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Medicare is one of the most popular health insurance programs in the United States. While most people know that the insurance is primarily for retirees, how this program works or even when to sign up for Medicare is not always clear.
Medicare is a federal health insurance program that’s available for people 65 years of age and older, people who have disabilities, and people with certain medical conditions. It is broken into several Parts:
Together, Medicare Part A and Part B are known as Original Medicare. There is also Medigap, or Medicare Supplement Insurance, which is insurance coverage someone can purchase from private insurance companies to fill in the gaps of their Medicare coverage.
While exceptions apply, according to the official site, US citizens and certain non-citizens are generally eligible to enroll in the program under one the following circumstances:
Most people who enroll in Medicare do so as soon as they are able to, although some people choose to wait until later. There are several Medicare enrollment periods when someone can enroll into the program, so long as they meet the eligibility requirements for health coverage.
People’s first opportunity to enroll into the program is known as the initial enrollment period. It lasts for 7 months, starting 3 months before someone’s 65th birthday.
Occurring annually between October 15 – December 7, this period allows people to change their current Plans, according to the official site.
This period occurs annually between January 1 – March 31, according to Medicare.gov. During this period, someone who already has a Medicare Advantage Plan (Part C) can:
Medigap’s open enrollment period is a 6-month window that starts as soon as someone has Part B coverage and they’re at least 65.
Every year between January 1 – March 31 is the general enrollment period, when anyone who is eligible to enroll can enroll. If the person is not eligible for a special enrollment period, people may have to pay a monthly late-enrollment penalty.
In certain cases, people may be eligible for a special enrollment period, a period outside of other enrollment periods when they can sign up for coverage. People may be exempt from late-enrollment penalties during this time.
Not enrolling in Medicare during the initial enrollment period can result in a late-enrollment penalty. This penalty varies on several factors, including the specific Medicare Part and the amount of time someone has delayed enrollment.
These penalties might be waived under special circumstances, such as in cases where the individual qualifies for Extra Help, which is a Medicare program that helps low-income individuals help pay for Part D coverage.
Depending on the circumstances, someone may be automatically enrolled into Medicare Part A and/or Part B.
Someone may still have to pay premiums in these circumstances, which is why someone who does not want Part B coverage has to manually start a process to refuse coverage. People will not be automatically enrolled into Part C or Medigap, so people who want these types of coverage will need to start the enrollment process themselves.
Navigating Medicare benefits, insurance plans, beneficiaries, retirement benefits, current employment and employer coverage, and knowing when coverage starts can all be confusing. For those who are wondering if they should contact Social Security, their local Social Security office, or Medicare, this helpful PDF should help point them in the right direction.
Disclaimers – This article does not constitute professional, legal, financial, health care, or medical advice. Information in this article may be subject to change.