Medicare is health care coverage for those age 65 and older. It’s important to understand Medicare enrollment and coverage options to avoid penalties down the road. Whether you’re reaching the age of 65 or you’re older and switching from your workplace insurance to Medicare, it’s important to know how to navigate enrollment.
Original Medicare consists of several parts, including:
-Part A (hospital insurance), which helps cover inpatient care in hospitals, nursing facilities, hospice and home health care.
-Part B (medical insurance), which helps cover services from doctors and health providers, outpatient care, home healthcare, certain medical equipment and preventive services.
-Part C (Medicare Advantage), which is a bundled plan that includes Part A, Part B and often Part D. Coverage often includes benefits such as vision, hearing and dental. These plans are only available through private insurers.
-Part D (drug coverage), which helps cover prescription drug costs, including recommended shots or vaccines. You needto have Part A and B (Original Medicare) to enroll in Part D coverage or join a Medicare Advantage Plan.
-Medigap, which covers additional out-of-pocket costs in Original Medicare, such as coinsurance.
The parts of Medicare you should enroll in are dependent on your health care needs. If you’re unsure of which coverage best suits your needs, reach out to your provider to discuss your options.
Key Enrollment Periods
You can only enroll in Medicare at certain times of the year and under certain qualifications. The following are times for enrollment:
Initial Enrollment—Medicare enrollment starts three months before you turn 65 and goes through three months after the month you turn 65 years old. During that time, you can enroll in Medicare Parts A and B, prescription drug coverage (Part D) and Medicare Advantage (Part C).
Medicare Supplement Open Enrollment—This enrollment is for those looking to supplement Original Medicare. As long as you have signed up for Part B, you can buy a supplemental plan during the six-month enrollment period. This enrollment period starts the first day of the month you turn 65 and lasts six months.
General Enrollment—Enrollment is available for Part A and/or Part B between Jan. 1 and March 31 of each year. The following scenarios must apply:
-You didn’t sign up when first eligible.
-You are not eligible for a Special Enrollment Period.
Annual Enrollment Period—This enrollment period is for anyone who wants to make changes to their current enrollment coverage. The enrollment period is from Oct. 15 to Dec. 7 each year. The following changes can be made to your coverage at that time:
-Switch from Original Medicare to Medicare Advantage or vice versa
-Add or drop a Medicare prescription drug plan
-Switch to a new plan from your current insurer or to a new insurer
Medicare Advantage Enrollment Period—This enrollment period begins Jan. 1 and ends March 31 each year. This enrollment period allows for those enrolled in Medicare Advantage to either enroll in another Advantage Plan with or without prescription drug coverage or Original Medicare.
Special Enrollment Period (SEP)—This enrollment period allows you to switch or drop a Medicare Advantage or prescription drug plan outside of the traditional enrollment periods. Certain events must occur to qualify for SEP, such as:
-Moving out of your plan’s serviceable area
-Moving into or out of a nursing facility, rehab facility or other long-term care facility
-Changing employment or your employer-provided plan ends
Medicare enrollment can be confusing, so it’s important to know all the health care and enrollment options before you get started. If your time for enrollment is coming up, reach out to a provider to get started, especially if you have further questions. Reach out today to avoid future penalties.