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When can I start enrollment into medicare

Turning 65 Enrollment Options

1. Medicare A and B with a Medicare Supplement and a Drug plan

  • Enrollment for a Medicare supplement plan can begin up to 6 months before your medicare begins
  • Enrollment into Medicare A and B starts 3 months before your medicare begins
  • Enrollment into Drug Plan begins after you receive your medicare card

2. Medicare A and B with a Medicare Advantage Plan

  • Enrollment into Medicare A and B starts 3 months before your medicare begins
  • Enrollment into Medicare Advantage plan begins after you receive your medicare card

Enrollment into medicare due to disability (any age)

  • Enrollment into Medicare A and B starts 3 months before your medicare begins
  • Enrollment into Medicare Advantage plan begins after you receive your medicare card
Your medicare coverage choices

When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get your Medicare coverage—Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Some people need to get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap).

What Part A covers

In general, Part A covers:

2 ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area
What Part B covers

 

Part B covers 2 types of services

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive servicesHealth care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts Assignment.

Part B covers things like:

2 ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

 

What Medicare health plans cover

Generally, a Medicare health plan is offered by a private company that contracts with Medicare to provide Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) benefits to people who enroll in the plan.

Medicare health plans include:

What not covered by Part A and Part B?

Medicare doesn’t cover everything. Some of the items and services Medicare doesn’t cover include:

  • Long-term care (also called Custodial care )
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care

Find out if Medicare covers a test, item, or service you need.

If you need services Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance or a Medicare health plan that covers them.

What do Medicare Advantage Plans Cover?

Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies. In all types of Medicare Advantage Plans, you’re always covered for emergency and Urgently needed care.

The plan can choose not to cover the costs of services that aren’t Medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.

Most Medicare Advantage Plans offer coverage for things that aren’t covered by Original Medicare, like vision, hearing, dental, and wellness programs (like gym memberships). Plans can also cover more extra benefits than they have in the past, including services like transportation to doctor visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness. Plans can also tailor their benefit packages to offer these new benefits to certain chronically ill enrollees. These packages will provide benefits customized to treat those conditions. Check with the plan to see what benefits are offered and if you qualify. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan. In 2020, the standard Part B premium amount is $144.60 (or higher depending on your income).

If you need a service that the plan says isn’t medically necessary, you may have to pay all the costs of the service. But, you have the right to appeal the decision.

You (or a provider acting on your behalf) can request to see if an item or service will be covered by the plan in advance. Sometimes you must do this for the service to be covered. This is called an “organization determination.” If your plan denies coverage, the plan must tell you in writing.

You don’t have to pay more than the plan’s usual cost-sharing for a service or supply if a network provider didn’t get an organization determination and either of these is true:

  • The provider gave you or referred you for services or supplies that you reasonably thought would be covered.
  • The provider referred you to an out-of-network provider for plan-covered services.
How do i get Parts A and B?

Some people get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) automatically and other people have to sign up for it. In most cases, it depends on whether you’re getting Social Security benefits. Select the situation that applies to you to learn more.

Il be getting benefits from social security or the Railroad Retirement Board at least 4 months before I turn 65

Do I need to sign up?

No. In most cases, you’ll automatically get Part A and Part B starting the first day of the month you turn 65.

If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.

Note

If you live in Puerto Rico, you automatically get Part A. If you want Part B, you need to sign up for it. Complete an Application for Enrollment in Part B (CMS-40B) to sign up for Part B. Get this form and instructions in Spanish.

Should I get Part B?

Most people should enroll in Part A when they turn 65, but certain people may choose to delay Part B. Find out more about whether you should take Part B.

How do I sign up?

You don’t need to sign up if you automatically get Part A and Part B. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday.

When do I sign up?

You don’t need to sign up since you automatically get Part A and Part B.

Can I get a health or drug plan?

When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D). There are specific times when you can sign up for these plans, or make changes to coverage you already have.

I wont be getting benefits from Social Security or the Railroad Retirement Board at least 4 months before I turn 65

Do I need to sign up?

If you aren’t getting benefits from Social Security (or the RRB) at least 4 months before you turn 65, you’ll need to sign up with Social Security to get Part A and Part B.

