Posted on February 3, 2022 by Austin Lang
Posted on February 3, 2022 by Austin Lang
Medicare is complicated: between eligibility requirements, enrollment periods, and all of those different letters, it’s easy to get overwhelmed. Luckily, here at MedicareInsurance.com, we want to make things easier for you. Before you decide on your healthcare coverage, here are the top five things you need to know about Medicare enrollment.
Medicare eligibility is a tricky subject. Most people become eligible for Medicare when they turn 65. However, certain groups, including people under 65 who have received Social Security disability benefits for at least two years, people with ALS, and people with End-Stage Renal Disease, may also be eligible for Medicare. If you’re unsure if any of these conditions apply to you, they probably don’t. Still, it’s essential to know when you’ll become eligible so that you can plan accordingly.
Once you’re sure that you’re eligible, you might be asking: ‘How do I enroll in Medicare?’. The good news is, it’s likely that you’re already enrolled!
If you’re living in the United States and U.S. Territories (except Puerto Rico) and collecting Social Security, and if you meet one of the eligibility requirements for Medicare, the federal government will automatically enroll you into Medicare Part A and Part B. You’ll receive a packet of information a few months before your coverage begins outlining the details. Enrollment in Part A usually comes at no cost and is mandatory for citizens collecting Social Security benefits. Part B is optional and usually comes with a slight premium (about $170 according to NerdWallet).
If you aren’t currently collecting Social Security for any reason, you’ll need to sign up by contacting Social Security directly.
To make sure you’re receiving the coverage you need for your specific situation, you need to understand how the different parts of Medicare cover different healthcare needs.
Medicare Part A and Part B comprise “Original Medicare.” Part A covers hospital visits, including inpatient surgery, while Part B covers doctor visits, medical equipment, and outpatient surgery. However, Original Medicare does not cover vision, dental, or hearing, nor does it have a cap on out-of-pocket expenses.
Medicare Part C, also known as Medicare Advantage, is designed to fill these gaps. These plans, which are offered by private insurance companies, usually cover factors like eyeglasses, dentures, hearing aids, and other needs that Original Medicare doesn’t cover.
Medicare Part D: Prescription Drug Coverage helps cover prescription medication costs. It is often included in Medicare Advantage plans, but is also available as a standalone option for those enrolled in Original Medicare.
Like with regular health insurance, there are annual Medicare enrollment periods during which people can apply for coverage.
The first is your Initial Enrollment Period (IEP), which lasts for three months before and after you first become eligible, for a total of seven months. After your initial enrollment period, most people can only change their coverage during the Annual Enrollment Period from October 15th through December 7th. Failure to enroll during your IEP can result in a financial penalty, so it’s essential to sign up as soon as you can.
If you find yourself with needs your current plan can’t cover, you can change your Medicare Advantage plan during the Open Enrollment Period from January through March of each year. Specific Special Enrollment Periods may also become available throughout the year, particularly if you’ve recently moved, or if a 5-star plan becomes available in your area.
Like movies and restaurants, Medicare Advantage plans also receive a star rating from the Centers for Medicare and Medicaid Services (CMS). A plan can have one to five stars, with more stars indicating a better plan. This ranking isn’t strictly a measure of coverage either: the CMS measures factors such as customer satisfaction, chronic condition management, and how well the plan helped their members stay healthy to determine their star ratings, awarding better performing plans with financial incentives that can lead to better coverage for you.
Despite this, a 5-star plan might not necessarily be the best option for your situation. Different plans cover different things, and it’s important to find a plan that doesn’t leave any gaps in your coverage. For instance, if a plan has an excellent rating but won’t cover you during your trips to visit family out of state, you may want to consider other options.
At MedicareInsurance.com, our agents specialize in helping you compare Medicare Advantage plans in an effort to help you get coverage for your specific needs. We can help you figure out your eligibility, navigate enrollment periods, and discover which plans are available in your area.
Austin is dedicated to breaking down complex topics, like Medicare, in a way that's easy to understand. He graduated with an M.A. from Florida Atlantic University in 2018.