The Ultimate Guide to Medicare Enrollment
Taking control of your healthcare as you age can be a scary proposition.
Chances are, you’ve been (or currently are) covered by an employee-sponsored health insurance plan, or you’ve been purchasing a plan through the Marketplace.
As you approach age 65, it’s time to start thinking about the next phase of your healthcare journey.
This guide will give you all the information you need to gain a greater understanding of what Medicare is, how it works and what your options are – so you’re ready to enroll in a plan that fits your needs and budget.
Table of Contents
1. What is Medicare?
Medicare is the health insurance program that is run by the federal government. It’s available to those who are 65 or older, those under 65 who have certain disabilities and those with end-stage renal disease.
The four Medicare parts – plus supplemental coverage
These are the four parts of Medicare, as well as an explanation of supplemental/Medigap coverage:
- Part A covers hospital stays, skilled nursing care, hospice and home health care.
- Part B covers medically necessary doctor visits, outpatient surgery, clinical lab tests, physical therapy, home health care and medical equipment.
- Part C is another way to refer to Medicare Advantage plans. The coverage does not come from the federal government but from private health insurance companies.
- Part D is a prescription drug plan that’s offered by private health insurance companies.
- Supplemental or Medigap plans are offered by insurance companies to fill in the gaps of your Medicare plan for the costs of deductibles and coinsurance.
Combining Medicare parts
There are a couple different ways that you can configure your Medicare coverage.
It’s suggested that you work with an independent insurance agent in order to determine which option is best suited for your particular needs.
Let’s look a deeper look at the options.
You have the ability to combine Original Medicare – Part A (your hospital insurance) and Part B (your medical insurance) – with Part D (your prescription drug coverage). You can also add a supplemental or Medigap plan, which fills in the “holes” in your Medicare coverage.
These are the Medicare Part C or Medicare Advantage plans combinations:
- Medicare Part A (your hospital insurance), Medicare Part B (your medical insurance) and Part D (your prescription drug plan).
- Medicare Part C assists with paying the deductibles for Parts A and B. It can also be used for skilled nursing options, copays and coinsurance costs. It may also include vision, hearing or other wellness services.
Don’t be afraid to ask for the help of an independent insurance agent in order to get the coverage that’s right for your situation.
2. Choosing the right Medicare plan for you
There’s no one-size-fits-all solution when it comes to deciding on coverage. It’s an important decision that requires you to take a close look at your needs and your budget.
Answering some specific questions can give you clarity about what your exact needs are in terms of Medicare coverage.
The answers to each of these questions will give you and your insurance agent the information they need to help you form a good healthcare gameplan.
- What is the status of your health?
- Are you currently in treatment for any chronic conditions?
- Do you take prescription drugs on a regular basis?
- What doctors do you normally see?
- What hospital do you prefer?
- Do you travel frequently?
- What were your medical costs last year?
- How much room do you have in your budget for health insurance?
Are you more comfortable paying a higher monthly premium in exchange for low out-of-pocket costs or would you rather pay a lower monthly premium and pay higher out-of-pocket costs?
It may seem like a tedious chore to answer a list of questions such as these, but it really does go a long way in indicating the type of coverage that will be best for you.
Take the time to thoroughly go through the answers with a professional.
3. What to do when it’s time to enroll in a Medicare plan for the first time
Once you’ve reviewed the questions yourself, it’s time to consult a specialist who will help you:
- Pinpoint the companies and plans that are the best suited to your unique needs.
- Look up the doctors and hospitals that you prefer to make sure they’re on the list of approved providers.
- Make sure your prescription drugs are covered.
- Go over the plan. They’ll be able to explain the benefits and coverage in-depth.
- Understand the monthly premium rates you’ll be responsible to pay.
- Get answers for all the questions you have.
- Complete your application for enrollment. In some cases, they may be able to do this over the phone.
- Obtain approval from the insurance company you chose.
You’ll receive a personal Welcome Kit and a Document Envelope to keep your important insurance paperwork together.
This is a free service that InsureOne Benefits provides. We encourage you to let us help you review your situation every year – or more often, if necessary.
We’ll be here to lend a hand when it’s time to renew your policy or during the Annual Election Period, which is from October 15 until December 7.
First-time Medicare enrollment
Here’s a timeline of what you need to know if you’re enrolling in Medicare for the first time.
