Apply For Medicare

Applying for Medicare

Medicare is a federal health insurance program run by the government. The program provides Medicare beneficiaries with different types of medical insurance, including inpatient and outpatient services. Applying for Medicare can be a daunting task. Understanding the basics of the enrollment process can help make your sign-up experience much more straightforward.

Who is eligible for Medicare?

Before applying for Medicare, it’s important to know who is eligible to enroll. Many people confuse Medicare eligibility with Social Security (SS) eligibility. Although the federal government runs both Medicare and SS, their enrollment processes are not the same. Anyone 65 or older who is a legal citizen or a permanent resident who has lived in the United States for five years or more is eligible for Medicare. Your work history or employment status does not determine your Medicare eligibility.

There are also times when someone under the age of 65 is eligible for Medicare. You are eligible to sign up for Medicare under 65 if:

• You are considered permanently disabled and have received Social Security Disability Insurance benefits for at least 24 months.

• You have End-Stage Renal Disease (ESRD) and need a transplant or dialysis

• You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s Disease.

When should you apply for Medicare?

When you should enroll in Medicare will depend on a few things. Some people are enrolled automatically, while others will use their Initial Enrollment period.

Automatic Enrollment

It’s possible to be automatically enrolled in Medicare. In most cases, you will need to be receiving SS benefits or Railroad Retirement benefits or live in Puerto Rico. However, the specifics of the enrollment can differ. Let’s take a look at each scenario.

Social Security

Suppose you’ve been receiving Social Security benefits for at least four months. In that case, you will automatically be enrolled in Original Medicare Part A and Part B. Automatic enrollment also applies to those receiving SSDI benefits for at least 24 months.

Railroad Retirement

Railroad Retirement benefits work similarly to SS when it comes to automatic enrollment. If you are receiving benefits from the Railroad Retirement Board (RRB), you will likely be enrolled in Medicare Part A and Part B automatically.

Living in Puerto Rico

If you live in Puerto Rico and are getting benefits from SS or the RRB you will likely be automatically enrolled in Medicare Part A. However, you won’t be automatically enrolled in Medicare Part B. You will have to contact SS at 1-800-772-1213. If you are deaf or hard of hearing you can contact SS using 1-800-325-0778.

Initial Enrollment Period

However, most people will need to apply for Medicare during their Initial Enrollment Period (IEP). The IEP is a seven-month-long period for you to enroll in Original Medicare. This period begins three months before your 65th birthday month and ends three months after your 65th birthday month.

The effective date of your Medicare coverage will depend on when you enroll during your IEP. The sooner you enroll, the quicker your Medicare coverage will begin. Once you have applied for Medicare, it typically takes about three weeks for your Medicare card to arrive.

If you miss your IEP and don’t qualify for a Special Enrollment Period (SEP), you will likely need to enroll during the General Enrollment Period (GEP). The GEP takes place each year from January 1st to March 31st. If you enroll using this period, your coverage will not start until July 1st, and you will likely be charged a late enrollment penalty.

The IEP is also a good time to enroll in a Medigap plan and a Part D prescription drug plan, or you can choose a Medicare Advantage (MA) Plan. Doing so will help you avoid any penalties.

What forms do you need to apply for Medicare?

The application for Medicare may be easier to complete if you have certain documents ready to go. For example, you may need your W-2, tax forms, or more. The exact forms you need will depend on a few different factors, including whether or not you were born in the US or a foreign country, your current health insurance, and more. The SS website has a checklist for online Medicare, retirement, and spouses’ applications.

Can you delay Medicare?

Yes, it is possible for you to delay Medicare at 65. However, you will need to meet specific requirements and provide proof of creditable coverage.

If you or your spouse actively works for an employer with more than 20 employees and you are covered under that employer’s insurance, you should be able to delay all parts of Medicare without penalty. However, the cost for Part A is $0 for most people, so you may consider doing the same (unless you plan to contribute to an HSA account). You will pay $0 for Part A if you have worked in the US for at least ten years (40 quarters) and have paid payroll taxes during that time.

To prove you have creditable group health plan coverage, you must submit two forms: the CMS L564 form and the CMS 40B form. You can find both forms on the SS website.

However, if you or your spouse actively works for an employer with 20 employees or less, you will need to enroll in Part A and Part B during your IEP to avoid any penalties. Even if you are covered under the employer’s group health plan, you should still enroll. You will want to register because Medicare would be considered your primary coverage in this situation.

Final Thoughts

The information surrounding the Medicare enrollment process can be hard to decipher. However, knowing your eligibility and enrollment periods will be a great help to you. Be sure to do your research ahead of time to know what to expect.

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