How & When Do I Enroll in Medicare Parts A & B?

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There are a number of times when you can sign up for Medicare Parts A & B and each of these come with a set of guidelines and limitations. For some who are lucky, they get automatically signed up for one or both programs. For others, the government offers a window of seven months wherein you can enroll in Medicare without being pressured by any medical underwriting. In some instances, the application process will have to be manually done.

The ideal time to enroll into Medicare Parts A & B is when you’re about to turn 65 years old. You will be provided an initial enrollment window for applying to Parts C and D, as well. It is important to know what this period covers especially if it is your first time.

WHEN to Apply for Medicare Part A and Part B

Initial Enrollment Period (IEP)

  • The seven months allowed for the IEP cover the following:
  • 3 months before you turn 65 years’ old
  • The month of your 65th birthday
  • 3 months after your 65th birthday

For example: If your birthday is in August, your IEP begins May 1 and ends November 31.

Note: If you are not able to enroll during this 7-month period, you have another chance during the next General Enrollment Period. You will also find yourself without health insurance for the entire duration of waiting, which can be risky. Medicare allows for late enrollment, however, but you will have to be prepared to shoulder the late fees and penalties.

General Enrollment Period

The GEP happens between January 1 and March 31 of every year. During this time, you can sign up for Medicare Part A and/or Part B if you were not able to sign up during the IEP and if you are not covered by the Special Enrollment Period although you might be required to pay a higher premium. If you decide to go with this option, your coverage will begin July 1 of the same year.

Special Enrollment Period for Medicare

SEPs may be availed if you were able to delay your enrollment to Medicare services. These will only apply for very specific terms, such as when you still have insurance coverage from your office (employer), eight months after this coverage closes for Part A and Part B, and 63 days after this coverage ends for Part C and Part D.

SEP can also apply if you are still covered by benefits from a union group health plan from your current employment or your spouse’s. If you have a disability and are working, or are receiving benefits from a family member who is employed, the SEP can also be considered if the company where you or your family is working has 100 employees or more.

Special Enrollment is also open to individuals who are volunteers and are serving in another country.

Open Enrollment

If you WERE able to avail of Medicare programs during the given period but would like to change your plan, you can do so during the Open Enrollment Period. Also Annual Coordinated Enrollment Period or Annual Election Period, this happens from October 15 to December 7 every year.

If you avail of this option, your revised coverage will begin January 1 of the following year. Open enrollment was created for several reasons, not just for those who missed the Initial Enrollment Period. To be clear, it is open to the following:

  • Those who have Medicare Part A and Part B who want to shift to a Part C
  • Those with Medicare Part C who want to return to Part A and Part B
  • Those with Medicare Part C who want to change to new Part C program
  • Those who are just signing up for Medicare Part A and Part B (who will be given the option to join, cancel, or switch to a Part D plan for prescription medication)

When to Apply for Medigap Plans

You can only avail of any of the 10 Medigap plans when you are already enrolled in Medicare Part A and Part B.

HOW to Apply for Medicare Part A and Part B

Some people will get enrolled into Medicare automatically, while some have to apply for it.

If you are already receiving disability benefits or Social Security retirement benefits the moment you turn 65 years old, you will be automatically enrolled in Part A and Part B. If this is so, you can expect to receive a welcome packet and Medicare ID card in the mail about three months before your birthday.

If not, there are three ways to apply: By Phone, Online, or in Person.

  • By Phone: Call the Social Security customer hotline 1-800-772-1213
  • In Person: Visit the Social Security office in your area
  • Online: Visit the Social Security official website

Things to Remember

  • You do not need to enroll for Medicare every year. However, you will be given a chance during the Open Enrollment period to review your program and make a switch as you wish.
  • Medicare is under the management of the Centers for Medicare & Medicaid Services (CMS). Social Security operates closely with the CMS by ensuring that citizens are enrolled into the program.
  • The Medicare ID is red, blue, and white. It will contain important information such as your Medicare Claim Number, what parts of Medicare (A or B) you have, when your coverage begins, and how to contact Medicare.
  • The Medicare number is typically the same as your Social Security number for practical reasons. Be sure to keep this safe and not share it with just anybody, save for your doctors and healthcare providers.

