birthday.
You may also have the option to enroll during a special enrollment period, if you qualify.
AND like Part C, the annual open enrollment period is October 15th to December 7th.
It is in your best interest to enroll in some type of prescription drug coverage (either Part C or Part D) during your individual open enrollment period or a special enrollment period. Should you have any gaps in your prescription coverage after enrolling in Original Medicare, you may be subject to a late penalty. This will be tacked onto your monthly premium. No one wants to pay more than what is necessary, so please make sure to plan ahead.
Enrolling in a Medicare Supplement Plan
Similar to a Medicare Advantage Plan, Medicare Supplement Plans limit your out of pocket spending and bridge the gaps of Original Medicare. These plans do not cover prescriptions. Therefore, you will need Part D if you enroll in a Medicare Supplement plan. However, these plans are standardized. So, benefits do not vary from carrier to carrier. This makes comparison shopping much easier. Additionally, if your doctor accepts Medicare, they accept your supplement plan. Medicare offers a very large network of doctors and hospitals.
You can enroll in a Medicare Supplement Plan year round. There are no annual enrollment periods or late penalties associated with supplements. However, it is in your best interest to enroll during your initial enrollment period. For a Medicare Supplement Plan this is the six month period after you have enrolled in Medicare Part B. During this time, you are guaranteed any supplement plan without medical underwriting. After this time, you can still enroll, but you may be subject to medical underwriting and therefore denied.
How to Enroll
For Original Medicare, you will either be automatically enrolled or you will need to contact social security to enroll. You can visit your local office to fill out paperwork, logon to socialsecurity.gov or call social security directly.
For Medicare Part C, Medicare Part D, or a Medicare Supplement Plan you have three options:
- Contact the carrier directly and speak with an agent
- Go through a broker
- Logon to Medicare.gov
Medicare Part C, Medicare Part D, and Medicare Supplement Plans are all offered by private carriers. So, you can contact the company directly and speak with an agent to enroll. However, this is absolutely not something we’d recommend. You will not receive an additional discount or any type of incentive by working directly with a carrier. Commissions are already calculated into rates and are regulated by law. If you work directly with a carrier’s agent, you will only be privy to that carrier’s plans which will make it harder to shop around.
A broker is a third party liaison who works for you, not the insurance company. A broker will help you compare all the different plans available to you to ensure that you get the right plan for your needs at the lowest possible price. There are no additional or hidden fees when working with a broker. If you’d like our help, you can reach us here at iHealthBrokers at 888-918-0518 or schedule a call today. Of course you can also research in advance or complete the enrollment process through Medicare.gov. You can see a walkthrough of Medicare.gov in the video below.
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.