Home » Understanding of the Medicare Enrollment process. How and when to enroll in Medicare

Understanding of the Medicare Enrollment process. How and when to enroll in Medicare

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Medicare enrollment process: How and when to enroll.

There are few important things that you need to know to enroll yourself for Medicare. To sign up for Medicare you need to contact at toll-free number i.e. 1-800-772-1213, their services will be available from Monday to Friday, from 7 AM to 7 PM. You can also contact your local social security office, either you can also contact online at www.socialsecurity.gov.

Who is eligible for Medicare enrollment?

  • To register yourself in Medicare it is necessary for an individual to be a citizen of the US or is a legal resident and is living there for consecutive 5 years.
  • When you reach age 65 you are eligible and automatically get registered in part A (Hospital insurance).
  • In case you are not getting automatically registered in it you can register yourself through Medicare part B (Medical insurance) when you reach the age requirement i.e. 65.
  • In case of any disability, an individual can automatically get registered through Medicare part A and part B and will be able to get disability benefits for 24 months.
  • If you are suffering from end-stage kidney failure and need dialysis on a regular basis, you should register yourself for it if you are not automatically registered.
  • There is an automatic enrollment for hospital assurance and medical assurance if you are suffering from Amyotrophic Lateral Sclerosis (ALS).

When do you automatically get enrolled in Medicare?

There are few conditions in which you get registered in Medicare automatically. On the contrary, there are exceptions in some cases where you are not automatically registered.

  • Retirement Benefits

If you are taking retirement benefits from Railroad Retirement Board or Social Security Retirement Board at the age of 65 you will automatically get registered in both parts. You will be required to manually register yourself for Medical assurance if you are living out of 50 United States or D.C.

  • Disability Benefits

When it comes to availing disability advantages from the Railroad Retirement Board or Social Security Retirement Board, when you will become 65 years old you will get registered in Medicare hospital assurance by default. Moreover, you will also sign up for medical insurance subsequent to finishing two years of your disability benefits. You can apply for Medicare if you have kidney failure but if you have ALS you will spontaneously get registered in basic Medicare without waiting for the disability benefits to end.

Initial Period of Medicare Enrollment

Most of the time, enrollment in part A is commonly automatic. During your early signup days, there is a possibility to manually get registered in part A or part B. This manual registration lasts for 7 months overall. Moreover, it will be initiated 3 months in advance of your 65th birthday and it will last for 3 months following your birth month.

When one is not getting retirement Benefits

You can sign up for Medicare part A/ part B around the age of 65 in case you didn’t get retirement benefits in your Starting Subscription Period. In case you do not want to take benefits of retirement by the age of 65, one can register in Medicare programs and take all retirement plus points later on.

When you lack eligibility criteria for retirement benefits

When you cannot meet the eligibility criteria, you are also not eligible for automatic registration in the basic one. You can sign up for a Medicare hospital allowance or medical allowance throughout the initial entitlement period and have to pay a premium for its hospital support and medical support. The price of the premium program will be based upon the amount and quality of your work and taxes paid by you.

*Enrollment Criteria for Medicare part B

If you are eligible for hospital assurance you are also eligible for medical assurance and you can register yourself into it by paying your premium amount. In case if you are not registered in part you need to meet the following criteria for enrollment in part B.

  • Your age should be 65 years or older
  • You should be a citizen of the U.S.
  • You are a citizen of the U.S by law and living there for continuous 5 years.

Other than that your disability will make you automatically eligible for medical support. In case of serious renal disease or ALS, you are eligible for both parts without considering the limit of age.

*Delaying Part B Enrollment

There are so many cases in which people get registered without paying for hospital support but most of the people need to pay their premium for medical support. Some people delay their registration in medical assurance as they have health assurance benefits available already by the employer. In this case, you can join part B in the special subscription period without any penalty. The special entitlement period lasts eight months after the end of your health benefits from your employer. You are qualified for a special entitlement period only in case you are currently an employee as after retirement health benefits are not considered.

*How much does Medicare part B cost?

The amount that is required for medical support entitlement varies according to the individual’s situation and changes with every passing year. The amount is automatically taken away from your social security benefits but if you are not taking these benefits a three months bill is sent to you. In 2021 the premium amount is $148.50. The premium also depends upon the income level so if your income increases the premium amount will also increase from the standard one.

What if I don’t want to enroll in Medicare part B?