Is Original Medicare Enough for You?

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Original Medicare includes a wide range of medical services and treatments, but they do not cover everything that a person over 65-years of age may eventually require. Because the federal government is the one that provides it, it easy for recipients to assume that it offers comprehensive benefits. However, closer inspection of the actual needs of a senior will reveal that it only shoulders a portion of the potential medical expense one could be faced with.

This doesn’t mean that Medicare is a Band-Aid solution and is only meant to create a semblance of protection. For many people who are perfectly healthy, it is, indeed, sufficient but only until the unexpected may occur. The issue is that many people at age 65 are in need of ongoing medical care and this is why Medicare Supplement plans are offered by private insurers as add-ons.

What Original Medicare Includes

Before deciding if Original Medicare is enough for you, we have to first lay out what it does cover. There are four parts to the Original plan, with each responsible for a specific set of medical services.

Part A
Part B
Part C*
Part D
Inpatient and hospital coverage
Outpatient and medical coverage
Also called Medicare Advantage, it is an alternative way of obtaining Medicare benefits and consists of different health plans regulated by Medicare itself but operated by private insurance companies (such as PPOs and HMOs)
Coverage for prescription drugs

*Part C may only be obtained only if you already have Medicare Part A and Part B

HMO = Health Maintenance Organization; PPO = Preferred Provider Organization

More About Medicare Advantage

Medicare Advantage or Medicare Part C offers the same benefits as Part A and Part B, and most also cover Part D drug coverage in their packages. It is up to the insurance provider to decide how extensive its package will be and those who subscribe may or may not be asked to pay a monthly premium.

These plans are not available in all geographical areas and HMO’s typically require its members to visit only the hospitals and doctors that are listed in their networks to obtain full benefits, except when it is an emergency. Some PPOs allow members to seek services outside of the network but will charge higher copays. This is why Medicare advisors do not recommend this plan to people who do a lot of traveling.

What Original Medicare Does Not Include That U.S. Seniors Need?

Original Medicare does not cover most types of hearing, vision, or dental care. While Medicare Part A pays for specific dental services that happen in a hospital setting, and Part B covers care caused by an injury, that’s all there is to it. It does not include tooth extractions, dental plates, cleanings, fillings, dentures, and related services. Hearing aids, getting prescription eyeglasses, routine eye exams, and contact lenses are also not part of the plan.

Even Medicare Supplements (Medigap) do not cover these types of medical care. If they do (Enhanced Plans), you will have to pay a higher premium. If these are important to you and you do not want to pay upfront fees per procedure, you can enroll in a Medicare Advantage plan or purchase a supplemental insurance policy that covers specifically these services. Some private insurers offer special policies for vision, dental, and hearing only.

Another thing that Original Medicare does not cover is Long-term Care Coverage. This includes services received in a skilled nursing facility, a day care center for older adults, and an assisted living community. Given that these services can be very expensive, it’s not really a surprise why the government will not cover these costs. For that reason, you might want to enroll in a stand-alone long-term care insurance policy.

Why a Medicare Supplement Plan Is Important

The gaps in the Original Medicare are the reasons why Medigap (Medicare Supplement) is necessary. Because many 65-year-olds need ongoing care – and even if they don’t currently, the consequence of age could eventually reveal new illnesses, Medigap plans offered by private insurers are a necessity.

There are 10 different types of Medigap policies that priced differently depending on the extent of the coverage and benefits that are offered. Medigap may only be acquired if you have Medicare Part A and Part B and can only be purchased through private insurance companies. The coverage of the Medigap plans are standard across the U.S. but the fees will differ by company.

It is, thus, crucial that you shop around and compare rates first before deciding on which Medigap plan to sign up for. Just take note that you only have a limited period before and after your 65th birthday to choose a policy without being required to undergo medical underwriting. During this Open Enrollment Period, insurance providers are required to sign you up regardless of your pre-existing medical condition or health status.