Medicare is a federal health insurance program for people 65 and older, as well as some people under 65 with certain disabilities or medical conditions. Medicare covers a range of health care services, such as hospital stays, doctor visits, preventive care, prescription drugs, and more. If you are turning 65 soon, you may have some questions about how to get started with Medicare. Here are some key points to keep in mind:
When to Apply for Medicare
The best time to enroll in Medicare is during your initial enrollment period, which starts three months before the month you turn 65 and ends three months after the month you turn 65. If you enroll during this period, your coverage will start on the first day of the month you turn 65 (or the month before if your birthday is on the first day of the month).
If you miss your initial enrollment period, you can still sign up for Medicare during the general enrollment period, which runs from January 1 to March 31 each year. However, you may have to pay a late enrollment penalty for Part B (medical insurance) and Part D (prescription drug coverage) if you sign up later.
There are some exceptions to these rules if you are still working and have health insurance from your employer or your spouse’s employer. In that case, you may qualify for a special enrollment period to sign up for Medicare without a penalty when your employment or employer coverage ends.
How to sign up for Medicare when you Turn 65
There are different ways to enroll in Medicare, depending on your situation. Here are some common scenarios:
- If you are already receiving Social Security benefits or Railroad Retirement Board benefits when you turn 65, you will be automatically enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). You will receive your Medicare card in the mail about three months before your 65th birthday.
- If you are not receiving Social Security benefits or Railroad Retirement Board benefits when you turn 65, you will need to sign up for Medicare Part A and Part B yourself. You can do this online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office.
- If you want to enroll in Medicare Part C (also known as Medicare Advantage) or Part D (prescription drug coverage), you will need to sign up for these plans separately through a private insurer that offers them.
What are the parts of Medicare Plan?
Medicare has four main parts that cover different types of health care services:
- Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care. Most people do not pay a premium for Part A if they or their spouse have paid Medicare taxes for at least 10 years.
- Part B covers outpatient medical care, such as doctor visits, lab tests, preventive services, durable medical equipment, and some home health care. Most people pay a monthly premium for Part B based on their income.
- Part C, also known as Medicare Advantage, is an alternative way to receive your Medicare benefits through a private insurer that contracts with Medicare. Medicare Advantage Plans must cover everything that Original Medicare (Part A and Part B) covers, but they may also offer extra benefits, such as vision, dental, hearing, wellness programs, and more. Most Medicare Advantage Plans also include prescription drug coverage. You pay a monthly premium for Part C in addition to your Part B premium.
- Part D covers prescription drugs that you get at a pharmacy or through mail order. You can get Part D through a stand-alone prescription drug plan or through a Medicare Advantage Plan that includes drug coverage. You pay a monthly premium for Part D based on your income and the plan you choose.
How much does Medicare cost
The costs of Medicare vary depending on several factors, such as the type of plan you choose, the services you use, the providers you see, and whether you qualify for any financial assistance programs. Here are some common costs that you may encounter:
- Deductibles: The amount you pay out of pocket before your plan starts to pay for covered services. For example, in 2022, the Part A deductible is $1,556 per benefit period and the Part B deductible is $233 per year.
- Coinsurance: The percentage of the cost that you pay for covered services after you meet your deductible. For example, in 2022, the Part A coinsurance is $389 per day for days 61-90 of each benefit period and $778 per day for days 91 and beyond. The Part B coinsurance is 20% of the Medicare-approved amount for most services.
- Copayments: The fixed amount that you pay for covered services at the point of service. For example, some Part C and Part D Plans may charge you a copayment of $10 for a doctor visit or $20 for a prescription drug.
- Premiums: The monthly amount that you pay to have a plan. For example, in 2022, the standard Part B premium is $170.10 per month and the average Part D premium is $33.06 per month. Your premiums may be higher or lower depending on your income and the plan you choose.
How to get help with Medicare costs
If you have a low income and limited resources, you may qualify for some programs that can help you pay for some or all of your Medicare costs. These programs include:
- Medicare Savings Programs: These programs help pay for your Part A and Part B premiums, deductibles, coinsurance, and copayments. There are four types of Medicare Savings Programs, each with different eligibility criteria and benefits. You can apply for these programs through your state Medicaid agency.
- Extra Help: This program helps pay for your Part D premiums, deductibles, coinsurance, and copayments. You can apply for this program through Social Security or your state Medicaid agency.
- Medicaid: This is a joint federal and state program that provides health coverage for people with low incomes and disabilities. If you qualify for both Medicare and Medicaid, you are considered a dual eligible and you may get more benefits and pay less for your health care. You can apply for Medicaid through your state Medicaid agency.
- State Pharmaceutical Assistance Programs: These are state-run programs that help pay for prescription drugs for people with low incomes. Each state has its own program with its own eligibility criteria and benefits.
How to learn more about Medicare
Medicare can be confusing, but there are many resources available to help you understand your options and make informed decisions about your health care. Here are some ways to learn more about Medicare:
- Visit Medicare.gov, the official website of the Medicare program, where you can find information about plans, benefits, costs, enrollment, and more.
- Call the toll-free number of the Medicare program, where you can speak to a customer service representative who can answer your questions and provide personalized assistance.
- Contact your State Health Insurance Assistance Program (SHIP), a free counseling service that provides unbiased advice and guidance on Medicare issues. You can find your local SHIP at shiptacenter.org.
- Read the Medicare & You handbook, an annual publication that explains the basics of Medicare and compares different plans and services. You can get a copy of the handbook by mail or online at Medicare.gov.