Turning 65 is a milestone birthday for many reasons, one of which is the beginning of Medicare coverage for many Americans.
You or your spouse may have worked and paid Medicare taxes during the course of your lifetime. Now it’s finally time to take advantage of these important benefits.
Here are several common questions about when Medicare coverage starts and what you need to do to prepare.
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For most people, the answer is yes. You can get premium-free Part A (Medicare hospital insurance) at age 65 if you are already receiving Social Security benefits or Railroad Retirement Board (RRB) benefits or if you’re eligible to receive them but haven’t filed yet.
You can also receive premium-free Part A if you or your spouse had Medicare-covered government employment. Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
If you don’t qualify for premium-free Part A, you can still buy that same coverage. In 2021, you’ll pay a premium of either $259 or $471 a month, depending on how long you or your spouse worked and paid Medicare taxes.
The Medicare.gov website provides an easy-to-use tool to help you determine when you might be eligible for Medicare and what you may pay for as a premium.
When turning 65, you can also purchase Medicare Part B if you’re not automatically enrolled in Part B. Medicare Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Together, Medicare Parts A and B are known as Original Medicare.
Part B is optional. If you’re automatically enrolled in Part B, you’ll find instructions on the back of your red, white and blue Medicare card about how to disenroll from Part B if you choose.
The amount you pay for Medicare Part B depends on your annual income; however, most people end up paying the standard premium of $148.50 per month in 2021.
You’ll also be responsible for paying $203 in order to meet your Part B deductible in 2021. After you meet your deductible for the year, you typically pay 20% of the Medicare-approved amount for any additional services or devices that are covered by Medicare Part B.
Another Medicare insurance option you may be able to consider is Medicare Advantage (or Part C), which are Medicare health plans offered by private companies approved by the Centers for Medicare & Medicaid Services (CMS).
A Medicare Advantage plan replaces your Original Medicare coverage, meaning that your private insurance plan provides all of the same benefits offered by Original Medicare, but it may also offer additional benefits that Original Medicare doesn’t offer, such as dental, hearing, vision, transportation and other benefits.
Medicare Part C plans also usually include Medicare Part D prescription drug coverage. Medicare Advantage plans may require you to pay a monthly premium, the amount for which may vary by plan. Some Medicare Advantage plans, however, feature $0 monthly premiums.
If you want Medicare prescription drug coverage, you can enroll in a Medicare Advantage plan that includes drug coverage, or you can consider a standalone Part D drug plan. You can be enrolled in Original Medicare (Parts A and B) and a Part D plan. If you have a Medicare Advantage plan that doesn’t include drug coverage, you can also enroll in a Part D plan.
Like Part A, you may be able to sign up for Medicare Parts B, C and D starting three months before turning 65, if you’re eligible.
You can always change your mind, but you could potentially have to pay late enrollment penalties depending on the parts of Medicare you sign up for and your reasons for not signing up when you were first eligible.
Note that in some circumstances, you may be eligible to enroll in Medicare Part B during a special enrollment period (SEP). This can occur, for example, if you’re covered by a group health insurance plan from a current employer – either your own or your spouse’s – when you first become eligible for Medicare and you eventually decide to sign up for Medicare once that coverage ends. In this case, you typically would have eight months to enroll in Medicare Part B, and you won’t be subject to a penalty.
The Medicare Annual Enrollment Period (AEP, also called the annual election period or the fall Medicare open enrollment period) takes place from October 15 – December 7 each year. During this period, you may be able to join, switch or drop a Medicare Advantage or Medicare Part D plan.
Yes, but only if you meet certain eligibility qualifications. For example, you may be eligible if you have been receiving Social Security disability or RRB disability benefits for at least 24 months or if you have a specific illness such as amyotrophic lateral sclerosis (ALS, Lou Gehrig’s Disease) or end stage renal disease (ESRD) and meet certain requirements.
Medicare coverage begins the first day of the month in which you turn 65 if you sign up during your initial enrollment period. If your birthday is on the first day of the month, it starts the first day of the previous month.
If you sign up during your initial enrollment period but after your 65th birthday, your Medicare coverage will typically start up to three months after you sign up. As mentioned above, if you sign up for Medicare Part A and/or Part B during the Jan. 1 – March 31 general enrollment period, your coverage will start July 1.
If you’re still confused, not to worry. The official government website for Medicare has an easy-to-use calculator to determine your eligibility date. Just follow the instructions provided and you’ll see an estimate of the date which you may be able to start collecting Medicare benefits according to your circumstances and even calculate an estimate of any monthly premiums.
Another option is to contact a licensed insurance agent. They can help you determine your eligibility date and explore the best Medicare options for your situation.
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Lisa Eramo is an independent health care writer whose work appears in the Journal of the American Health Information Management Association, Healthcare Financial Management Association, For The Record Magazine, Medical Economics, Medscape and more.
Lisa studied creative writing at Hamilton College and obtained a master’s degree in journalism from Northeastern University. She is a member of the American Health Information Management Association, American Academy of Professional Coders, Society of Professional Journalists, Association of Health Care Journalists and the American Society of Journalists and Authors.
Lisa currently resides in Cranston, Rhode Island with her wife and two-year-old twin boys.
LinkedIn: Lisa Eramo