New to Medicare Frequently Asked Questions
New to Medicare FAQ
New to Medicare Frequently Asked Questions
If you signed up for Social Security before age 65 (eligibility for full benefits currently begins at age 66), you will automatically be enrolled in Medicare parts A and B and receive your card three months before your 65th birthday. Part A covers hospitalization and is generally premium-free; Part B covers outpatient care, such as doctors’ visits, x-rays and tests, and costs $134 a month for people who enroll in 2017 (or more for high earners).
Everyone else needs to take steps to enroll—or face a lifetime late-enrollment penalty (unless you’re still working and have employer coverage; see below). Go to www.socialsecurity.gov to sign up anytime from three months before until three months after you turn 65 (your “initial enrollment period”), even if you are waiting to file for Social Security benefits.
You may not have to. If you’re already receiving Social Security retirement benefits when you turn 65, you’ll be enrolled in Medicare automatically. If this is the case, you’ll be automatically enrolled in Parts A and B of Medicare (more on the parts in a bit), and you can expect to receive your Medicare benefits card about three months before you turn 65.
If you aren’t receiving your Social Security retirement benefit when you turn 65, you’ll have to apply for Medicare, which you can do quite easily on the Social Security Administration’s website. Your initial enrollment period begins three months before the month of your 65th birthday and extends for three months after.
People who are turning age 65 have an initial enrollment period that lasts until three months after their 65th birthday. If you don’t sign up during that period, you’ll have to wait for a general enrollment period or a special enrollment period (if you delayed signing up because you had an employer group health plan). Coverage start dates depend on what type of period you signed up in.
Anyone age 65 or over is eligible for Medicare. Most people age 65 and over are covered under Medicare Part A for free, based on their work records or on their spouse’s work records.
People over 65 who are not eligible for free Medicare Part A coverage can enroll in it and pay a monthly fee for the same coverage. The premium base rate depends on the number of work credits you’ve earned. If you pay for Part A hospital insurance, you must also enroll in Part B medical insurance, for which you pay an additional monthly premium.
The rules of eligibility for Part B medical insurance are simpler than for Part A: If you are age 65 or over and are either a U.S. citizen or a permanent resident who has been here lawfully for five consecutive years, you are eligible to enroll in Medicare Part B medical insurance. This is true whether or not you are eligible for Part A hospital insurance.
That depends on the size of your company. If you or your spouse (if you’re covered by your spouse’s insurance) is still working for a firm with 20 or more employees, the employer’s insurance is your primary coverage, and Medicare is secondary and can fill any gaps in coverage. You aren’t required to sign up for Medicare at 65, and you won’t have a late-enrollment penalty as long as you sign up within eight months of leaving your job and losing work-based coverage (or losing coverage under your spouse’s insurance).
This depends on your situation. If you’ve worked at least 10 years (40 quarters) under Medicare-covered employment and paid Medicare taxes during that time, you qualify for premium-free Medicare Part A and will be automatically enrolled at age 65 even if you’re still working. If your spouse has enough employment quarters, you can also qualify for premium-free Medicare Part A based on his or her work history.
Another Medicare eligibility requirement is that you need to be an American citizen or permanent legal resident of at least five continuous years.
If you don’t have enough work history to get Medicare Part A without paying a premium, you can decide to delay enrollment if you already have health coverage through an employer or union (or through your own work or your spouse’s employer). Medicare Part B always comes with a monthly premium, so you may similarly choose to delay your Part B enrollment if you or your spouse are still working and have employer-based group coverage.
Remember, if you don’t sign up for Medicare when you’re first eligible and don’t have other coverage based on current employment, you could have to pay a late-enrollment penalty later when you do enroll. The late-enrollment penalty applies to Medicare Part B (and Part A, if you have to pay a premium for it).
One factor to consider is that even if you have health coverage through your employer or union, Medicare may help pay for some of the costs not covered by your group health plan. For example, enrolling in Medicare may be useful if you work for a small company (less than 20 employees) because Medicare could be the primary payer before your group health insurance. You may want to consult with your employer or union benefits administrator for specifics on how your health coverage and costs may compare with Medicare.
If you do decide to wait until your group coverage ends to enroll in Medicare Part A and/or Part B, you’ll have an 8-month Special Enrollment Period to sign up for Medicare that starts once you stop working or your group coverage ends (whichever happens first). You can also enroll in Medicare at any time that you are still working and have employer-based coverage.
If you choose COBRA after you stop working, do not wait until your COBRA coverage ends to sign up for Medicare. If you delay enrolling in Medicare Part A and/or Part B after your Special Enrollment Period ends, you’ll have to wait until the next General Enrollment Period (January 1 to March 31 every year) to enroll, and you may have to pay a late-enrollment penalty.
