What is Medicare and who is eligible?
On July 30, 1965, President Lyndon B. Johnson signed the bill that led to the formation of Medicare. The original Medicare program included Part A (Hospital Insurance) and Part B (Medical Insurance), also known as “Original Medicare.” Over the years, Congress has made changes to Medicare benefits and to include many groups of eligibles.
Medicare is a national health insurance for people 65 or older, certain people under 65 with disabilities, and people of any age with End-Stage Renal Disease. Medicare has many moving parts and it is important to understand how they fit together for you.
Watch out for your Medicare card 3 months before your birthday if you're already receiving benefits!
What are the Parts of Medicare?
Medicare
Part A
Hospital Insurance
Helps pay for inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
Most people don’t pay a monthly premium for Part A if they or their spouse have worked and paid Medicare taxes for at least 10 years.
Medicare
Part B
Medical Insurance
Helps pay for doctor services, outpatient care, medical supplies, preventive services, and some home health care.
You pay a monthly premium for Part B. The amount may change each year.
Medicare
Part C
Medicare Advantage
An all-in-one alternative to Original Medicare (Part A and Part B). Plans are offered by private insurance companies.
- Includes Part A and Part B
- May include extra benefits
- May have lower out-of-pocket costs
Medicare
Part D
Prescription Drug Coverage
Helps pay for prescription drugs.
Plans are offered by private insurance companies.
You pay a monthly premium for Part D. The amount may change each year.
When to Enroll
When to enroll depends on your specific situation. If you are already retired (woohoo!), in most cases you want to enroll in Medicare within the 3 months before your 65th birthday, so that your Medicare coverage begins on the 1st of your birthday month. Your Initial Enrollment Period is the seven month window around your 65th birthday. You can enroll into Medicare at any time within the seven months without penalty, however if you enroll in your birthday month or the three months after, the Part B coverage will start the month after your enrollment (You cannot choose the month).
Automatic Enrollment
If you are already receiving Social Security or Railroad Retirement Benefits, you will be automatically enrolled in Medicare. You’ll get your red, white, and blue Medicare card in the mail about 3 months before your 65th birthday or before your 25th month of receiving disability benefits. If you are fast approaching your birthday month and don’t have your card, call the Social Security Administration to check on the status.
Manual Enrollment
Those eligibles not already receiving Social Security or RR Benefits may enroll in Medicare through Social Security one of three ways:
- Setting up a phone appointment
- Enroll on the Social Security website (in about 15 minutes or less) after you create an account
- Make an appointment or walk into your local Social Security office
After you apply, it will take usually 2 to 4 weeks for your card to arrive, so you should plan to apply several weeks before you need the coverage to begin. And remember, this will enroll you in Medicare Part A and B. If you want to enroll in a Medicare Advantage Plan, Prescription Drug Plan, or Medicare Supplement you can work with a licensed agent (like me!) to help navigate options in your area.
Now what?
Let’s say you have enrolled into Medicare and have your red, white, and blue card in your hand. What is the next step? Learn more about Medicare Advantage and Medigap plans to see which type of plan may be a good fit for your needs.