5 Things to Know Before Enrolling in Medicare

2. Learn how to enroll if you’re not on Social Security

If you’re not getting Social Security benefits already, you must learn how to enroll in Medicare yourself, know the timelines and be ready to make some important decisions. To sign up, you must:

• Be within three months on either side of the month you turn 65. If your birthday is on the first of a month, the government counts your birthday as being in the previous month.
• Decide if you’ll keep any health insurance you’re receiving through your job or your spouse’s job.
• Choose the type of coverage best for you. Your company health insurance with premium-free Part A can be another layer of insurance if you’re working and hospitalized. If you plan to stop work at age 65, you’ll want to decide between original Medicare and Medicare Advantage.
• Decide if you’ll want to buy a private insurer’s Part D plan if you’ve opted for original Medicare and don’t have prescription drug coverage already. You can find a plan later, but to avoid a penalty, you’re given 63 days to make sure your medications are covered through your employer, retiree insurance, Tricare or something similar to Part D after you get Part A or Part B. A Medicare Advantage plan with drug coverage also fills the bill.
• Also determine whether you want to purchase a Medigap plan if you’ll be on original Medicare. Your once-in-a-lifetime Medigap open enrollment period lasts six months from when your Part B plan begins. That’s when you can buy any Medigap plan offered in your area at the best rates for your age, no health vetting required.

3. Sign up for Parts A and B of Medicare

Even before you decide between coverage through original Medicare or Medicare Advantage, you first need to sign up for Part A and Part B, which combined make up the base of your coverage. Your enrollment options and timing depend on when you stop full-time work and other circumstances.

Remember, unless you or your spouse work for a company that has 20 or more employees and provides you with health insurance, you typically should sign up for Medicare at age 65 to avoid coverage gaps. When and how you enroll depends on these factors:

• You already get Social Security retirement benefits. If so, you’ll be enrolled automatically in Parts A and B. If you live in Puerto Rico, be aware that the rules for this U.S. territory are different.
• You can enroll during your initial enrollment period — the three months before your 65th birthday, your birthday month and the three months following.
• You qualify for a special enrollment period. You can enroll in Medicare after your initial enrollment period if you meet certain conditions, such as you or your spouse are still working and have health insurance coverage from that employer. You can enroll in Part B up to eight months after you or your spouse stop working and lose that insurance. If you miss that eight-month window, you may have to pay a late enrollment penalty or have a gap in coverage.
• You wait for the general enrollment period. You can’t sign up for Medicare at any time, but if you missed your initial or any special enrollment period, you can sign up from Jan. 1 to March 31 every year. Be prepared to pay a late penalty.

You’ll hear a lot of publicity about open enrollment. That’s the period from Oct. 15 through Dec. 7 annually when Medicare enrollees can switch Part D or Medicare Advantage plans. It isn’t for first-timers.

4. Understand what you could pay out of pocket

Medicare isn’t free to those who participate, and expenses can add up. You can expect to share costs by paying Part B and Part D premiums — and sometimes Part A and Medicare Advantage premiums — as well as any deductibles, copayments or coinsurance for services you use.

• Original Medicare from the government doesn’t have a limit on out-of-pocket costs. It’s intended to work with a Medigap plan that has monthly premiums to make health care affordable when you need it.
• Medicare Advantage plans have out-of-pocket limits, but you do purchase the plans from a private insurer. You’ll also pay premiums and copays and must meet a deductible.
• Part D prescription drug plans have their own monthly premiums from private insurers and often have deductibles and copays.
• Most dental, hearing and vision services aren’t included in original Medicare, but some baseline coverage is usually available with Medicare Advantage. If you opt for original Medicare, you can purchase a separate policy, sometimes sold alongside your Medigap plan, to help pay for these expenses.

5. Choose your additional coverage

This last step comes after you’ve enrolled in Part A and Part B, but it includes important decisions you still need to make.

• Which option is better for you? Medicare’s Plan Finder tool is a great way search Part D, Medigap and Medicare Advantage plans to choose between original Medicare and Medicare Advantage.
• Do you need Part D prescription drug coverage? We walk you through the steps using the Plan Finder to search for drug plans in your area.
• Do you want a Medigap policy? A supplemental policy can help pay out-of-pocket costs under Parts A and B. You can compare Medigap benefits on the Medicare website and find a Medigap policy with its Plan Finder tool.

Here are 3 ways to get personalized help

Assistance is only a phone call or live chat away.

Medicare has on-call help 24/7, except on some federal holidays, at 800-MEDICARE (800-633-4227). Or visit the Medicare Helpful Tools webpage. If you’re comfortable using live chat, you can click on the Chat Now button on Medicare’s Talk to Someone webpage.

State Health Insurance Assistance Programs (SHIPs), federally financed but locally maintained in your state or territory, offer in-depth, unbiased help for prospective enrollees, their families and caregivers. The toll-free national number, 877-839-2675, will direct you to your local SHIP or you can find its number through a link to your area’s SHIP.

Chapter, a commercial Medicare advisory service working with AARP, can help you compare plan options and enroll in coverage. You can call 800-227-7956 directly or find out more information on this web page.

The full array of plans is always available for you to search and compare in the Medicare Plan Finder.

This story, originally published Jan. 28, 2022, was updated with current Medicare enrollment deadlines, costs and coverage, plus expanded guidance on choosing plans and finding help.