Yes, in certain situations, you can delay your Medicare Part B enrollment without paying higher premiums (also known as a late-enrollment penalty). If you didn’t enroll in Medicare Part B when you were first eligible because you or your spouse was working and had group coverage through an employer or union, you can choose to sign up for Medicare Part B during a Special Enrollment Period (SEP) without paying a late-enrollment penalty.
You can sign up for Medicare Part B at any time that you have coverage through current or active employment. Or you can sign up for Medicare during the eight-month Special Enrollment Period that starts when your employer or union group coverage ends or you stop working (whichever happens first). If you get COBRA or retiree benefits after you stop working, keep in mind that this doesn’t count as coverage based on current employment; make sure you don’t wait until your COBRA benefits end to enroll in Medicare Part B.
Remember that if you do not enroll in Medicare Part B during your Special Enrollment Period, you’ll have to wait until the next General Enrollment Period, which occurs from January 1 to March 31 each year. You may then have to pay a late-enrollment penalty for Medicare Part B because you could have had Part B and did not enroll. If you owe a late-enrollment penalty, you’ll pay a 10% higher premium for every 12-month period that you were eligible for Medicare Part B but didn’t sign up for it. You may have to pay this higher premium for as long as you’re enrolled in Medicare.
There are a few other situations when you may be able to delay Medicare Part B without paying a late-enrollment penalty. For example, if you were volunteering overseas or if you were living out of the country when you turned 65 and weren’t eligible for Social Security benefits, you may be eligible for a Special Enrollment Period when you return to the United States. The length of your SEP will depend on your situation. If you aren’t sure if you qualify for a Special Enrollment Period, call Medicare to confirm at 1-800-633-4227 (TTY users 1-877-486-2048), 24 hours a day, seven days a week.
It depends. If you’re receiving benefits from Social Security or the Railroad Retirement Board (RRB) at least four months before you turn 65, you do NOT need to sign up; you’ll automatically get Part A and Part B starting the first day of the month that you turn 65. You should receive your Medicare card in the mail three months before your 65th birthday. If you are NOT receiving benefits from Social Security or the RRB at least four months before you turn 65, you will need to sign up with Social Security to get Parts A and B. To sign up to receive Parts A and B, you can enroll online with Social Security, call Social Security at 1-800-772-1213, or visit your local Social Security office.
It depends on how you are receiving your current insurance. If you are receiving employer-sponsored health insurance through either your or your spouse’s job when you turn 65, you may be able to keep your insurance until you (or your spouse) retire(s). You will need to contact your employer’s benefits representative to find out whether or not they will continue your coverage when you turn 65. Since Medicare Part A is premium-free for most beneficiaries, you may want to enroll in Part A as soon as you are eligible (i.e., three months prior to the month of your 65th birthday), even if you will continue to receive employer-sponsored insurance at that time. If you are covered under an employer plan, you may want to delay signing up for Part B until you (or your spouse) retire(s). However, it is a good idea to check with Social Security or Medicare to confirm you will not fact a penalty for late enrollment. Similarly, unless you have drug coverage that is as good as what Medicare drug plans offer, you will need to sign up for a Medicare prescription drug plan when you enroll in Medicare or you may face a late enrollment penalty.
If you do not sign up for Part B at the appropriate time, you may face a late enrollment penalty that will increase your Part B premium by 10% of the standard monthly premium for each 12-month period that you delayed enrollment. Similarly, there is a late enrollment penalty if you do not sign up for Part D coverage when you were first eligible to do so and do not have drug coverage that is as good as what Part D offers (“creditable coverage”). The Part D penalty for late enrollment is equal to 1% of the national average premium multiplied by the number of months you did not have “creditable” drug coverage.
If you have coverage through a Marketplace plan, you should sign up for Medicare when you turn 65 and notify your Marketplace plan that you now qualify for Medicare coverage. Your Marketplace coverage will not be cancelled automatically by your plan when you turn 65 and sign up for Medicare, but if you receive premium tax credits to help you pay for your Marketplace plan premium, your eligibility for these tax credits will end when your Medicare Part A coverage begins (people with Medicare are not eligible for these tax credits, and the premium tax credit can only be used for the purchase of Marketplace coverage).
If you choose to enroll in Medicare Part A and keep your Marketplace coverage, you will have to pay the full price for your Marketplace plan, and Medicare will be the primary payer. If you were receiving financial assistance for your Marketplace coverage prior to signing up for Medicare, you will receive a letter in the mail from the Marketplace informing you that you are no longer eligible to receive this financial assistance since you are enrolled in Medicare Part A. You should contact your Marketplace plan to make sure that your financial assistance is stopped when your Medicare coverage begins. If you do not stop receiving the premium tax credit and other financial assistance for your Marketplace plan when your Medicare coverage begins, you may have to repay some or all of the amount of financial assistance you received for the months you had both types of coverage.
