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How To Enroll in Medicare

Joining Medicare can seem like a daunting process, but it doesn’t have to be. Before enrolling in Medicare, it’s important to understand your options to help you better determine the coverage you may need and ensure you receive it.


Understanding Medicare Programs

Medicare is an American federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS) and is limited to qualified U.S. citizens and legal residents. 

Medicare coverage has four parts:

  • Medicare Part A covers inpatient hospital stays, skilled nursing service and eligible home care.
  • Medicare Part B covers outpatient services, including doctor visits, durable medical apparatus, lab investigations, ambulance services, mental health care and preventive services.
  • Medicare Part C, or Medicare Advantage, covers everything that parts A, B, and sometimes D cover, and may offer even more coverage, depending on the plan.
  • Medicare Part D covers prescription drugs. 

Original Medicare refers to both parts A and B together. In Medicare Advantage plans, or Part C, the government contracts with private health insurance plans to provide coverage. Unlike Original Medicare, Medicare Advantage plans may include an out-of-pocket maximum and additional benefits, such as hearing, dental and vision coverage. Some Medicare Advantage plans include Part D, or prescription coverage.

The government pays for parts A, B, and C, although a premium is charged for Part B. Private insurers may or may not charge an additional premium for Part C depending on the plan chosen.

 

Medicare Prescription Drug Coverage & Medigap

Medicare prescription drug coverage is not automatic. If you want prescription drug coverage, you must enroll in either a standalone Part D plan or a Medicare Advantage Prescription Drug plan, offered through private insurance companies. Some people may choose to delay Medicare Part D enrollment; however, if you don’t sign up for prescription drug coverage when you are first eligible for Part D, a late-enrollment penalty for signing up after that date may apply. 

Medicare supplement insurance plans (or Medigap) are designed to cover costs that Original Medicare does not, like copayments and deductibles. The best time to apply for Medicare supplement insurance plans is during the six-month period that starts the date your Medicare Part B coverage becomes effective, because insurers cannot require a health screening to set the plan’s premium. After this Medigap open enrollment period, rules governing what insurers can require of applicants vary by state. Medigap plans are sold like Medicare Advantage plans, through private insurance companies, and are accessible via brokers or online.

 

Enrolling in Medicare

When enrolling in Medicare, you will want to consider either Original Medicare (Part A, with optional parts B and D), or a Medicare Advantage (Part C) plan. 

A major consideration is that there is no out-of-pocket limit for Original Medicare, which means there is no cap to the amount you pay out of pocket for your health care. In Medicare Advantage (Part C) plans, there is a limit to how much you have to pay out-of-pocket each year for in-network medical services that are under Medicare Part A and Part B. This limit is called the maximum out-of-pocket amount for medical services. There may be exceptions if the Medicare Advantage plan is a preferred provider organization (PPO). 

Enrolling in Medicare can be done:

  • Online at www.SocialSecurity.gov
  • By calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7 AM to 7 PM
  • In person at a local Social Security office

Former employees of a railroad can sign up for Medicare through the Railroad Retirement Board (RRB) over the phone at 1-877-772-5772 (TTY users 1-312-751-4701). The lines are open Monday through Friday, 9 AM to 3:30 PM. An RRB agent will handle your enrollment.

 

When to Enroll in Medicare

Qualified US citizens and legal residents can enroll in Medicare during specific windows of time:

  • If you are already receiving retirement benefits at the age of 65, you will be automatically enrolled in both Medicare parts A and B, unless your permanent residence is outside of the 50 United States or Washington, DC (such as in Puerto Rico). In that case, you are automatically enrolled in Medicare Part A, but you will have to enroll yourself in Part B.
  • If you are under the age of 65 and a recipient of disability benefits from Social Security or the RRB, you will be automatically enrolled in both Medicare parts A and B. Medicare enrollment due to disability occurs after receiving 24 months of monthly disability benefits.

Receipt of retirement benefits is not required to enroll in Medicare. Anyone turning 65 can enroll during the initial enrollment period, a seven-month window that spans three months before one turns 65, including the month of the 65th birthday, and three months later. 

Enrolling in Medicare can be done during the general enrollment period from Jan. 1 to March 31 every year if you do not enroll during your initial enrollment period, but a late enrollment penalty applies if you do not sign up for Part B when you become eligible. The monthly Part B premium will be 10 percent higher for each full 12-month period that a person was qualified for Part B but did not join Medicare or enroll for Part B. 

You can apply for Medicare Advantage plans (Part C) during your initial enrollment period and the annual election period, which runs from Oct. 15 to Dec. 7 of every year. During the annual election period, Medicare beneficiaries may shift from Original Medicare to a Medicare Advantage plan, and vice versa, or shift between Medicare Advantage plans.