In Medicare allowance, if you automatically get registration in medical assurance, you can drop the cover-up by following a few options:

  • If you receive a red, white, or blue card before starting Medicare allowance you can send the card back by following the instructions given on the card. Otherwise, you will have to pay part B premiums if you keep the card along with you.
  • You can drop part B assurance by contacting the Social Security Retirement Board as you have signed up through Social Security.
  • Social Security will guide you to drop your part B coverage once it gets started. You can send the signed request to them and your part B coverage will drop on the first day of the month when they will receive your request.
  • If you are getting health benefits from your current employment you can get advice from a health administrator about enrollment in part B and can also delay the enrollment. The administrator will help you to make a registration decision and will also tell the consequences regarding the dropping off of Medicare part B.

General Enrollment Period

The period for general enrollment starts from the 1st of January to March 31st of every year. If you do not sign up for Medicare hospital support or medical support on your eligibility you will have to pay a penalty for late registration.

Late Enrollment Penalty

When you do not register yourself for Medicare when you get eligible for it you will get a penalty for that. Your yearly premium for Medicare will be 10% higher as compared to the normal one. This higher premium will last as long as you will be enrolled in Medicare. There are exceptions for late-registration penalties like if you have health assurance from your employer’s health scheme or from your spouse’s employer you can delay enrollment without any penalty. This health assurance and benefits should be from the current employer.

Special Enrollment Period

When you do not enroll in Medicare as you are already having health coverage and benefits from the employer despite fulfilling eligibility criteria. There is a special subscription period available for you which is eight months. These eight months start from the day when you end your employment or when your health coverage ends. In the Special entitlement period, you do not have to pay any sort of penalty for late enrollment. In case of Severe Renal Failure you are eligible for Medicare enrollment then you cannot enroll yourself for Medicare in a Special subscription Period.

How to sign up for Medicare advantage

Private insurance companies having contracts with Medicare can provide Medicare advantages. It is also known as Medicare part C, by enrolling yourself in it you can get original Medicare benefits. Its plans should provide Medicare part A and part B benefits. Some additional benefits like prescription drug coverage are also available in the Medicare advantage scheme. In case you are not enrolled in original Medicare part A and part B coverage you are not eligible to enroll for the Medicare advantage plan. To enrol yourself in the Medicare Advantage scheme you should be enrolled in original Medicare part A and part B. If you want to enroll yourself in this plan you can enroll during two subscription periods. One of them is the Initial Coverage Election Period and the other one is the Annual Election Period.

Medicare Advantage Plan: Initial Coverage Election Period

Most of the people are eligible for enrollment in this proposal during the initial coverage election period. In case you have delayed your enrollment for its medical assurance, this subscription period takes place at the same time as the initial entitlement period. This entitlement period starts three months before you own both Medicare hospital assurance and medical assurance. The end date for this entitlement period will be the last day of the month in which you have Medicare part A and part B enrollment or the last day of your Medicare medical assurance Initial Enrollment Period. If you are eligible for disability benefits and have reached 65, the Initial Enrollment Period depends solely on the day when you have started your disability benefits.

Medicare Advantage Plan: Annual Election Period

The annual Election Plan starts on October 15 and ends on December 7 of the year. During this period you can add, drop or alter your Medicare advantage plan. Medicare advantage schemes could be switched according to your requirement. You can also change from its beneficial plan with or without any medical insurance plan.

Open Enrollment Period

The limited annual subscription period is available for people in the Medicare Advantage Open Enrollment Period. It starts on the 1st of January and ends on the 31st of March every year. During this Open Entitlement Period, if you have a Medicare plan subscription you can switch among different Advantage schemes. You can also return to your real idea by disembroiling yourself from the Medicare plan. During this period you cannot make other cover-up changes. You can also join an independent drug scheme by dropping your Medicare advantage plan. The original Medicare proposal does not have patent medicines coverage. You can make changes in your Medicare scheme only in the Annual Election Period, Medicare Open subscription Period, and Special Election Period.

Enrollment in Medicare Prescription Drug Coverage

Medicare Prescription drug coverage is not done automatically and is also an optional thing. For enrolling yourself you can sign up for an independent Medicare patent medicines plan or Medicare beneficial plan that offers drug insurance. Private Insurance agencies provide Medicare pharmaceutical plans and Medicare plans. You can only enroll yourself for one proposal as you cannot enroll in a stand-alone Medicare Prescription Drug plan and Medicare Advantage plan collectively.

*Eligibility Criteria for Medicare part D

To get enrollment in this part it is necessary to have enrollment in novel Part A and Part B of it. You should be living in the proposal’s service area. There are certain engagement periods in which you can join the specific Medicare plan.

