Medicare open enrollment occurs from October 15 to December 7. During this time, you can change your Medicare coverage for the following year. You can also enroll in Medicare when you reach the age of 65. Whether you are signing up for the first time or changing your current plan, you will want to learn some important facts about enrolling in Medicare.
9. Qualifying for Medicare
You might be worried that you will not qualify for Medicare because you have not paid enough taxes during your work career. However, this is not true. Do not delay your enrollment past your personal deadline, or it could cost you later.
Payroll taxes were deducted from your payroll when you worked so that you can enroll in Part A after you turn 65. In such a situation, you will not pay any premiums if you contributed 40 credits (quarters), which is comparable to 10 years’ worth of work.
Medicare Part A will pay for any stay at a skilled nursing facility or hospital. It also includes some health services plus hospice care. If you are unsure of how many credits you have, then you can contact Social Security at 800-772-1213.
If you are signing up for Medicare Part B, then you do not need to have any credits. Part B covers doctor services, medical equipment, and outpatient care. Part D offers prescription drug coverage.
To qualify, you must meet the following criteria:
- Be a U.S. citizen
- Be 65 or older
- Have resided in the U.S. for five years or longer
You will need to pay the required monthly premium to qualify for Medicare Part B or Part D.
If you have not contributed enough to payroll taxes to enroll in Part A, then you might still qualify based on your spouse’s work record even if you are divorced or a widow/widower. If you have not been married, then you can pay $458 per month with 30 or fewer credits or $252 per month with 30 to 39 credits.
Some people do qualify for Medicare at a younger age if they have certain medical conditions or are disabled.
8. Enrolling in Medicare
If you are a Medicare newbie, then you can enroll at 65 years old if you do not have health coverage after the age of 65.
Do not wait to receive a letter telling you that it’s time to enroll in Medicare; the government will not send you a letter telling you this. The only time you will receive a letter is if you are already receiving Social Security benefits before 65.
7. When to Sign Up for Medicare
Every situation is different when it comes to enrolling in Medicare:
- Initial enrollment period (IEP) at 65: This is the time when you no longer have health coverage from your or your spouse’s employer. The IEP period will last for seven months. The fourth month is your birthday month when you turn 65.
- Initial enrollment for those under the age of 65: If you have a disability, then you might qualify for Medicare. The fourth month of your IEP is when you receive the 25th payment for disability. Social Security will contact you and let you known when your coverage starts. You get an another seven-month IEP at 65.
- Special Enrollment Period (SEP): This occurs after you turn 65 and takes place because you had health insurance with an employer via either yourself or your spouse at that time. If this is the case, then with SEP you can sign up without any late penalties. However, if your employer has fewer than 20 workers, they can request that you sign up before 65.
6. Health Savings Account
If you have a health savings account, be aware that you can no longer contribute to the HSA after you enroll in any part of Medicare. You will need to postpone signing up for Medicare Part A or Part B until you retire.
Also, you’ll need to postpone applying for Social Security because in such a situation you cannot opt out of Part A.
5. Your Spouse’s Medicare
Medicare offers no family package coverage. Every person must separately apply for Medicare. If your older spouse retires and takes Medicare and they were your source of health insurance, you will be required to find coverage for yourself through either your own employment, COBRA, or plans such as those offered by the health insurance marketplace.
If you and your spouse both have Medicare, then you will pay separate premiums, copays, and deductibles based on your own unique plans.
4. When You Miss Your Medicare Enrollment
If you do not sign up for Medicare when you are required, you will encounter serious consequences:
- If you miss your IEP, you can only sign up during the general enrollment period (GEP), which runs from January 1 to March 31. In such a situation, your coverage begins on July 1.
- You will also have to pay late penalties that are 10 percent of the full 12-month period. You must pay Part B penalties for as long as you are on Medicare Part B, and with Part A you will pay twice the number of years that you spent delaying enrollment.
If you are penalized and under the age of 65 but on disability, then the penalty will be waived. Also, if the state pays the fees because you are considered low income, then the penalties will be wiped out.
3. How to Enroll in Medicare
The Social Security Administration handles Medicare enrollment. Any time you are already receiving Social Security retirement or disability benefits and you reach Medicare eligibility, the SSA signs you up automatically for Medicare Parts A and B. If not, then you will need to call 800-772-1213 or go to the Social Security website.
Please remember if you are not receiving Social Security benefits at 65, you will not be notified when it is time to enroll in Medicare.
You can sign up for Medicare online at the Social Security website. However, it can be complicated if you need to produce documents to prove eligibility. Often proof of marriage or your spouse’s birth date is required.
2. Signing Up for Medicare While Living Abroad
It is difficult to sign up for Medicare when you are living overseas. Although you cannot use Medicare outside of the United States, you’ll still want to sign up. Remember that delaying enrollment can cost you money from the late fees.
To sign up for Medicare while living abroad, you must contact the U.S. embassy in the country you live in. Visit the international operations page on the Social Security website to learn more.
1. What If You Can’t Afford Medicare?
Medicare does cost money. You will need to pay premiums, copayments, and deductibles. If your income is low, then you might qualify for certain programs to help cover the cost.
- Medicaid: This is a health program for people with low incomes. The rules for qualifying vary from state to state.
- Medicare Savings Programs: You might qualify for a Medicare savings program, which can help you pay copays and the deductible.
- Extra Help: With the Extra Help federal program, you may receive low-cost Part D prescription drug coverage if your income is below a certain level.