This post is for those of you starting on your journey to find out more about Medicare. I know there is a ton of information out there and I’d like to help simplify some of it. It all boils down to 3 main points:
1. When to enroll in Medicare
2. How to enroll in Medicare
3. What plan should I enroll in once I am eligible.
#1) We’ll start off with the easy one first. “When to enroll in Medicare.” You are eligible for Medicare at age 65, period. It doesn’t make any difference if you are rich or poor, in great shape or in a wheelchair. Some are eligible before age 65 due to disability or having certain conditions such as ESRD or ALS.
For those of you still working, if you are covered by your EMPLOYERS GROUP health insurance plan, you won’t need to do anything until you retire or otherwise lose that coverage. When you retire or lose your group coverage, you have 8 months to sign up for Part B with no penalty and 2 months to sign up for Part D with no penalty. You will have to provide proof of prior coverage to enroll.
Medicare Part A is premium free if you worked at least 10 years (or 40 quarters) paying the Medicare payroll tax out of your paycheck.
Medicare part B has a premium that increases every year. For 2022, the Part B Premium is $170.10.
#2) You enroll in Medicare through the Social Security agency. You can enroll in one of 3 ways:
You can enroll yourself through the SSA.gov website. You will need to set up a www.ssa.gov account in advance to do this.
You can call Social Security and enroll over the phone. This is usually an hour-long call to make an appointment for 6 weeks later. The appointment only takes 5 minutes to collect the data. You can call Social Security up to 3 months in advance of your Part B effective date. If you are turning 65 soon, that is the 3 months before you turn 65. If you are 65 and currently covered by Employment Group Insurance, it can any time in the 3 months before you retire or lose coverage.
You can visit a local Social Security office. This is a hit or miss situation right now with Social Security offices being shut down or appointment only in some cases.
If you delayed taking Medicare Part B because you are/were still working, they will need a form filled out by your employer showing your prior group health coverage The form is CMS Form L564 and will need to be faxed back to your local Social Security office. If you fax it to the national number, it will be lost and need to be re-sent! (It sometimes gets lost going to the local office too but is usually easier to find.)
#3) What plan should I choose? This is the tough one since there are a ton of choices out there. Your first choice is do you want a Medicare Supplement (Medigap) or Medicare Advantage plan?
Medicare Supplements pay AFTER Medicare pays. If you apply for a supplement plan in the first 6 months you have Medicare Part B you are in your Medicare Supplement open enrollment period. There are no health questions asked. If you apply for a supplement plan after the 6-month open enrollment period carriers can deny you supplemental coverage if you fail their underwriting questions. If you choose a Medicare Supplement, you will also need to purchase a Part D drug plan.
Medicare Advantage plans pay INSTEAD of Medicare. Carriers sign a contract with the Federal government and must cover all of your Part A and Part B services. Most Medicare Advantage plans also provide Part D coverage as well. Medicare Advantage plans are pay as you go plans with different co-pays for the various medical services you may need.
An important note to remember. Medicare Supplements only pay after original Medicare and do NOT work with Medicare Advantage plans. If you an insurance policy to cover the more expensive Medicare Advantage costs, look at purchasing an INDEMNITY plan to cover unexpected costs. (Think AFLAC coverage but for Medicare)
We’ll have separate posts about how to choose a Medicare Supplement plan or what to look for in a Medicare Advantage plan, so bookmark us and come back often.
Your Medicare Store is here to help with all your Medicare questions. You have many choices, let us help. We hold free educational events every 2nd Saturday of the month at our location in Mesa on the corner of Southern Ave and Gilbert Rd. We don’t ever charge for our services.
Feel free to call, text or email us your questions