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MEDICARE INSURANCE

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

What is Part A?

Part A is Hospital Insurance. It covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

What is Part B?

Part B is Medical Insurance. It covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Apply for Medicare

Automatic enrollment:

Some people get part A and B automatically if you are:

  • Already getting benefits from Social Security or the Railroad Retirement Board
  • Under 65 and received disability benefits from Social Security for 24 months
  • Have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig)

Submit Application:

Some people need to sign up for Medicare if you are:

  • Not getting Social Security or Railroad Retirement Board.
  • Qualify for Medicare because of End Stage Renal Disease (ESRD)

When to Apply?

When first eligible:
  • When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.
  • In most cases, if you don't sign up for Medicare Part B when you're first eligible, you'll have to pay a late enrollment penalty. You'll have to pay this penalty for as long as you have Part B and could have a gap in your health coverage.

When to Enroll: Your 7- Month Initial Enrollment Period (IEP)

Between January 1 - March 31 each year

You can sign up for Part A and/or B during the General Enrollment Period Between Jan 1 - March 31 each year if both of these apply:

  • You didn't sign up when you were first eligible.
  • You aren't eligible for a Special Enrollment Period (see below).
  • You must pay premiums for Part A and/or Part B. Your coverage will start July 1. You may have to pay a higher premium for late enrollment in Part A and/or a higher premium for late enrollment in Part B.

When is the General Enrollment Period?

Special Circumstances:

Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period (SEP). If you're covered under a group health plan based on current employment, you have a SEP to sign up for Part A and/or Part B anytime as long as:

  • You or your spouse (or family member if you're disabled) is working.
  • You're covered by a group health plan through the employer or union based on that work.
  • You also have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
  • The month after the employment ends
  • The month after group health plan insurance based on current employment ends
  • Usually, you don't pay a late enrollment penalty if you sign up during a SEP.

When Is My Special Enrollment Period?

What's not covered?

  • Medicare doesn't cover everything. If you need certain services Medicare doesn't cover, you'll have to pay for them yourself unless you have other insurance or you're in a Medicare health plan that covers them.
  • Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments.
  • Some of the items and services that Medicare doesn't cover include:
    • Long-term care (also called custodial care)
    • Most dental care
    • Eye examinations related to prescribing glasses
    • Dentures
    • Cosmetic surgery
    • Acupuncture
    • Hearing aids and exams for fitting them
    • Routine foot care

Choose your Coverage

There are 2 main ways to get your Medicare coverage - Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). Some people get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap).

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