3 months before your 65th birthday
This is when your initial enrollment period begins.
- Already receiving Social Security? You’ll automatically be enrolled in Medicare Parts A and B and should receive your card in the mail at this time (three months before you turn 65).
- Not receiving Social Security? You’ll need to enroll now so that your benefits begin on the first day of your birthday month.
Now is the perfect time to get the advice of an independent third-party provider for help with the enrollment process.
This is also the best time to sign up for Medicare Part D, which is your prescription drug coverage. Keep in mind that it isn’t mandatory and it’s offered by private insurance companies.
You should also consider a Medicare Advantage Plan (Part C) at this point in your enrollment journey. Medicare Advantage combines Parts A, B and C into one plan. Note that it’s not a federal plan and it’s offered by private insurers.
The month you turn 65
You have the option to wait until now to enroll in Medicare: however, you’ll have a one- to three-month waiting period before your coverage kicks in if you do.
The longer you wait to enroll, the longer you’ll have to wait for your coverage to begin.
Your 65th birthday through 3 months after
This in the end of your initial enrollment period.
3 months past your 65th birthday
Once you reach this point, you’ve missed the initial enrollment period.
There are penalties for failing to enroll in Medicare. Work with a trusted advisor so you don’t miss the Annual Election Period.
4. Re-enrolling in Medicare: the Annual Election Period
The Annual Election Period is the one time during the year when you are able to change your coverage.
The dates are the same each year: October 15 through December 7.
Let’s take a look at what options you have during this period of time:
- Switch from your Original Medicare plan to a Medicare Advantage plan.
- Switch from Medicare Advantage to Original Medicare.
- Change to a different Medicare Advantage plan from the one you currently have.
- Switch from a Medicare Advantage plan that doesn’t have prescription drug coverage to one that does have it.
- Change from a Medicare Advantage Plan that does have prescription coverage to one that doesn’t.
- Enroll in a Medicare prescription drug plan for the first time.
- Change prescription plans.
- Stop your Medicare prescription coverage.
Reviewing your health insurance needs
It can be tricky to assess your needs sometimes, but the Annual Election Period is the time to do it so that you can make any necessary adjustments to your coverage.
It’s very important that you evaluate your prescription drug plan, for example.
Do you take any new medications since you initially enrolled? If so, is your current plan sufficiently covering them?
You should also look at your overall health and your budget. Have there been any changes significant enough to warrant looking for a new policy?
If you’re not having any issues, your health is relatively the same and you’re satisfied that the plan you have meets your needs at the lowest possible cost, then and only then, can you let the Annual Election Period roll on by!
Evaluate your Medicare coverage yearly
Just because nothing has changed significantly yet, doesn’t mean it isn’t going to.
Some circumstances will require you to make a change and you need to be prepared.
Here are the reasons you may need to make a change in the future:
- You want a new primary care physician who isn’t part of your plan.
- You need better coverage.
- You need to save money.
- You aren’t happy with the arrangement you currently have.
- You move to a new area.
- Your health has changed.
- Your prescription drug needs have changed.
- Your plan changes.
- You move into or out of a nursing home.
- There’s a change in your marital status.
5. Medicare’s Special Enrollment Period
What happens to your coverage when you make a move or life just happens.
Medicare does allow for these circumstances that are out of your control with a special enrollment period or SEP.
There are some rules that govern what changes you can make and when you can make them.
Here’s a breakdown of what circumstances qualify you for making changes during the SEP.
- Making a move. Because a move isn’t usually a snap decision, you’ll most likely have time to find out what you need to do to adjust your coverage. There are time parameters that you have to abide by. If you tell your carrier before the move, you have from one month before the move to two months after to make changes.
- Losing current coverage. You could lose coverage due to a job loss, losing prescription drug coverage or you simply choose to leave the plan. The general rule is that you have two full months after the month you make the change.
- Chance for alternate coverage. It’s possible that you could be eligible for coverage through the Veteran’s Association (VA), through your employer, or you may be enrolled in a Program of All-Inclusive Care for the Elderly (PACE) plan. The parameters are more flexible for this type of change. If the coverage is through an employer, you can make the switch whenever you’re eligible to begin the new plan. If it’s for another reason, you can make the transition at any time.
- Contract termination. Medicare may terminate their contract with your plan, necessitating you finding a new plan. Situations like these are usually handled on a case-by-case basis. If Medicare terminates the plan, you have two months before and one month after the contract ends.
