New to Medicare 2024: Feeling lost? You are not alone

Change isn’t always easy. For some people. moving from employer-sponsored health insurance to Medicare is one of those rites of passage that can leave them frazzled. Instead of one packaged plan, Medicare is broken into three parts – Part A covers hospitalization, Part B covers doctor’s visits and Part D covers prescriptions.

The massive amount of mail that people new to Medicare receive certainly doesn’t help either!

New to Medicare as Your Primary Insurance

Leaving employer coverage to transition to Medicare as your primary insurance can be overwhelming because it’s all new to you.  However, it’s a painless process once you understand steps to take.

If you are already receiving Social Security, the government will auto-enroll in both parts of Medicare. If not, you must enroll yourself either online,  or (if you can get an appointment) at your local Social Security office.  It is important to understand that this is to enroll in original Medicare (Parts A and B). Once that is accomplished you will also need to enroll on prescription coverage through a private carrier. 

Then you can decide if you want to supplement your Medicare benefits with either a Medicare Supplement which fill in the gaps in Medicare (think copays and maximum out of pocket costs) or use a Medicare Advantage plan (which uses a doctor network may add a prescription card and additional benefits). These enrollments can be done with the assistance of an insurance agent who specialized in Medicare coverage

Here is an overview of the steps you will take to get the ball rolling:

• Confirm you are eligible for Medicare by calling 800-MEDICARE
• Read about Medicare costs so that you can be prepare for what you will pay. If your income is above a certain level there are IRMAA (income related monthly adjustment amount)fees applied to your Medicare premiums. You can check at https://www.ssa.gov/benefits/medicare/medicare-premiums.html  scroll down to the bottom and you will see a chart
• Apply for Medicare at your local Social Security office or online at their website
• Receive and verify your red, white and blue Medicare ID card. Make sure shows you are enrolled in both Part A and Part B.
• Talk to a qualified Medicare specialist (aka a certified insurance agent) about your coverage options: Medicare Advantage or  Medicare supplemental insurance coverage
• You can either search for a Part D plan (prescription plan) on www.Medicare.gov or your insurance agent can do this for you.  Make sure to put in all your prescriptions so you can see their costs throughout the year and determine which drug plan best suits you
• Review your coverage annually to make sure you are getting the most appropriate insurance at the right price

How to Apply for Medicare

Applying for Medicare can feel intimidating, but it’s easier than you might think.

The Social Security office handles applications for Medicare Parts A and B. They offer several easy options, so you can choose how to apply. If you are aging into Medicare, you may apply as early as 3 months prior to the month of your 65th birthday, the month you turn 65 or three months afterwards.

This is your Initial Enrollment Period (IEP) to enroll in Parts A and B. (It is also your enrollment period for Part D, but you purchase Part D separately from an insurance company. You do not enroll in it through Social Security because Part D is voluntary.) During your IEP you will not have any late penalties, pre-existing condition waiting periods or rate increases due to a condition

When to Apply for Medicare

Don’t confuse applying for Social Security with applying for Medicare.  These are two separate applications. People age into Medicare at age 65, regardless of whether they are taking retirement income benefits yet. If you are a citizen age 65 or older and need medical insurance, you are entitled to enroll in Medicare. You can postpone Social Security payment until age 72.

If you already taking Social Security income benefits or Railroad Retirement Board benefits, you will be automatically enrolled in Medicare Parts A and B at age 65. Your card should arrive 1- 2 months before you turn 65.

If you are NOT yet taking retirement benefits, then you will need to enroll yourself.

When to Apply for Medicare

Medicare may or may not be your primary coverage. If your employer allows you to continue the employer sponsored coverage and the company has more than 20 employees or the company has retiree coverage you may prefer this coverage.  It is important to understand the differences before making this decision. Filing for Medicare at age 65 is very important if you work for a small employer (defined here as less than20 employees)! In recent years, carriers have been either declining or delaying payments for individuals who are Medicare eligible.

Enrollment Periods for Medicare

When you file for Medicare can affect the effective date of your coverage so it’s important to know the deadlines ahead of time.

Also, if you are leaving employer coverage in the middle of your IEP, then your IEP trumps any other election period. We’ve seen this several times where people assume their Medicare coverage will start immediately after the group coverage ends.

However, if you are in your IEP and your birth month has already passed, the chart below demonstrates when you can apply and when your coverage will begin. Remember, if you have no other coverage and you fail to enroll during your 7-month IEP, you will be subject to a Part B late enrollment penalty of 10% per month for every full 12-month period that you were not enrolled.

Medicare Enrollment Periods

• Turning 65

  • What Period: Initial Enrollment Period (IEP)
  • What Part: Parts A, B, and D (Advantage Plans)
  • Time Period: 3 months before turning 65, the month you turn 65, or 3 months after
    
    

• Missed IEP and no SEP qualification

  • What Period: General Enrollment Period (GEP)
  • What Part: Parts A & B
  • Time Period: Jan. 1 – Mar. 31 each year; coverage starts July 1st
    
    

• Already enrolled in Medicare Advantage or Part D

  • What Period: Annual Election Period (AEP)
  • What Part: Enroll, change, or disenroll in Medicare Advantage and Part D for coverage starting Jan. 1st
  • Time Period: Oct. 15 – Dec. 7 each year
    
    

• Already enrolled in Medicare Advantage

  • What Period: Medicare Advantage Open Enrollment Period (MAOP)
  • What Part: Change Medicare Advantage Plan or return to Original Medicare
  • Time Period: Jan. 1 – Mar. 31 each year
    
    

• Special Situations (e.g., change of residence, loss of coverage)

  • What Period: Special Enrollment/Election Period (SEP)
  • What Part: Qualifying situations to enroll in Medicare, Medicare Advantage, or Part D mid-year
  • Time Period: 8 months for Parts A & B; 2 months for Medicare Advantage and Part D
    
    

• People enrolling in Part B

  • What Period: Medigap Open Enrollment Period (MGOP)
  • What Part: To enroll without underwriting
  • Time Period: First 6 months after receiving Part B (must also have Part A)

Would you like some assistance in decide on what Medicare plan is right for you? Agents listed on the Medicare Agent Directory are always available to help you with this decision.

Patti Goldfarb is a Medicare Broker Licensed in FL, NJ and NY. Contact Patti through her listing here on the directory, or visit SeniorFinancialLife.com.