Initial Enrollment Period for Medicare part D

If you have an Initial Enrollment Period for this part you can enroll in a stand-alone Prescription Drug Plan. The eligibility for prescription drug coverage depends upon the area in which you are living and the previous enlistments you have. You can enroll for a Prescription Drug plan if you are living in a service area covered by a health scheme and also you have its hospital support or/and part B. The Initial Enrollment Period for this Part is the same as it is for medical assurance. This seven month period starts three months before the elections for medical assurance and ends after three months of eligibility. When you are eligible for enrollment in Medicare part D, it is necessary to enroll yourself in a Medicare Prescription drug plan, Medicare Advantage Prescription Drug plan, or creditable Prescription drug coverage. If your employer provides you with commendable drug coverage you can delay your registration for this part. However, in case of late enrollment after your eligibility, you must pay a late enrollment penalty if you are without commendable Prescription drug insurance for 63 consecutive days.

Medicare Part D Annual Election Period

The Medicare Part D Annual Election Period starts on the 15th of October and ends on the 7th of December. You can sign up for Medicare Prescription drug coverage in the Annual Election Period if you were unable to enroll during the Initial Enrollment Period. Throughout the Annual Election Period, you have a chance to Sign up or you can also drop the prescription drug program. You can also switch from the Medicare beneficial plan having no coverage for the prescription drug to the scheme having prescription drug coverage and vice versa. If you want to make changes in your prescription drug coverage and go back to your novel Medicare without having a special Election Period you can easily make changes in Medicare Advantage Open Enrollment Period. That period starts on the 1st of January and ends on the 31st of March. Its hospital assurance and medical assurance do not have prescription drug coverage so if you want to switch to forerunner one you can sign up for a stand-alone Medicare prescription drug scheme until March 31st.

*Costs Variation for Part D in different situations

When you are enrolled in this part you have to pay some amount of premium that varies in different situations and circumstances.

Cost in initial coverage phase

You will have to pay a share of the cost according to the specific idea in which you are enrolled and that too after meeting the deductible. You could have two types of shares that you pay to the pharmacy while picking up the parcel. One of them could be a flat amount that is also known as copayment and the other one is the percentage of the total amount i.e. coinsurance.

Costs in the Coverage gap

The amount of initial coverage limit in 2021 is $4,130 and it keeps on changing yearly. You will automatically enter the part D coverage phase if you have spent $4,130. In this specific phase, you will have to pay 25% of the cost of the prescription.

Cost before meeting deductible

You need to pay the full amount of your premium until the deductible is met.

Costs in Catastrophic Coverage

You can automatically get catastrophic coverage if you have paid your annual premium for prescription drugs from your pocket. After that, for the rest of the year, you will only have to pay some amount of copayment or coinsurance. The catastrophic coverage begins after spending $6,550 in 2021.

Supplement Insurance Plans

The forerunner Medicare Coverage has gaps that are filled by the Supplement Insurance plan’s additional coverage. You can enroll for a Medicare supplement Insurance plan during the individual Medigap Open Enrollment Period. This is the six months period that starts from the very first day of the month in which you turn 65 and get eligibility for part B. The Medigap Open Enrollment period does not start until you sign up for its medical assurance. The Guaranteed issue right is given to you in the Medigap Open Enlistment Period to buy any Medigap scheme. The allowance companies can neither reject your application nor charge higher for your health conditions and disabilities. On the contrary, if you do not have Medigap Open Enrollment Period, you will be charged higher for your health problems and disabilities. These ideas are available at private insurance companies and can also be purchased through brokers.

*When to enroll if an individual is still working

If you have worked under Medicare-covered employment and also paid taxes for it and have worked for at least 10 years then you are eligible for hospital allowance and part B will make you automatically eligible for enrollment in this part at the age of 65. You can also get premium-free enrollment for hospital allowance on your spouse’s work history. If you do not have the required work history then you can also delay your enrollment as you will be having health assurance from your employer. If you are enrolled at a specific time of enrollment you will have to pay a penalty for late enrollment.

*Why Join Medicare if you are still working

If you have health assurance and health benefits from your employer or your spouse’s employer still it is preferable to enroll yourself in it. This will help you to pay some amounts that are not provided by the health benefits of your employer. For example, if you are working in a small company your enrollment for this program will be more useful for your health facilities. You can wait for your retirement and can enroll yourself in eight monthly special admission periods. If the special subscription period ends you will have to wait for the next general enlistment period in case of delay, you may have to pay a penalty for late enrollment.

