GETTING STARTED WITH MEDICARE


 As you get started with Medicare, you have a choice in how you get your Medicare coverage. And, there are some important decisions for you to make. Follow these 3 steps to help you get started:


1. Sign Up For Medicare Through Social Security


If you're over 65 (or turning 65 in the next 3 months) and not already getting benefits from Social Security, you need to sign up to get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You won't get Medicare automatically.


 
What do I need to know before signing up for Medicare?


Medicare is health insurance for people 65 or older, certain people under 65 with disabilities, and people of any age with End-Stage Renal Disease (ESRD). Learn how to get started with Medicare if you have a disability or if you have ESRD.


Your first chance to get Medicare usually starts 3 months before you turn 65 and ends 3 months after you turn 65. Find out when you're eligible for Medicare.


You can only enroll in Medicare at certain times, and the cost can go up the longer you wait to sign up. Getting Medicare late can mean lifetime premium penalties and delays in when your coverage can start.


Deciding to enroll in Part B is an important decision. It depends on the type of coverage you have now, and whether you can sign up later (without a penalty). Not all other health coverage is the same as Part B. Find out if you should get Part B.


If you're getting benefits from the Railroad Retirement Board (RRB), you'll get Medicare Part A and Part B automatically when you're first eligible. Contact your local RRB office for more information about enrolling in Medicare.


 
When will I get my Medicare card?


You'll get your Medicare card in the mail about 2 weeks after you sign up. Your card is included in your official "Welcome to Medicare" packet.


If you already get benefits from Social Security, you'll get Medicare Part A and Part B automatically when you're first eligible and don't need to sign up. Medicare will send you a "Welcome to Medicare" packet 3 months before you turn 65. You'll still have other important deadlines and actions to take, so read all of the materials in the packet. (If you live in Puerto Rico, you'll only get Part A. If you want Part B, you need to sign up for it.)


 

2. Choose Your Coverage


People get Medicare coverage in different ways. You'll get lots of information to help you make a decision about how to get your Medicare coverage:


  • An official "Welcome to Medicare" packet with important information about your coverage options.
  • Your official "Medicare & You" handbook once you're enrolled and every year each fall.
  • Mail from private insurance companies, agents and brokers, marketing the Medicare plans they offer.


There are 2 main ways to get Medicare coverage:

Original Medicare – Includes Part A and Part B. You can use any doctor or hospital that takes Medicare, anywhere in the U.S.



If you don't get Part D or a Medigap policy when you're first eligible, you may have to pay more to get this coverage later. For Part D, this could mean a lifetime premium penalty.


Medicare Advantage – An "all in one" alternative to Original Medicare. These "bundled" plans include Part A, Part B, and usually Part D. Most plans offer extra benefits that Original Medicare doesn't cover – like vision, hearing, dental, and more.


  • Plans may have lower out-of-pocket costs than Original Medicare.
  • In most cases, you'll need to use doctors who are in the plan's network.


 

How Medicare works with other insurance


If you have Medicare and other health insurance or coverage, each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" to pay. In some cases, there may also be a third payer.


What it means to pay primary/secondary 


  • The insurance that pays first (primary payer) pays up to the limits of its coverage.
  • The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover.
  • The secondary payer (which may be Medicare) may not pay all the uncovered costs.
  • If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.


If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should've made.


How Medicare coordinates with other coverage


If your questions about who pays first, or if your coverage changes, call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627). Tell your doctor and other health care provider about any changes in your insurance or coverage when you get care.


 

Am I In Trouble If I Miss Signing Up In Time?


Medicare is very strict about when you can and need to enroll in or change your Medicare Coverage.  If you have Employer Coverage for example you're fine as it is considered Credible Coverage.



  • Unless you are enrolled in Medicare Part B during your IEP, you will most likely be subjected to paying a late enrollment penalty. This can hurt because all late enrollment penalties continue as long as you have  Medicare Coverage.  The Late Penalty is 10% for each year that you should have had Part B coverage but didn't. The standard premium for Part B is $144.60 in 2020, which means you’ll pay an extra $14.46 every month. This will increase if the standard Part B premium goes up next year, which it likely will. You’ll pay this penalty even if you ultimately choose to enroll in a Medicare Advantage Plan.



  • You might have to continue with no Part B for a long period of time. If you fail to enroll in Medicare Part B  during your IEP, you will not be able to enroll until the  General Enrollment Period, or GEP. This means your  coverage won’t start until July 1 that year.


  • If you don’t have creditable Part D prescription drug coverage and miss your IEP, you’ll pay a penalty with your Part D premium—again, as long as you have the coverage. The penalty is 1% per consecutive month that you went without coverage for prescription drugs. The national base premium is currently about $36 per month, so if you go without coverage for a year, you’ll pay an extra $4.30 a month, and probably will even pay a little more if the Part D base premium increases. And; this penalty will be in force as long as you have Part D coverage.



