• Medicare is government health insurance for people over 65 and people under 65 with certain disabilities.
  • There are three main parts to Medicare:
    Part A – Inpatient Hospital insurance
    Part B – Outpatient Medical insurance
    Part D – Prescription drug coverage
    (Part C is simply another name for a Medicare Advantage plan)
  • You must enroll in Medicare Parts A and Part B before you can enroll in a Medicare Supplement or Medicare Advantage plan. You only need to be enrolled in Part A “or” Part B to enroll in a Part D Prescription Drug plan.
  • The BEST time to sign up for Medicare Part A and B with Social Security is during your Initial Enrollment Period (IEP). This is the 7 month window surrounding your 65th birthday (3 months before, the month of and 3 months after your birthday). Unless you are delaying your Part B enrollment because you plan on working past age 65 and getting “creditable coverage” from you employer, or getting creditable coverage from your spouse’s employer insurance, you should enroll in Medicare during your Initial Enrollment Period (IEP). Otherwise, you could face a lifetime Part B (and possibly Part D) Late Enrollment penalty for not signing up when you first became eligible.

  • If you are planning on delaying your Part B enrollment when you turn 65 because you are still working and getting employer group health insurance, your employer insurance must be “creditable coverage”, if its not, when you go to sign up for Part B later, Medicare will charge you a “Part B Late Enrollment Penalty” (an additional 10% Part B premium penalty for every 12 months you delayed). If your employer employer has less than 20 employees, your group health insurance is NOT creditable. Check with your employer benefits administrator to be sure the employer group health insurance is “creditable”. Your employer will give you a “creditable coverage” certificate when you retire. SAVE THIS CERTIFICATE as you will need it to show Medicare you had continuous “creditable coverage” later when you go to enroll in Part B and Part D for the first time.

  • Medicare Part A (Hospital) is usually “premium-free” if you (or your spouse) worked and paid Medicare taxes for 10+ years (40 quarters).
  • Most people pay a Standard Part B monthly premium directly to Medicare ($164.90 in 2023). This is required for people with a Medicare Supplement or a Medicare Advantage plan. Click HERE for more information on Part B costs.
  • If you started collecting Social Security benefits before age 65, Medicare will automatically enroll you in Medicare Parts A and B and will mail you your Red, White and Blue Medicare card approximately 3 months before your 65th birthday.
  • Medicare will deduct your Part B premium from your Social Security Benefits if you have already started collecting your Social Security benefits prior to age 65.
  • If you choose to delay your Social Security benefits past age 65 because you’re still working, but you want to receive Medicare Part A and Part B benefits at age 65, Medicare will send you a paper bill quarterly to pay your Part B monthly premium.
  • Medicare Supplement (Medigap) plans “fill the gaps” of Original Medicare Parts A and B. Original Medicare would still be your primary health insurance and Medigap would be your secondary payer.
  • Medicare Advantage plans is when a private insurance company takes over your Original Medicare and packages Parts A and Part B in one insurance HMO/PPO type plan (similar to what you may have had with employer group health insurance). Most Medicare Advantage plans include prescription drug coverage and other perks like routine dental, vision, hearing, gym memberships and more.
  • Medicare Supplement plans do NOT include dental, vision, hearing or prescription drug coverage.
  • You can NOT have a Medicare Advantage plan AND a stand-alone drug plan (PDP) at the same time. If you are on Original Medicare, you would get a Stand-Alone drug plan (PDP). If you are on Medicare Advantage and you want drug coverage, you get a MAPD (Medicare Advantage Prescription Drug plan)

  • You can NOT have a Medicare Supplement (Medigap) AND a Medicare Advantage plan at the same time.

  • Many private Insurance companies like Aetna, Cigna, Humana, etc., names you may be familiar with from your employer group insurance, usually offer plans for both Medicare Supplement (Medigap) and Medicare Advantage, as well as Part D Prescription Drug plans.
  • Medicare is an “individual” program. You can NOT have your spouse on your policy (like you may have with employer coverage). Each Medicare beneficiary has to have their own policy.

Before you can enroll in a Medicare Advantage or Medigap plan, you must have already signed up for Medicare Part A and Part B with the government. You can manually enroll in Original Medicare Part A and Part B during one of the enrollment periods below:

Initial Enrollment Period (IEP) – This is the 7 month window surrounding your 65th birthday, where the 4th month is your birthday month. Example: If your birthday is in May, your 7-month Initial Enrollment Period is from February 1 through August 31. (Your actual coverage effective date depends on the exact month you enroll. Click HERE for more on Initial Enrollment Period)

General Enrollment Period (GEP) – If you missed your 7 month “Initial Enrollment Period – IEP” (listed above), you will have to wait until the General Enrollment Period, which is every year January 1 through March 31, your coverage will start the month after you sign up. You might pay a monthly late enrollment penalty, if you don’t qualify for a Special Enrollment Period.

Special Election Period (SEP) – This is a special circumstance, there are several possible, however, the most common is where you were allowed to delay your Part B enrollment after turning 65 because you were still working and receiving “creditable coverage” from your or your spouses employer group insurance. (Note: click HERE for list of Special Election Period examples).

*NOTE: Click HERE to estimate your Medicare eligibility & premium

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