Medicare enrollment has the potential to be a bit confusing. There are certain dates when you can enroll. There are eligibility requirements, different coverage options and various out-of-pocket Medicare costs you may face.
It can be overwhelming, even for someone who has been enrolled in Medicare for years, let alone someone signing up for Medicare for the first time.
Here are five Medicare enrollment tips for 2019 that can help you as you sign up for Medicare or as you evaluate your current Medicare coverage and consider your options.
With so many different parts of Medicare, it’s important to know which type of coverage (or combination of coverage options) is right for you.
Medicare Part A is hospital insurance and covers inpatient care at places like hospitals and skilled nursing facilities.
Medicare Part B is medical insurance and covers health care services like outpatient appointments, doctor’s office visits, preventive services and medical equipment and supplies.
Medicare Part C is also known as Medicare Advantage and serves as an alternative option to receiving your Medicare Part A and Part B benefits. By law, Medicare Advantage plans must cover everything that Part A and Part B cover (except hospice care, which you still receive through Medicare Part A).
Medicare Part D plans offer coverage for prescription drugs.
Medicare Supplement Insurance is also known as Medigap and helps cover out-of-pocket Medicare costs such as Medicare copayments, coinsurance and deductibles.
Each part of Medicare carries its own set of eligibility requirements, which are laid out below.
To qualify for Part A of Medicare, you must meet at least one of the following requirements:
Most people qualify for “premium-free Medicare Part A” because either they or their spouse worked and paid Medicare taxes for at least 40 quarters (the equivalent of 10 years of full-time employment).
Medicare Part B follows the same eligibility requirements as Medicare Part A. However, Part B is optional and you can choose not to enroll. Keep in mind that if you opt out and decide you want it later, you may have to pay a late enrollment penalty for as long as you have it.
Part B comes with a monthly premium. If you have a higher income, you may pay higher premiums than other beneficiaries.
Part C eligibility requires enrollment in both Part A and Part B. If you have ESRD, you might not be eligible to enroll in a Medicare Advantage plan unless it is a Special Needs Plan.
Also, because the selection of Medicare Advantage plans varies from one area to the next, you must reside in a particular plan’s service area in order to be eligible to enroll in that specific Medicare Advantage plan.
If you want to enroll in a Medicare Part D plan, you must be enrolled in Medicare Part A and live in the area where that particular Part D plan is offered.
You must be enrolled in both Medicare Part A and Part B in order to be eligible for Medicare Supplement Insurance. If your Part A and Part B enrollment is based on a disability, your ability to buy a Medicare Supplement Insurance plan may depend on the state in which you live, as not all states require insurance carriers to offer Medicare Supplement Insurance plans to people under 65.
After determining your eligibility, it’s important to know when you can sign up for Medicare coverage. In some instances, missing an enrollment period can mean having to wait another year for coverage, and it can also lead to late enrollment penalties when you finally do sign up. Here are the periods when you can enroll in Medicare or change your Medicare coverage in 2019.
Your Initial Enrollment Period is a seven-month period that begins three months before your 65th birthday, includes the month of your birthday and continues for another three months thereafter.
Applies to: Part A, Part B, Part C and Part D
If you failed to sign up for Medicare during your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you can enroll during the Medicare General Enrollment Period. This period lasts from January 1 to March 31 each year. However, your coverage won’t begin until July 1 and you may have to pay a late enrollment penalty.
Applies to: Part A and Part B
If you have Medicare Part A and enrolled in Part B during the General Enrollment Period, you can sign up for a Medicare Prescription drug plan or a Medicare Advantage plan (with or without drug coverage) from April 1 to June 30.
During the fall Medicare Open Enrollment Period (sometimes also referred to as the Medicare Annual Election Period, or AEP), Medicare beneficiaries can add, drop or change Part C and Part D plans. The period lasts from October 15 through December 7 each year.
Applies to: Part C and Part D
There are a number of situations that could qualify you for a Special Enrollment Periods. You may qualify for this type of enrollment period if you did not sign up for Medicare during your Initial Enrollment Period because you were still covered by employer or union insurance, if you moved outside of your plan’s service area, if your current plan has ended its contract with Medicare and for a few other reasons.
The timing of these Special Enrollment Periods can vary based on your circumstances, and each part of Medicare carries its own set of Special Enrollment Periods.
Applies to: Part A, Part B, Part C and Part D
If you belong to a Part C or Part D plan that does not hold a five-star rating, you can use this enrollment period to enroll in a five-star plan.1 This period lasts from December 8 to November 30 each year.
Applies to: Part C and Part D
Your six-month Medigap Open Enrollment Period begins the month that you are 65 years old and enrolled in Medicare Part A and Part B. During this period, insurance carriers cannot deny you coverage or charge your higher premiums because of your health.
Applies to: Medicare Supplement Insurance
The general costs for each type of Medicare coverage can be broken down as follows:
Most people receive Part A without a premium after paying Medicare taxes while still working. Those who did not pay enough Medicare taxes to qualify for premium-free Part A pay up to $437 per month for Part A coverage in 2019.
Part B carries a standard monthly premium of $135.50 in 2019. You may pay more if you have an income above a certain threshold.
Because Part C is sold by private insurers, the costs associated with a Medicare Advantage plan can vary from one plan to the next. In 2018, Medicare Advantage plan holders paid an average premium of $35.55 per month for their plan.2 Some Medicare plans have a $0 monthly premium.3
Part D plans are also sold by private insurance companies and their costs will vary. In 2018, Part D plan beneficiaries paid an average monthly premium of $52.23.3
Medicare Supplement Insurance plan costs will vary from one plan to the next based on the insurance company that sells each policy.
Here’s how each type of Medicare coverage option is distributed across the U.S.
Medicare Part A and Part B are provided by the federal government and available in every area of the U.S.
Medicare Advantage plans are sold by private insurance companies and are offered in every state except Alaska in 2019. However, there may be certain areas within each state that are not serviced by a Medicare Advantage plan. You must live in your plan’s service area to enroll.
Just like Part C, Part D plans are sold by private insurers and are available in every state. But there may be certain areas within a state that are not serviced by a particular Part D plan.
Like Part C and Part D plans, Medicare Supplement Insurance is sold in all 50 states, but availability can vary. Massachusetts, Minnesota and Wisconsin have different plan options than other states.
Once you’ve narrowed down your desired coverage options, you’ll need to know how to enroll in your Medicare plan or plans.
If you already receive Social Security or Railroad Retirement benefits, you will be automatically enrolled in Part A and Part B, and your Medicare card should have arrived in the mail a few months before your 65th birthday.
If you are under 65 but receive disability benefits, you will be automatically enrolled in Part A and Part B following your 24th month of collecting disability benefits. If you have ESRD, you will need to manually enroll. If you have ALS, your enrollment will happen the same month your disability benefits begin.
If you are interested in finding a Medicare Advantage plan that fits your unique needs, you can speak with a licensed insurance agent to compare plans that may be available where you live. Request a free, no obligation quote online or call TTY Users: 711 24 hours a day, 7 days a week.
1 Medicare evaluates plans based on a 5- star rating system. Star Ratings are calculated each year and may change from one year to the next.
2 MedicareAdvantage.com’s internal analysis of CMS 2018 Medicare Advantage Landscape Source Files and 2018 Prescription Drug Plan Landscape Source Files. May 2018.
3 You must continue to pay your Medicare Part B premium. $0 premium plans may not be available in all areas.
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