What Is Creditable Coverage?


Most Medicare beneficiaries who are still working have group coverage through an employer or an employers union plan.  This allows you to delay enrollment in Part A and/or B without penalties.  When you retire, you can sign up for those Parts during a Special Enrollment Period (SEP). Medicare credits you for having employer group coverage at any large employer (20+ employees.)


Later when you retire, you will be eligible for a 63-day Special Enrollment period to sign up for Parts A and/or B with no late enrollment penalties.


The Medicare Special Enrollment Period is an eight-month period that begins either the month you or your spouse quits working or the month your group coverage ends, whichever comes first.


When Is General Enrollment for Medicare?


If for some reason you missed or forgot to enroll in your Initial Enrollment Period (IEP) you will have to wait to enroll in the General Enrollment Period (GEP). This runs from January 1 through March 31 each year.


Even though you can enroll in Original Medicare during this time, you are still subject to the late enrollment penalties. However, in most cases your new Medicare coverage will not go into effect until July 1st, meaning you might have an extended period with no Insurance.


Keep in mind that the General Enrollment Period only applies to Original Medicare. If you want a Medicare Advantage plan or Medicare Part D coverage for prescription drugs, you’ll have to wait for the Annual Enrollment Period. From October 15 through December 7th.



What is Medigap Insurance?


 

Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:


  • Copayments
  • Coinsurance
  • Deductibles


 

Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here's what happens:


  • Medicare will pay its share of the Medicare-approved amount for covered health care costs.
  • Then, your Medigap policy pays its share.


8 things to know about Medigap policies 


  1. You must have Medicare Part A and Part B.
  2. A Medigap policy is different from a Medicare Advantage Plan.  Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
  3. You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
  4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
  5. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
  6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
  7. Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
  8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare.


Medigap Policies Don't Cover Everything


Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.


Insurance Plans That Aren't Medigap


Some types of insurance aren't Medigap plans, they include:


  • Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
  • Medicare Prescription Drug Plans
  • Medicaid
  • Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
  • TRICARE
  • Veterans' benefits
  • Long-term care insurance policies
  • Indian Health Service, Tribal, and Urban Indian Health plans


Dropping your entire Medigap policy (not just the drug coverage) 


You may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage). Or, you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.

If you decide to drop your entire Medigap policy, you need to be careful about the timing. When you join a new Medicare drug plan, you pay a late enrollment penalty if one of these applies:



 

Medigap Costs


Medicare doesn't pay any of the costs for you to get a Medigap policy. You have to pay the premiums for a Medigap policy.


Medigap helps pay your Part B bills 


In most Medigap policies, the Medigap insurance company will get your Part B claim information directly from Medicare. Then, they pay the doctor directly. Some Medigap insurance companies also provide this service for Part A claims.


If your Medigap insurance company doesn't provide this service, ask your doctors if they "participate" in Medicare. This means that they "accept assignment" for all Medicare patients. If your doctor participates, the Medigap insurance company is required to pay the doctor directly if you request it.


Compare the costs of Medigap plans 


Insurance companies may charge different premiums for the same exact policy. As you shop for a policy, be sure you're comparing the same policy. For example, compare Plan A from one company with Plan A from another company.

In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. If you buy a Medicare SELECT policy, you have the right to change your mind within 12 months and switch to a standard Medigap policy.The Medicare Advantage Open Enrollment Period


 

Medicare Advantage Plans


Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Your Medicare services aren’t paid for by Original Medicare. Below are the most common types of Medicare Advantage Plans. 




 

Part D late enrollment penalty


The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:


  • A Medicare Prescription Drug Plan (Part D)
  • A Medicare Advantage Plan (Part C) (like an HMO or PPO) or another Medicare health plan that offers Medicare prescription drug coverage
  • Creditable prescription drug coverage


 

3 ways to avoid the Part D late enrollment penalty


1. Join a Medicare drug plan when you're first eligible.


You won't have to pay a Part D late enrollment penalty, even if you've never had prescription drug coverage before.


2. Don't go 63 days or more in a row without Medicare prescription drug coverage or other creditable drug coverage.


Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, CHAMPVA, or health insurance coverage. Your prescription drug plan must tell you each year if your drug coverage is creditable coverage. They may send you this information in a letter, or draw your attention to it in a newsletter or other piece of correspondence. Keep this information because you may need it if you join a Medicare drug plan later and want to avoid the Part D late enrollment penalty.


3. Keep records showing when you had creditable drug coverage, and tell your plan about it.


When you join a Medicare drug plan, the plan will check to see if you had creditable drug coverage for 63 days or more in a row. If the plan believes you didn't, it will send you a letter with a form asking about any drug coverage you had. To avoid a Part D penalty, complete the form and return it to your drug plan by the deadline in the letter. If you don't tell the plan about your creditable drug coverage, you may have to pay a Medicare Part D late enrollment penalty.