How to Start Medicare
Medicare is a federal health insurance program primarily for people aged 65 and older, as well as those with certain disabilities. It’s an important part of healthcare coverage in the United States, but it can be confusing to navigate. In this guide, we’ll cover the essentials of Medicare, from the different parts to enrollment and plan selection.
Note that Medicare is distinct from Medicaid, which is a separate government program that provides healthcare coverage for those with limited financial resources, regardless of age.
The Parts of Medicare
Medicare is composed of four main parts, each covering different aspects of healthcare.
Part A
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services.
Part B
Covers doctor visits, outpatient care, preventive services, and some medical equipment and supplies.
Part C
Also known as Medicare Advantage, is an alternative to original Medicare (Parts A and B). These plans are offered by private insurance companies and must provide at least the same coverage as original Medicare, and may include additional benefits.
Part D
Covers prescription drug costs. These plans are also offered by private insurance companies.
When to Enroll in Medicare
If you’re already receiving Social Security or Railroad Retirement Board benefits, you’ll be automatically enrolled in Parts A and B. If not, you’ll need to enroll manually through the Social Security Administration.
At Age 65
For most people, the initial enrollment period for Medicare is around their 65th birthday. You can sign up for Medicare as early as 3 months before your 65th birthday, and your coverage will start on the first day of your birth month.
After Age 65
If you are still covered by a group health plan from an employer with 20 or more employees when you turn 65, you have the option to delay your Medicare enrollment without incurring any late penalties. This applies whether the coverage is from your own employer or your spouse’s.
Many people think it makes sense to take advantage of this delay and stick with their employer plan. But I actually recommend that most people in this situation still enroll in Medicare, even if they don’t need to right away.
Here’s why: Medicare’s benefits are simply better and increasingly more cost-effective than most employer-sponsored plans, especially for spouses. As group health insurance costs continue to rise and plan designs get skimpier each year, Medicare is becoming a better deal.
Plus, if you’re the spouse on the employer plan, you’re likely paying the full “retail” price to be added, without any employer subsidy. In that case, Medicare is usually a no-brainer – you’ll get more comprehensive coverage at a lower monthly cost.
Even if you do decide to delay Medicare enrollment and stick with your employer plan for now, I’d still recommend signing up for Medicare Part A. It’s free to most people, and it can act as a secondary payer behind your group coverage, helping to minimize your out-of-pocket costs.
The key is to make sure you enroll in Medicare when you do eventually lose that employer coverage, whether it’s due to retirement, your spouse’s retirement, or any other qualifying event. Waiting too long can result in late enrollment penalties that stick with you for the rest of your time on Medicare.
How to Enroll in Medicare
Medicare enrollment is done through the Social Security Administration.
Online
This is the easiest and fastest method.
https://www.ssa.gov/medicare/sign-up
By Phone
Call the Social Security Administration at +1 800-772-1213
Tell the representative you want to sign up for Medicare Parts A and B, or Part A only.
Available in most U.S. time zones Monday through Friday, 8 a.m. to 7 p.m., in English, Spanish, and other languages.
At Your Local Social Security Office
Some Social Security offices will help you enroll in Medicare on-site. This is becoming less common, though. To find the office closest to you, search here: https://secure.ssa.gov/ICON/main.jsp
Choosing a Medicare Plan
When it comes to your Medicare coverage, you have two main options.
Option 1: Original Medicare + Medigap + Part D
This option gives you the flexibility to see any healthcare provider that accepts Medicare, and you can purchase additional coverage, such as a Medigap (supplemental) plan and a Part D prescription drug plan, to fill in the gaps.
Option 2: Medicare Advantage with Part D Included
Medicare Advantage plans are offered by private insurance companies and provide all the benefits of original Medicare, and may include additional coverage for things like dental, vision, and hearing. These plans typically have network restrictions, but may have lower out-of-pocket costs.
Understanding Medicare Costs
Use this calculator to estimate your monthly Medicare costs.
What to Do During Medicare’s Fall Enrollment Period
Each year, during the Medicare Annual Enrollment Period (AEP) from October 15 to December 7, you can make changes to your Medicare coverage for the following year. This is an important time to review your plan, as benefits and costs may change annually.