If you’re turning 65 and close to getting Medicare coverage, there are a few things that you should know to ensure that you get the coverage that is right for you. Let’s go over five things you should know regarding Medicare insurance.
- People can be eligible for Medicare coverage for different reasons
Some people are eligible for Medicare when they turn 65. Some people under 65 are also eligible if they have a certain Railroad Retirement Board disability or if they’re getting Social Security Disability Insurance for a minimum of 24 months. There is no waiting period for Medicare if you have amyotrophic lateral sclerosis (ALS), and people who have End-Stage Renal Disease can also qualify.
- You may have to enroll in Medicare Parts A and B
Some people collecting disability are automatically enrolled in Medicare Part A and Part B when they turn 65, but you may have to sign up. You’ll have a 7-month Medicare Initial Enrollment Period that begins 3 months before your 65th birthday, continues during your birthday month, and ends 3 months after. You may get Part A premium-free if you worked and paid taxes into Medicare for 40 quarters. Part B is voluntary, but most people enroll when they are first eligible to avoid paying late enrollment fees when you sign up later.
- Medicare enrollment only happens at certain times
Did you know that the law only allows you to enroll in Medicare during certain time periods? They include:
- Initial Enrollment Period – This is the seven-month period when someone first becomes eligible for Medicare insurance. People eligible due to their age have this period that starts three months before they turn 65, the birthday month, and three months after the birthday month to enroll. For those eligible due to disability, this same period starts three months before they hit the 25th month of disability payments. It also includes the 25th month and three months after it. Your coverage start dates will vary depending on which month you enroll, and it can get delayed by three months.
- General Enrollment Period – This period starts on January 1 and goes to March 31 every year. Your coverage will start on July 1.
- Special Enrollment Period – You can enroll in Medicare outside of the other two periods if you experience certain life events. For instance, you may qualify for an SEP if you didn’t enroll when you first became eligible due to a working spouse or because you were working and had employer-sponsored group health plan coverage due to your employment. Your coverage will typically start the month after you enroll, but it can get delayed up to three months.
- You have choices to make
You can get your Medicare coverage through Original Medicare or through a Medicare Advantage plan. Original Medicare is provided by the federal government, but Medicare Advantages are an alternative. Medicare Advantage plans are offered by private insurance companies. MA plans are required to provide the same Part A and Part B benefits as Original Medicare, but most plans include additional coverage, such as prescription drug coverage, vision and dental care, and fitness programs.
- Understand which insurance pays first
When you have both Medicare insurance and another plan that are both responsible for paying on the same medical claim, the coordination of benefits rules will determine how Medicare pays with your other insurance plan. When you’re considering declining or delaying enrolling in Part B, you should know as the beneficiary:
- Whether or not your employer-sponsored Group Health Plan will pay secondary or primary to Medicare
- If your employer-sponsored plan pays secondary to Medicare, you have to know how and whether it’ll pay if you don’t enroll in Medicare Part A or Part B.
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