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What is Medicare ?

Think about Medicare

Medicare starts when you turn 65 whether you are retiring or not. If you have creditable insurance through an employer then you don't need to add Medicare Part B at additional expense, however, verify this with your employer's insurer to be sure that their contract doesn't require that you maintain both Part A and Part B as your primary payer or you could be liable for Part B expenses that would have been covered by the insurance.

If you have an employee benefit plan make sure you know for certain how Medicare works together with your employee benefit plan. If Medicare is the primary payer then you must also purchase Part B in order to have complete coverage.

What is Medicare?



Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

Social Security manages access to this benefit and issues replacement cards. You can visit them at https://www.ssa.gov. Medicare handles the claims side of administration including managing contracts with insurers, doctors, and other service providers. Medicare has been tasked with getting more bang for the taxpayer buck by setting high standards for care and holding it's contractors to those standards.

The different parts of Medicare help cover specific services:

When Can I Join 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. You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans.

If you are newly eligible for Medicare because you turned 65 you might sign up for a Medicare Advantage Plan and/or a Medicare Prescription Drug Plan. You can enroll in Medicare during the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you turn 65, your coverage will begin the first day of the month you turn 65.

If you are newly eligible for Medicare because I have a disability (under 65) you can sign up for a Medicare Advantage Plan or a Medicare Prescription Drug Plan. In some states you might be able to sign up for a Medicare Supplement plan instead of Medicare Advantage. Your Medicare coverage begins 24 months after you get Social Security or Railroad Retirement Board (RRB) disability benefits. You can enroll during the 7-month period that starts 3 months before your 25th month of getting Social Security or RRB disability benefits and ends 3 months after your 25th month of getting disability benefits. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you first get Medicare, your coverage will begin the first day of your 25th month of entitlement to disability payments.

Medicare Part B Late Enrollment Penalty

If you don't sign up for Medicare Part B when you're first eligible, you may have to pay a late enrollment penalty of 10% pro-rated for every year that you could have had Original Medicare after age 65; and didn't; AND you had no creditable coverage from an employee benefit plan. If you have coverage through an employee benefit plant please check with your insurer to make sure that your employee benefit plan is creditable for both Part B & D. Employers are required to send out an annual creditable coverage notice. Always keep a copy of all creditable coverage notices or know where to look them up online in case the government's records need to be updated manually.

Market Rules

The Centers for Medicare and Medicaid Services (CMS) that manages the Medicare program has rules about when beneficiaries can join or leave Medicare Advantage and Prescription Drug Plans. These are considered Medicare plans covered under Medicare Part C, or MA plans, and Part D, PD plans, sometimes combined to become MAPD plans. Unless you are new to Medicare or have a Special Election Period (usually because you involuntarily lost coverage or decided to leave an employee benefit plan) you are "locked in" outside of the standard enrollment and disenrollment periods.

Medicare Annual Enrollment Periods


Special Election Periods

Outside of your initial or the Annual Election Period you can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP. For more information read about SEPs on Medicare's web site. Some low income people that have applied for and received "Extra Help" or Medicaid have ongoing SEPs every month and may change plans at any time. These marketing rules only apply to the Medicare Advantage program including prescription drug plans.

Find & Compare Medicare Plans in Your Area 
Call (360) 834-0200 or (800) 547-1567 for help from me sorting through all of this.

If you are looking for information you don't find here please look at you should be able to find the answers here or on our Resources page or search in the index on the top of every page.

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To keep reading about Medicare see our Medicare Costs page.

 
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