Step by Step Guide to Medicare Enrollment

Are you turning 65 soon? If so, you should familiarize yourself with the Medicare Enrollment procedures.

Original Medicare

Let’s start with Original Medicare. First a brief run down over what it is and what it covers:

Original Medicare is Part A, your hospital insurance, and Part B your medical insurance. They will cover most of your medical needs, but there are some notable exceptions such as dental, vision, hearing and prescription drugs. 

There are premiums, copays and coinsurance and deductibles to be aware of. You will likey not have a monthly premium for Part A if you qualify through yours or your spouse’s work history. If you or your spouse have worked at least 40 quarters (basically 10 years) then there is no monthly premium for Part A. If not, you’ll pay either $278 or $506 each month for Part A. 

There is a premium for Part B and that is determined by your income. The base premium in 2023 is $164.90. But it can be more based on your income.

If you are receiving social security or railroad retirement benefits at least 4 months before you turn 65, you should receive your card in the mail 3 months before you turn 65. In this case, your enrollment is automatic.

If you wish to defer Original Medicare (specifically Part B) you will need to follow the instructions on the back of the card and send it back. If you keep the card, you will keep Medicare Part B and you will be charged for it.

If you do NOT receive your card in the mail. You can do so in the seven months surrounding your 65th birthday. 

You can also enroll during the general enrollment period which is every year from Jan 1-Mar. 31 or during a SEP if you qualify. 

Medigap

With Original Medicare, there are still copays and deductibles to meet. And because there is no out of pocket maximum, if you have major medical needs, you could wind up with major medical bills. For this reason, many people look into a Medicare Supplement Plan.

You can enroll in a Medigap plan year round, but are best served doing so in the six months after you turn 65 and enroll in Part B. So if you defer Part B, this window wouldn’t begin unti you reenroll.

During this time, you will not be subject to medical underwriting. After this time, you may be subject to medical underwriting which means you could be charged more or denied outright.

To enroll in a medigap plan, first choose which of the 10 plans is most appropriate for your needs and budget.

Part D

Because Original Medicare does not cover prescription drugs except in very limited instances, you will likely also need a Part D plan. Part D covers prescription drugs.

There are some major changes coming to Part D in 2024 and 2025 so make sure to check out our video about that. But basically you will pay an extra monthly premium to have access to lower cost prescriptions. The price for the drug is based on the tier. There are five tiers which get more expensive as you move from tier 1 to tier 5. You may have a deductible to meet, although many plans offer lower deductibles and no deductible for lower tier medications. 

Additionally, Medicare will track your spending as you move from deductible to initial coverage. If you continue to spend, you may reach the coverage gap or donut hole. During this time, your prescription drug costs will increase but if you continue to spend, you may reach the catastrophic coverage phase and your costs will drop drastically. Unfortunately, this will reset when your plan does. 

Enrollment for Part D begins when you first become eligible for Original Medicare. You can also enroll during the AEP Oct. 15-Dec. 7. Make sure to review your plan every year during this time as well. You can also enroll during a SEP if you qualify. 

Medicare Advantage

Finally, there is Medicare Advantage aka Part C. These are a replacement to Original Medicare. They must offer at least the same benefits, but often offer lower copays and deductibles as well as other benefits such as dental, vision, hearing and prescription drug. They will also impose an out of pocket maximum.

However, there are major drawbacks to MA including restrictive networks and the issue of preauthorization so please proceed with caution.

You can enroll in a Part D plan when you first become eligible for Original Medicare. You can also enroll during the AEP Oct. 15-Dec. 7. Make sure to review your plan every year during this time as well. You can also enroll during a SEP if you qualify.