Ron Elledge is a seasoned Medicare consultant and author of “Medicare Made Easy.” As a Medicare expert, he regularly consults beneficiaries on Medicare rules, regulations, and strategies.
Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Medicare is a health insurance program provided by the federal government for qualifying individuals, including people age 65 and older, those with certain disabilities, and individuals with End-Stage Renal Disease (ESRD).
Some people may confuse Medicaid and Medicare programs. The primary difference is that Medicaid is a needs-based insurance program, while Medicare is not. Your income is not a determining factor for Medicare qualification.
There are monthly premiums for certain parts of Medicare. Additionally, Medicare does have some limitations and regulations on what it will cover for health care costs. Read on to learn more about each part of Medicare, what’s covered, and how to enroll.
When you become eligible for Medicare, you have choices to make. First, you must decide whether you will enroll in Part A and B or Part A only and defer Part B. Most people choose Part A because it is premium-free. However, if you are enrolled in a Health Savings Account (HSA), you will not be able to continue contributing to it if you enroll in Part A. Once your A and B choices are made, you can keep Original Medicare and add a supplement and Part D plan, or opt for a Medicare Advantage Plan.
Here’s what each part of Medicare covers and costs.
|Medicare Part A||
|Medicare Part B||
|Medicare Part C||
|Medicare Part D||
What isn’t Covered by Medicare?
Original Medicare does not cover certain health services and costs, including:
- Long-term care
- Dental care (with some exceptions)
- Vision exams needed to prescribe glasses
- Cosmetic surgery
- Hearing aids and related exams
- Routine foot care
How Do I Enroll in Medicare?
There are a few different ways to enroll in Medicare. Some people are automatically enrolled in Medicare, and others will have to sign up on their own. However, everyone should check with Social Security three months before their expected start date to ensure everything is in order.
You will be enrolled automatically in Medicare if you:
- Are already receiving Social Security benefits (at least four months prior to start)
- Receive Railroad Retirement Board benefits (at least four months prior to start)
- Are under the age of 65 but have a social security disability for 24 months
- Have Amyotrophic Lateral Sclerosis (ALS) or End-StageRenal Disease (ESRD)
You will have to enroll in Medicare on your own if you:
- Are about to turn 65
- Are already 65 but not receiving Social Security benefits
There are also some individual circumstances that may change the timing of your enrollment. For instance, if you have employer-sponsored insurance, you may be able to wait to apply for Medicare Part B instead of being required to apply when you turn 65.
Medicare enrollment periods
The Initial Enrollment Period (IEP) for Medicare is a seven-month period beginning three months before you turn 65, the month in which you turn 65, and three months after you turn 65. For example, if you turn 65 on June 14, your IEP is from March 1st through September 30.
If you do not sign up during your initial enrollment period, and you are not covered by an employer health plan or are volunteering overseas for at least 12 months, you’ll begin accruing Part B late enrollment penalties. You will only be able to enroll during the General Enrollment Period (GEP). The GEP runs from January 1st through March 31st each year, with coverage starting July 1st.
Medicare Advantage plans cannot start before your Part B start date, so if you do not enroll in Part B by the end of your IEP, you’ll have to wait until the GEP for Medicare Advantage enrollment also. If you enroll in Part B during the GEP, you can join a Medicare Advantage Plan or a Medicare Drug Plan (Part D) between April 1 and June 30. Your Medigap open enrollment period starts the first month you have Part B and lasts for six months..
When does Medicare coverage start?
Your Medicare coverage start date depends on when you enroll. Remember, during the IEP, you can enroll three months before you turn 65, the month you turn 65, and three months after you turn 65.
|When you enroll||When coverage starts||Example: turning 65 on May 10th|
|The three months before you turn 65||The first day of the month you turn 65||May 1st|
|The month you turn 65||The first day of the month after you turn 65||June 1st|
|The month after you turn 65||Two months after you sign up||August 1st|
|Two or three months after you turn 65||Three months after you sign up||October 1st (if you enroll in July)
November 1st (if you enroll in August)
If you enroll during your IEP, you can coordinate your ancillary coverage, that is, Medigap and Medicare Part D or Medicare Advantage to start the same day as your Medicare Part A and B coverage.
If you enroll during a Special Enrollment Period, coverage generally starts the month after your sign up.
When you are ready to apply for Medicare, you can fill out an online application through the Social Security website or in-person at your local Social Security office.
Learn More From Our Sources
- CMS | Fact Sheet: 2021 Medicare Costs | Last Accessed September 2021
- Medicare | End-Stage Renal Disease (ESRD) | Last Accessed September 2021
- Medicare | Your Medicare Part A Costs | Last Accessed September 2021
- Medicare | Part B: Annual Wellness Visit | Last Accessed September 2021
- Medicare | Your Medicare Part B Costs | Last Accessed September 2021
- Medicare | Part D: Prescription Drug Coverage | Last Accessed September 2021
- Medicare | What Medicare Covers | Last Accessed September 2021
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last Accessed September 2021
- Medicare | When Can I Buy Medigap? | Last Accessed September 2021
- Medicare | When Does Medicare Coverage Start? | Last Accessed September 2021
- Medicare | Understanding Medicare Advantage and Part D Enrollment Periods | Last Accessed September 2021
- Medicare | Extra Help: Get Help Paying for Medicare | Last Accessed September 2021
- SSA | Sign up for Medicare through Social Security | Last Accessed September 2021