If you’re turning 65 or retiring, then you probably have been thinking about Medicare. You may have questions about how to ensure you get enrolled in time. You also may wonder if you will have adequate healthcare coverage. These are valid concerns and something you shouldn’t wait until the last minute to manage. Take time to learn about enrolling in Medicare and finding out what you can expect with Medicare coverage. Being prepared ensures you won’t have any medical insurance gaps or incur an enrollment penalty fee.
What Is Medicare and What Will It Cover?
Medicare is our country’s health insurance program for individuals over the age of 65 and for certain groups of people with disabilities. It consists of two parts.
Part A: is known as hospital insurance. It covers hospital care, nursing facility services, home health care, and hospice care.
Part B: is the medical insurance component of Medicare. It covers most doctors’ services, medical equipment, hospital outpatient services, preventative care, lab tests, X-rays, mental health, and some ambulance services.
While Medicare may not cover every penny of health expense, it covers the majority of things. You can also purchase a supplemental policy to help pay some of the out-of-pocket expenses and co-pays.
Who Is Eligible for Medicare?
Medicare eligibility is for people who are 65 years and older. Additionally, it is available for people younger than 65 who have a qualifying disability or anyone with a diagnosis of end-stage renal disease or ALS.
However, due to the timeframe for the sign-up process, it’s crucial to begin looking into it before you’re 65.
Who Is Automatically Enrolled in Medicare?
Certain groups of people do not need to worry about doing anything to enroll for Medicare because they already have Medicare eligibility. They will be automatically enrolled. Let’s take a look to see if you are among those who don’t need to do anything.
- If you are already receiving Social Security retirement benefits, then you won’t need to file for Medicare. You’ll automatically be on the list to receive it.
- If you get Railroad Retirement benefits, then you’re also eligible for automatic enrollment.
Who Needs to Enroll in Medicare?
If you are no longer working and don’t fall into the categories above indicating you would automatically become enrolled, you will need to manually enroll in Medicare. If you continue working past retirement age, you will need to ensure that you sign up for Part A and/or Part B of the Medicare insurance. It’s best to apply for both unless you have a spouse’s job-based coverage for Part B. If you don’t apply for Part B and you have a coverage gap, you could incur a late enrollment penalty fee.
When Should You Apply for Medicare?
You have a specific timeframe that is referred to as your Initial Enrollment Period or IEP. This timeframe is centered around when you turn 65, so the exact months are different for everyone. You have a 7-month window with which to work. Here’s the breakdown of your eligibility time:
- The first day you’re eligible is 3 months before you turn 65.
- You also have the entire month of your birthdate to enroll.
- Your IEP ends 3 months after the month you turn 65.
If for some reason, you miss signing up during your Initial Enrollment Period, there is the General Enrollment Period. The Medicare enrollment period of 2021 is between January 1 – March 31, and it is that time every year.
Additionally, special circumstances allow you to transition to an enrollment period that doesn’t incur penalties or fees. This is called the Special Enrollment Period (SEP). The main reason you would qualify for this special circumstance enrollment is that you were already covered by insurance through your or your spouse’s work. The timeframe for SEP is the month after you are no longer employed or receiving medical insurance, and it extends for 8 months.
If you were serving in a foreign country as a volunteer, you may also be eligible for the Special Enrollment Period (SEP). However, COBRA and retiree health plans are not eligible for the SEP.
When does coverage begin?
If you apply for Medicare during the regular IEP time and do it in the 3-month timeframe before you turn 65, your coverage will start on the first day of the month of your birthday. For example, if your birthday is June 3rd, your IEP is March to May. If you enroll in any of those months, then your coverage will begin on June 1st. If you wait until June to enroll, coverage begins the following month. However, if you enroll in any of the last three months of your IEP, it will take two to three months for coverage to begin after the time you enroll (not after your birthday month). So, for the June 3rd birthday, if you were to enroll in August, you would not get coverage until October or November.
There is one exception to the timeline above. If your birthday falls on the first day of the month, then everything gets shifted back a month. For example, if your birthday is on June 1st, your IEP is from February to August. If you enroll during the February to April window, then coverage begins on May 1st. When enrolling during the month of your birthday (June), coverage begins July 1st.
ABOUT GREATER TRI CITIES IPA
Independent Physicians Providing Personal Care
Greater Tri Cities IPA Medical Group is a local Independent Physicians Association comprised of over 40 primary care doctors and over 150 specialists in Northern San Diego County.
We are proactive about your health and when you enroll, you’ll gain access to an extensive health care network including local lab locations, 4 excellent hospital affiliations, direct referrals to many specialties, referral turnarounds as quickly as 24-48 hours, diversity amongst our physicians, and multi-lingual customer service.