Get Started With Medicare

Medicare First Steps

To get Medicare, individuals typically follow a specific process based on their eligibility criteria. Here’s a detailed guide on how to obtain Medicare:

1. Eligibility Criteria

• Age: Most people are eligible for Medicare when they turn 65.
• Disability: Individuals under 65 can qualify if they have been receiving Social Security Disability Insurance (SSDI) for at least 24 months.
• Specific Conditions: People with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) are eligible at any age.

2. Initial Enrollment Period (IEP)

• The IEP is a seven-month period that starts three months before the month you turn 65, includes your birth month, and ends three months after your birth month.
  • Example: If your birthday is in June, your IEP runs from March 1 to September 30.

3. Enrollment Steps

Automatic Enrollment

• Automatic Enrollment: If you are already receiving Social Security or Railroad Retirement Board (RRB) benefits, you will be automatically enrolled in Medicare Parts A and B starting the first day of the month you turn 65. You will receive your Medicare card in the mail three months before your 65th birthday.

Manual Enrollment

If you are not automatically enrolled, you need to sign up:

1. Online: Visit the Social Security Administration (SSA) website and apply online.
2. By Phone: Call the SSA at 1-800-772-1213 (TTY users can call 1-800-325-0778).
3. In Person: Visit your local Social Security office.

4. Choosing Your Coverage

Original Medicare (Parts A And B)

• Part A: Hospital Insurance
• Part B: Medical Insurance
  • After enrolling in Original Medicare, you can choose to add additional coverage:

Medicare Advantage (Part C)

• Combines Part A and Part B, often includes Part D (Prescription Drug Coverage), and may offer additional benefits like dental, vision, and wellness programs.
• You can enroll in a Medicare Advantage plan through private insurance companies approved by Medicare.

Medicare Prescription Drug Plans (Part D)

• Standalone plans that add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service (PFFS) plans, and Medical Savings Account (MSA) plans.
• Offered by private insurance companies approved by Medicare.

Medigap (Medicare Supplement Insurance)

• Optional insurance policies that help pay some of the healthcare costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.
• Offered by private insurance companies.

5. Special Enrollment Periods (SEP)

• If you missed your IEP, you might qualify for a SEP:
  • Working Past 65: If you or your spouse is still working and you’re covered by a group health plan.
  • Other Situations: Moving out of your plan’s service area, losing other insurance coverage, etc.

6. General Enrollment Period (GEP)

• If you didn’t enroll during your IEP or SEP, you can sign up during the GEP, which runs from January 1 to March 31 each year, with coverage starting July 1. Late enrollment penalties may apply.

7. Annual Enrollment Period (AEP)

• From October 15 to December 7 each year, you can join, switch, or drop a Medicare Advantage plan or a Medicare Prescription Drug plan, with changes taking effect January 1 of the following year.

8. Review And Decide

• Compare Plans: Use the Medicare Plan Finder tool on the Medicare website to compare plans based on costs, coverage, and customer ratings.
• Consult an Advisor: Consider speaking with a Medicare advisor or insurance agent to help choose the best plan for your needs.

9. Enrollment Confirmation

• After enrolling, you’ll receive a Welcome to Medicare packet that includes your Medicare card and other important information.

By following these steps, you can navigate the process of enrolling in Medicare and selecting the appropriate coverage for your healthcare needs.