*Low-income Subsidy

People with low income are provided with the government program that will be paying their premiums. The government program will help them to pay their monthly premiums, coinsurance, copayment, and annual deductible. The Social Security Act set resource limitations and made a census for the Federal Poverty level on the basis of which low-income beneficiaries are provided with extra help.

*Medicare Extra help Eligibility Criteria

The low-income subsidy is provided under this part for the beneficiaries who need extra help, for which you need to fulfill the eligibility criteria. The eligibility criteria changes with every passing year, the criteria for 2021is as follows.

  • Your income and savings should be less than the eligibility threshold.
  • Your annual income is higher than the eligibility criteria but you have a responsibility to support other family members, or you are living in Alaska or Hawaii.

The assets which are counted as your savings and income include cash, bank accounts, and real estate other than your residence, mutual funds, and saving bonds. Your residence, car, and allowance are not calculated while analyzing the assets for the low-income subsidy. You can apply for extra help by following the same steps as you have to follow for enrollment in the original one.

FAQs

When can I sign up for Medicare?

If you are already taking social security advantages then you will get enrolled into Medicare by default. Otherwise, it is preferable to enroll for Medicare benefits three months before turning 65. Premium needs to be paid for Medicare part B i.e. Medical allowance, it is your choice to keep yourself enrolled in Medicare part B or drop off. If you have not signed up at your eligibility you can enroll yourself during the General Enrollment Period.

The ways to sign up in Medicare

There are three ways through which you can enroll for Medicare benefits, these are as following:

  • Online at www.SocialSecurity.gov.
  • You can call Social Security at 1-800-772-1213 (TTY users 1-800-325-0778)
  • You can also contact me personally at your local social security office.

When is my Medicare initial Enrollment period?

Your initial admission period starts when you reach the age of 65. This is the seven months period that starts three months before you turn 65, the fourth month is your birth month, and three months after turning 65.

Medicare General Enrollment Period?

The general enlistment period starts on the 1st of January and ends on the 31st of March. If you enroll yourself during this period your allowance will start from July 1st. This period starts after your Initial Entrance Period.

Medicare Special Enrollment Period?

This is the time outside the regular open subscription period of the year when you can sign up for health assurance. You are provided with a Special Entitlement period when you have gone through certain circumstances in your life. These life events include losing health allowance, moving, having a baby, getting married, or adopting a child. In a special entitlement period, you have 60 days before or 60 days after the event occurs for the enrollment.

How to Sign up for Medicare Advantage: when can I enroll?

It is necessary to first enroll yourself in an original Medicare then you can switch to different Medicare Advantage plans. Medicare Advantage is also determined as Medicare part C. This is provided by private insurance companies and to the minimum, each of the Medicare advantage programs provide Medicare hospital allowance and part B advantages just like the basic Medicare. You can sign up in Medicare advantage throughout two enlistment periods i.e. Initial Coverage Election Period & Annual Election Period.

What is the Medicare advantage plan Initial Coverage Election Period?

Most of the beneficiaries are eligible for enrollment in the Medicare advantage plan in Initial Coverage Election Period. It is the period that begins three months before you get Medicare part A and sign up in part B either on the last day of the prior month you are qualified for plan A and become eligible for part B, 90 days after the birthday month.

When is the Medicare Advantage Plan Annual Election Period?

The annual Election Period starts on the 15th of October and ends on the 7th of December. During this period you can add a drop or change your Medicare advantage scheme. You can change a Medicare advantage plan to Basic Medicare and vice versa. You can also change Medicare beneficial programs with or without a medical insurance plan during this period.

When is the Medicare Advantage Open Enrollment Period?

This is the limited yearly enlistment time frame that begins from January 1 and finishes on March 31. You can switch between your different Medicare advantage schemes and can also unregister yourself from the advantage proposal to original Medicare. You can join a stand-alone Medicare prescription drug scheme but you cannot use this period to make most of the cover-up changes.

*Different cases of enrollment

You can register yourself whether you are still working and have not reached the age of 65 as well as at the time of retirement when you reach the age of 65 years and longer. You will receive automatic registration if you are taking retirement benefits or social security benefits from your employer. In case you are suffering from ALS or serious renal failure you can even get enrolled before the age of 65. There are different admission periods to which you can subscribe. These include the initial enrollment period, Supplement Open enrollment period, general subscription period, annual entitlement period, Medicare advantage open subscription period, and special enrollment period. You can join the proposal or can also deregister yourself in these periods. You can delay your admission in case you are having health assurance facilities from the employer or spouse’s employer. After delaying the enrollment you can subscribe to the scheme in the special subscription period without penalty otherwise you will have to pay a penalty for the late subscription.