Should I get Part B?

Most people should enroll in Part A when they turn 65, but certain people may choose to delay Part B. Find out more about whether you should take Part B.

Note
If you don’t qualify for premium-free Part A, you must sign up for Part B in order to buy Part A.

How do I sign up?

​​​​​​When do I sign up?

Learn about when you can sign up for Parts A and B.

Can I get a health or drug plan?

When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D). There are specific times when you can sign up for these plans, or make changes to coverage you already have.

I am under 65 and have a disability. Do I need to sign up?

expandI’m under 65 and have a disability.

Do I need to sign up?

You automatically get Part A and Part B after you get one of these:

  • Disability benefits from Social Security for 24 months
  • Certain disability benefits from the RRB for 24 months

Should I get Part B?

Certain people may choose to delay Part B. Find out more about whether you should take Part B.

How do I sign up?

You don’t need to sign up if you automatically get Part A and Part B. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 25th month of disability.

When do I sign up?

You don’t need to sign up since you automatically get Part A and Part B.

Can I get a health or drug plan?

When you decide how to get your Medicare coverage, you might choose:

There are specific times when you can sign up for these plans, or make changes to coverage you already have.

When does my coverage start?

If you sign up for Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) during the first 3 months of your Initial Enrollment Period, your coverage starts the first day of the month you turn 65. If your birthday is on the first day of the month, your coverage starts the first day of the prior month.

 

Example

Mr. Green’s 65th birthday is July 20, 2020. If he signs up for Medicare in April, May, or June, his coverage will start on July 1, 2020.

Example

Mr. Kim’s 65th birthday is July 1, 2020. If he signs up for Medicare in March, April, or May, his coverage will start on June 1, 2020.

Should I get Medicare Part A and B?

ost people should enroll in Medicare Part A (Hospital Insurance) when they’re first eligible, but certain people may choose to delay Medicare Part B (Medical Insurance). In most cases, it depends on the type of health coverage you may have. Select the situation that applies to you to learn more.

Note
You must pay your Part B premium every month for as long as you have Part B (even if you don’t use it).

What if I don’t want Part B?

Make sure you review the situation above that applies to you so that you understand how dropping Part B would affect you. If you want to drop Part B, here’s how to do it:

Your Medicare hasn’t started yet

If your Medicare hasn’t started yet, there are 2 ways to drop Part B:

  1. If you were automatically enrolled in both Part A and Part B and sent a Medicare card [JPG], follow the instructions that come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.
  2. If you signed up for Medicare through Social Security, contact Social Security.

Your Medicare has already started

If your Medicare has started and you want to drop Part B, contact Social Security for instructions on how to submit a signed request. Your coverage will end the first day of the month after Social Security gets your request.

I have employer coverage

It’s important to understand how your current coverage works with Medicare. If you have questions about your current insurance, the best source of information is your benefits administrator, insurer, or plan provider.

I have employer coverage and:

expandI’m turning 65
 

If you aren’t getting benefits from Social Security (or the RRB) at least 4 months before you turn 65, you’ll need to sign up with Social Security to get Parts A and B. However, depending on the size of the employer, you may be able to delay Parts A and B without having to pay a penalty if you enroll later. Learn more about whether you should get Parts A and B.

 

expandI’m over 65
 

In most cases, you don’t need to do anything until you (or your spouse) retire or you lose the employer coverage. If you didn’t enroll when you were first eligible, the size of the employer determines whether you have to pay a penalty if you enroll later. Learn more about whether you should get Parts A and B and what happens when your employment or coverage ends.

 

expandI’m under 65 and have a disability
In most cases, you don’t need to do anything until you (or your spouse) retire or you lose the employer coverage. If you didn’t enroll when you were first eligible, the size of the employer determines whether you have to pay a penalty if you enroll later. Learn more about whether you should get Parts A and B and what happens when your employment or coverage ends.
Is my test, item, or service covered?

Find out if your test, item or service is covered. Medicare coverage for many tests, items, and services depends on where you live. This list includes tests, items, and services (covered and non-covered) if coverage is the same no matter where you live.

https://www.medicare.gov/coverage

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