The process of enrolling in Medicare begins with knowing when you are eligible to enroll and what actions you must take to complete the process.
Once you are enrolled in Original Medicare , check out your options related to things like supplemental, prescription drug, and dental coverage to make sure you’re in the plan that fits your needs.
Your checklist of needs can change over time, so be sure to review your plan on an annual basis.
Even for a seemingly straightforward trip around town, a checklist can come in handy.
If you wouldn’t go grocery shopping without a checklist, you certainly shouldn’t shop for health insurance without one.
If you soon will be eligible for Medicare for the first time, here’s a checklist worth — well — checking out.
Find a local Medicare plan that fits your needs
For most people new to Medicare, their journey begins around the time they turn 65, but a little planning before your birthday can assure that you’re not late to the party.
The Initial Enrollment Period (IEP) for Original Medicare is a total of seven months surrounding your 65th birthday. Enroll in Medicare during this period, and you won’t face the prospect of Medicare’s late enrollment penalties. If your IEP has come and gone, you can still join Medicare during other Medicare enrollment periods on the calendar.
Use GoHealth’s Medicare Initial Enrollment Tool to find out your dates.
All U.S. citizens or Resident Aliens ages 65 and older are eligible for Medicare. You might be eligible before age 65 if you have certain disabilities or illnesses. You will need documentation to prove any and all statements in your application before you can receive your Medicare coverage.
Yes, I currently receive benefits from Social Security Administration
First and foremost, do you receive Social Security benefits? If you do, the Social Security Administration already has your information on file. In most cases, you won’t need to provide Social Security with new documentation to enroll in Medicare.
No, I have not started to draw my benefits from Social Security Administration
If you don’t receive Social Security benefits, typically you should plan to have documentation ready for when you enroll in Medicare. Whether you enroll online, in-person at your local Social Security office, or over the phone, you will need to show some basic documents to confirm your eligibility.
It’s a good idea to gather official documents like:
- Social Security number
- Citizenship status
- Any documentation associated with Social Security benefits and/or applying for Social Security benefits.
- Birth Certificate (or any two: immunization records, school records, state census records, insurance records, or medical records).
- Any documentation related to a federal pension or retirement
When it’s time to apply, the Social Security Administration will inform you which documents are needed.
Are you eligible for cost-saving Medicare subsidies?
Some folks think that becoming a Medicare beneficiary takes care of itself, but often — as is common in life — you have to deal with a few of the details.
If you receive Social Security benefits or Railroad Retirement Board benefits at least four months before turning 65, then your Medicare should arrive in your mailbox without you taking any action. Otherwise, it’s up to you to apply during your IEP by connecting with the Social Security Administration online, on the phone or in person.
Being eligible for Medicare is one thing. Knowing whether you should take advantage of your eligibility is another.
That question isn’t going to be answered in a few paragraphs, but GoHealth has resources to help make Medicare simple, not to mention no-obligation access to a licensed insurance agent ready to go through all the options.
In a nutshell, if you are covered by employer-sponsored health insurance, you may not want to switch to Medicare right away — or at least not both Parts A and B.
What extra benefits and savings do you qualify for?
Original Medicare — also known as Part A and Part B — is the starting point for Medicare. Only in rare cases would anyone initially pass on Part A because it’s hospital insurance that doesn’t have a monthly premium (as long as you or your spouse paid Medicare taxes through an employer for 10 years).
Part B, or medical insurance, isn’t quite as clear-cut because it does require a monthly premium:
- If you’re on an employer-sponsored health insurance plan (for a company with 20 or more employees), you can pass on Part B and not be charged a penalty, opting instead to sign up later during a Special Enrollment Period when your circumstances change.
- With few other exceptions, not enrolling in Original Medicare during your IEP will result in a 10% lifetime penalty on your Part B premium for every 12-month period you don’t enroll after your 65th birthday.
If you decide that it’s time to enroll in Parts A and B upon turning 65, then it’s time to look more closely at what Medicare benefits are right for you.
You’ve decided to sign up for Parts A and B. But that’s only part of the story.
Part A can be a lifesaver when it comes to hospital expenses, but the coverage only goes so far. It’s the same story with Part B, which covers lots of expenses related to doctors’ visits — but not everything. There are gaps in coverage when it comes to capping out-of-pocket costs because of expenses that might fall on you, such as coinsurance and copays.
To fill the gap and place a cap on your costs, you might consider Medigap — the term given to Medicare supplemental coverage administered by private insurance companies that can be added to Parts A and B.
That’s one approach. Another one? Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A & B benefits or coverages as Original Medicare. Along with receiving Part A & B benefits, Medicare Part C often bundles your benefits with additional ones like dental, hearing, vision and prescription drug coverage.
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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:
Original Medicare doesn’t include drug coverage, but Part D does. A Part D plan — a stand-alone plan administered by private insurance companies — can be paired with Original Medicare to help ease your burden at the pharmacy. Medicare Advantage plans also offer drug coverage.
Get the health benefits and savings you’re entitled to.
While there are ways to add supplemental and drug coverage to both Original Medicare and Medicare Advantage, a few offerings are exclusive to Medicare Advantage. Most Medicare Advantage plans offer options for dental, vision and hearing insurance — none of which are an option for Original Medicare beneficiaries. If those options are important to you, then…
In addition to offering some extra benefits and the ability to bundle, some Medicare Advantage plans also offer medical insurance without the monthly premiums charged to Part B enrollees. A GoHealth licensed insurance agent can walk you through the entire process of determining whether a Medicare Advantage plan is right for you — without cost or obligation.
Are you paying extra for dental, vision and hearing benefits?
Once you enroll in Original Medicare or a Medicare Advantage plan, you can take a deep breath. But that doesn’t mean you shouldn’t take stock of your situation in the future.
Each year from October 15 through December 7 — known as the Annual Enrollment Period (AEP) — brings you choices anew. During this period, you can switch from Original Medicare to Medicare Advantage or you can switch from one Medicare Advantage plan to another one. You also can add or switch Part D plans.
The most common reason for passing on Part B coverage is because you’re on an employer-sponsored insurance plan that provides similar coverage for medical expenses, a situation that also allows you to decline Part B for now without facing late penalties in the future.
If you are automatically enrolled in Parts A and B leading up to your 65th birthday and receive a welcome packet from the Social Security Administration (SSA), it will include instructions on how to opt out of Part B. If you aren’t automatically enrolled but want to decline Part B, you will need to complete CMS Form 1763 and may want to reach out to SSA to assure that you correctly do so.
Part D, like Part B, can be subject to a late fee that lasts for the lifetime of your premium — a 1% fee added for every month you wait to sign up after you go more than 63 days without creditable drug coverage following your Initial Enrollment Period.
Medigap doesn’t have a late fee, but if you don’t sign up for a plan within six months of enrolling in Part B, you aren’t guaranteed the ability to purchase a plan and are likely to face questions about your health that could impact the rate you pay. You don’t have to answer health questions if you add Medigap during that initial period.
While Part A of Original Medicare provides significant financial assistance for hospital stays, usually without a monthly premium, longer stays can prove costly without supplemental coverage. Part B is much the same because like Part A, you often must pay 20% coinsurance after your deductible is met, with no out-of-pocket maximum. The supplemental coverage offered by Medicare Advantage plans adds an out-of-pocket maximum that can help limit such costs.