FAQs

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

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).

In general, Part A covers:

• Inpatient care in a hospital
• Skilled nursing facility care
• Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
• Hospice care
• Home health care

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

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:

• Medicare Advantage Plans
• Other Medicare health plans
  • Medicare Cost Plans
  • Demonstrations/Pilot Programs
  • Programs of All-inclusive Care for the Elderly (PACE)
  • Medication Therapy Management (MTM) programs for complex health needs

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.

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.

Do I need to sign up?

Do I need to sign up?

expandI’m under 65 and have a disability.

Do I need to sign up?

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.

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.

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.

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