If you decide to drop your Marketplace coverage when you become eligible for Medicare, make sure your Medicare coverage has started before you cancel your Marketplace plan so that you avoid any gaps in coverage. You can start signing up for Medicare three months before your 65th birthday.
If you are eligible for Medicare, your initial enrollment period for Part A and Part B begins three months before the month of your 65th birthday and ends three months after it. For example, if your 65th birthday is in June, your enrollment period will extend from March 1st through September 30th. Once you have Part A and Part B, you are then also eligible to enroll in a Medicare Advantage (Part C) plan and/or a Part D (prescription drug) plan. If you are already receiving Social Security benefits when you turn 65, you will automatically be enrolled in Part A and Part B. If you are not already receiving Social Security benefits and you want to enroll in Medicare, you should contact Social Security.
Part B is voluntary, but you may face a penalty for late enrollment if you do not sign up it when you turn 65, unless you or your spouse are still working and have a group health plan from the employer. Similarly, Part D is voluntary, but you may face a penalty for late enrollment if you sign up for a Part D plan after your initial enrollment period ends and you go for more than 63 days without a source of drug coverage at least as good as what Medicare Part D offers.
Unless you or your spouse is still working and has current employer coverage, you should sign up for both Medicare Part A and Part B at 65. Retiree coverage can fill gaps in Medicare (which would otherwise require medigap and Part D policies or a Medicare Advantage plan), but it’s secondary to Medicare after age 65, and it may not kick in at all if you don’t sign up for Medicare. Federal retiree coverage is an exception; it remains your primary coverage if you don’t sign up for Medicare, but you will pay a penalty if you decide to sign up for Part B later.
Yes, as long as you haven’t enrolled in Medicare. If you are able to delay signing up for Medicare parts A and B (see above), you can continue contributing to an HSA. Before you decide, determine whether the HSA’s tax breaks, any employer contributions and other benefits are more valuable than the premium-free Part A coverage.
For Original Medicare, Part A and Part B a simple way to determine your exact Medicare effective date is to refer to the lower right corner of your Medicare card or to refer to your letter from either the Social Security Administration or the Railroad Retirement Board.
If you have any questions about when your Medicare coverage starts, you can contact Social Security at 1-800-772-1213, Monday through Friday, from 7AM to 7PM. For TTY services, call 1-800-325-0778.
If you worked for a railroad, you can call the Railroad Retirement Board at 1-877-772-5772, Monday through Friday, from 9AM to 3:30PM. For TTY services, call 1-800-325-0778.
If you enroll into a Medicare Advantage or Medicare Prescription Drug Plan, the date your coverage starts can vary, depending on when you enroll and which election period you qualify for. For questions about your effective date on these types of Medicare plan options, you can contact the Medicare health or drug plan directly.
The annual Medicare Open Enrollment period begins on October 15 and continues until December 7. For 2020 coverage, open enrollment will run from October 15, 2019, to December 7, 2019.
During the annual enrollment period (AEP) you can make changes to various aspects of your coverage.
- You can switch from Original Medicare to Medicare Advantage, or vice versa.
- You can also switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another.
- And if you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the general open enrollment, although a late enrollment penalty may apply.
If you want to enroll in a Medicare Advantage plan, you must meet some basic criteria.
- You must be enrolled in Medicare Part A and B.
- You must live in the plan’s service area.
- You cannot have End-Stage Renal Disease (some exceptions apply; ESRD patients will be able to enroll in Medicare Advantage plans as of 2021, under the terms of the 21st Century Cures Act).
Medicare beneficiaries with incomes above $85,000 for individuals and $170,000 for married couples are required to pay higher premiums. The amount you pay depends on your modified adjusted gross income from your most recent federal tax return. To determine your 2019 income-related premium, Social Security will use information from your tax return filed in 2018 for tax year 2017. If your income has gone down since you filed your tax return, you should contact Social Security and provide documentation regarding this change. At your current income level, in 2018, you would pay about $4,100 in annual Medicare premiums combined for Part B ($3,252) and Part D (around $835, on average).
Here’s a quick rundown of your Medicare coverage options beyond Original Medicare:
- You can have Original Medicare and enroll in a stand-alone Medicare Part D Prescription Drug Plan.
- You can have Original Medicare and purchase a Medigap (Medicare Supplement) plan. There are 10 standardized Medigap policies in most states, and they cover varying amounts of your Medicare Part A and Part B costs (such as coinsurance and deductibles), depending on the Medigap policy.
- Or you can enroll in a Medicare Advantage plan. With a Medicare Advantage plan, you get your Medicare Part A and Part B benefits through a private, Medicare-approved insurance company. Many Medicare Advantage plans include prescription drug coverage, so you can get all your Medicare health and drug benefits in a single plan.
You typically continue paying your monthly Medicare Part B premium with any of these options.