Not everyone is eligible for Medicare benefits. You become eligible to enroll in Medicare only under particular circumstances:
- Once you reach 65 years of age
- After two years of the receipt of disability payments from the Social Security Administration
- After a diagnosis of Lou Gehrig’s disease, and/or after a diagnosis of End-Stage Renal Disease (i.e. permanent kidney failure, which requires either a transplant or dialysis)
Ideally, you want to enroll in Medicare when you first become eligible—this is called your Initial Enrollment Period. If you do not enroll in Medicare at that time, you can enroll later during other specific enrollment periods. However, late enrollment will sometimes mean that you will be required to pay higher premiums for Medicare coverage.
Many people are automatically enrolled in Medicare Part A, Medicare Part B, or both. If you collect retirement benefits from the Social Security Administration or the RRB, you will be automatically enrolled in both Part A and Part B the first day of the month that you turn 65 years old. If you collect disability benefits from the Social Security Administration or the RRB, you will be automatically enrolled in both Parts A and B on the first day of the 25th month you collect benefits. A diagnosis of Lou Gehrig’s disease will also qualify you for automatic enrollment. If you are automatically enrolled in Part B under any of the above circumstances, and you do not wish to keep Part B, you need to notify Medicare immediately in order to avoid a bill for the monthly premiums.
Once your Initial Enrollment Period is over, there are several additional enrollment periods during which you can enroll in Medicare.
- The General Enrollment Period, which runs January 1 through March 31 of every year. During the General Enrollment Period you can enroll in Medicare Parts A and B. Your coverage would then begin on July 1 of that year.
- A Special Enrollment Period is typically an eight-month-long period that begins anytime you (or your spouse) lose health coverage offered through your employer or union. There are also a few other circumstances in which you may enter a Special Enrollment Period, such as a qualifying move or other loss of coverage. During the Special Enrollment Period you can enroll in both Part A and Part B without penalty.
- If you want to enroll in Medicare Part C (also known as a Medicare Advantage Plan) or Medicare Part D, you have to enroll either during your Initial Enrollment Period (which, is when you first become eligible for Medicare), during certain circumstances that would qualify you for a Special Enrollment Period, or during Annual Election Periods. You may also sign up for a Medicare Advantage Plan if you have Medicare Part A and you enroll in Medicare Part B during the Part B General Enrollment Period discussed above.
The Annual Election Period is a time every year during which you can review your Medicare benefits and make changes to your Medicare coverage. For Medicare Advantage Plans and Medicare Part D prescription drug coverage, the Annual Election Period runs from November 15 through December 31. (The 2012 Annual Election Period is scheduled to begin earlier in the year to allow you more time to review your plan and the year’s changes to Medicare benefits and Medicare coverage.) During the Annual Election Period, you can:
- Switch to a Medicare Advantage Plan from Original Medicare
- Switch back to Original Medicare from a Medicare Advantage Plan
- Switch Medicare Advantage Plans, including from a plan without drug coverage to a plan with drug coverage or vice versa
- Make changes to your prescription drug coverage, such as: join a drug coverage plan, drop your current drug coverage plan, or switch from one plan to another
It is wise to take full advantage of each year’s Annual Election Period. Medicare Advantage Plans change annually and the difference in premiums, deductibles, coinsurance rates, and copayments year to year may mean you have to make significant changes to your finances. Additionally, different plan providers add or drop doctors and hospitals to or from their networks all the time. Covered services will also often change. You need to review your plan every year to ensure that both your doctor and the medical services you use the most continue to be covered under your plan.
Another reason to spend time reviewing the different Medicare plans during this year’s Annual Election Period is the new health care law. This year’s health care reform bill includes many changes to Medicare benefits and Medicare coverage over the next few years. Some of these changes will directly affect your Medicare Advantage Plans and may change the costs associated with or the type of services offered by your plan. What was the perfect plan for you over the last two years may no longer be able to compete with a new, cheaper plan that offers more of the services you medically need. Some Medicare Advantage Plans offer free preventive services while others do not. Additionally, some plans offer lower annual deductibles or less expensive drug copayments than other plans. It is important to compare the different Medicare coverage options available to you during Medicare Annual Election Period so that you can make sure you have the best plan to fit your medical needs and budget.
For more information about Medicare benefits, Medicare supplements or the Medicare Annual Election Period, visit www.medicare.gov or call 1-800-MEDICARE.