A situation such as one of these can cause a considerable amount of uncertainty. Talking to an expert can help.
6. Why you need a professional’s help enrolling in Medicare
Navigating the Medicare landscape can be confusing. There are a lot of decisions to make, not to mention the complex terminology that you will encounter.
It’s complicated enough that you may end up making hasty decisions that don’t represent your actual needs.
An independent insurance expert has the knowledge to look at your situation as a whole and determine the best course for you.
Not only do they have a thorough understanding of all the ins and outs, they are able to explain everything to you in a way that you’ll be able to comprehend.
7. Additional coverage to consider
Health insurance alone won’t cover every possibility life could have in store for you. Think of these ancillary products as extra safety nets for the unexpected. Your loved ones will be grateful.
This type of policy covers the out-of-pocket and medical expenses that are related to experiencing an accident.
Accidents are expensive! If you’re covered, you can help to offset the costs that can add up quickly, such as those for medical procedures like surgery, as well as lodging and transportation, just to name a few.
Cancer, heart attack or stroke
The policy will pay a lump sum benefit after a diagnosis of one of these ailments.
An illness like cancer, heart attack or stroke can have devastating effects on your household’s financial situation.
Did you know these are the first, second and third items on the list of leading causes of death in the United States?
Or that one in five people who receive a cancer diagnosis use up most, if not all, of the savings as a result?
Cancer, Heart Attack, Stroke Insurance can help you to protect your savings and stay on top of your expenses in the event you’re affected by one of these illnesses. You’ll have the money you need to pay your rent or house payments, as well as utilities and other bills.
This coverage allows you the freedom to make the treatment choices that are right for you without worrying that they’ll send your family into financial ruin.
Critical Illness insurance
This policy is designed for those receiving a diagnosis of specific critical illnesses. A lump sum payment is made upon diagnosis.
When you suffer a serious illness, your health isn’t the only thing in the line of fire. Your finances can get battered, as well. When you have Critical Illness coverage, you’ll be taken care of beyond where your medical health insurance ends. The lump sum payment you receive can be used for travel expenses, medical bills or living expenses. You’re free to use the money in any way you choose.
Dental coverage provides you with coverage for the costs related to dental care.
There are a lot of medical health insurance plans that don’t cover dental care. That doesn’t mean it’s not important, though. A dental insurance policy gives you peace of mind that you’ll be able to get the care you need and get benefits for services like crowns, fillings, dentures and removals.
Final expense insurance
This policy helps with funeral costs and associated healthcare bills.
When you lose a loved one, the last thing anyone wants to have to worry about is money. Unfortunately, the average funeral costs about $10,000 and sometimes more. In addition, there are often medical bills associated with illness and end-of-life care. This coverage may seem morbid or unnecessary, but you’ll be glad you had the coverage when the time comes to use it. You can rest assured that your loved one is taken care of and that the rest of your family will be able to have what they need, as well.
Emergency room visits, skilled nursing, hospital, surgery and outpatient benefits are all features of a hospital indemnity insurance policy.
If you or a family member have ever had to ride in an ambulance or spend a night in the hospital, you know it’s not cheap. And most of the time, your health insurance won’t cover the whole cost of your treatment. A Hospital Indemnity plan will give you a chance to manage these costs without blowing your savings.
A recovery care policy is to offset the expenses related to a nursing home, a hospital stay and/or home care.
Did you know that a nursing home could cost you approximately $72,000 a year? Considering the statistic that almost three-quarters of people over the age of 65 will require long-term care, it’s definitely worth thinking about. Recovery Care Insurance can help you to have more control over your care.
Travel medical insurance
If you plan to take a trip abroad, it pays to look into travel medical insurance that will cover expenses related to emergency transportation, dental treatment, evacuation and more.
You may think that you’re covered by your standard health insurance, but many don’t provide coverage when you’re out of the country. If you have an accident or receive an injury while you’re away, you could be responsible for the expenses incurred.
Medicare doesn’t have to be a mystery
As you approach the age at which enrolling in Medicare is on your radar, it’s natural to feel a little overwhelmed.
This guide can help you determine when to enroll, how to do it and lays out your options for coverage.
It’s important that you seek the help of a professional to guide you through the process so that you’re sure to get the best policy for your situation.