Enrolling in a Medigap Policy: Purchasing Supplemental Insurance

A Medigap Policy is insurance created to supplement your Original Medicare Plan. It helps to cover some limitations of the plan’s coverage.

Policies will, of course, vary by available plans, coverage, and price. Therefore, before enrolling, make sure you spend time researching the plans and providers available to you, and choose the one that best fits your needs and budget. After you’ve selected the plan and company you are going with, it’s time to apply.

To apply, contact the company directly. They are required to provide you with a coherent summary of your policy, so spend some time reading it and ensuring that you understand it. If you don’t, feel free to ask as many questions as you need to ask. Never sign anything without knowing exactly what you are agreeing to. Once you’ve read the summary and are certain you understand it, fill out the application fully. Be as truthful and thorough as possible. If someone else fills your form out for you, go over it and make sure it is completely correct.

After applying, your policy will usually start the first month after you apply. You can request a specific start date if you like as well. If you don’t get your policy within 30 days you should definitely call the insurance company, and if you still haven’t gotten in within 60 days, you should call the State Insurance Department in your area.

When you pay for your Medigap policy, you can use a bank draft, a check, or a money order. Don’t make your payment out to the agent who was helping you with your enrollment. Rather, make it out directly to the company providing you with your coverage.

Enrolling in a Medicare Prescription Drug Plan

Many Medicare beneficiaries choose to enroll in Medicare Part D in order to meet medication needs.  Part D is especially important for people who require significant prescription medication.  It can help reduce your out-of-pocket costs and make necessary drugs more accessible and affordable.

If you have the Original Medicare Plan, you may choose to enroll in a prescription drug plan to add coverage.  You can also enroll to add coverage to certain Medicare Private Fee-for-Service Plans, certain Medicare Medical Savings Account Plans, and certain Medicare Cost Plans.  Another way to gain Prescription drug coverage is to choose a Medicare Advantage Plan that includes this drug coverage.

When you enroll in a drug plan, you will usually pay considerably less for your prescriptions, although you will sometimes be required to cover copayments, coinsurance, or deductibles.  The overall cost of your plan will depend on a number of factors, such as whether or not you are eligible for extra help, if you are willing to forgo brand-name drugs, what type of drugs you require, the quantity of medication you need, what your plan coverage gap is, and, ultimately, what prescription drug plan or provider you choose.

To enroll in a prescription drug plan, you may want to call the plan directly.  That way, you can ask them any pertinent questions you may have about the plan you’ve chosen.  You can also call Medicare for assistance, at 1-800-633-4227. 

Part D Late-Enrollment Penalty

Your Medicare Part D is the component of your plan that will provide you with your prescription drug coverage. It is an essential element of many people’s health care, and if you have medication needs – or think you may in the future – it is strongly advised that you sign up as soon as you become eligible.

If you fail to sign up during your initial enrollment period, and if you don’t have prescription drug coverage for 63 days or more, you will likely be responsible for a permanent late-enrollment penalty when you later join. The late-enrollment penalty changes each year, and will be charged to you for the duration of your drug coverage.

To figure out roughly how much your penalty will be, take 1% of the “national base beneficiary premium” and multiply it by the number of the full months you didn’t join when you were eligible. The amount will be added to your drug plan monthly premium.

If you didn’t sign up for a Medicare Prescription Drug Plan when you were first eligible and you’d like help figuring out what your late-enrollment penalty will be, there are some sources available to you. You can call 1-800-MEDICARE for help, or contact your State Health Insurance Assistance Program.

Joining a Medicare Advantage Plan

If you are considering enrolling in a Medicare Advantage Plan, you need to meet a few specific requirements in order to be eligible to join. You need to have Part A and Part B – Hospital and Medical Insurance.  You also need to live in the plan’s service area.  You usually can’t have End-Stage Renal Disease, and it must be within the plan’s enrolment period.  

In many cases, you will need to pay your Part B premium in addition to your Medicare Advantage Plan premium.  It’s also essential that you follow your plan’s specific rules and are aware of necessary out-of-pocket costs, like deductibles and copayments.  

Sometimes, depending on the plan or company you choose, you might be required to use specific health care providers, belonging to the plan’s network – or be charged a higher fee if you don’t.  If you enroll in an Advantage Plan, you won’t be able to buy a Medigap policy – and you won’t really need one, either.

When you join a Medicare Advantage Plan, you are, of course, still in the Medicare Program.  Advantage Plans, although run by private insurance plans, still follow Medicare rules, are approved by Medicare, and receive funding from Medicare. They are not even considered supplemental insurance plans – they are a part of Medicare.  Consequently, when enrolled in a Medicare Advantage Plan, you have Medicare rights and protection, including privacy rights and the right to appeal.  You also will still receive Medicare Parts A and B, and can usually get prescription drug coverage through your Medicare Advantage Plan. It is important to note that you can’t join a Medicare Prescription Drug Plan with most Medicare Advantage Plans unless you cancel your Medicare Advantage Plan and sign up instead for Original Medicare. Signing up for a Medicare Advantage Plan also often affords you other optional benefits, such as dental or vision.   

To enrol in a Medicare Advantage Plan, fill out an application, call the plan, or visit them online.  

Missed Your Optimal Enrollment Period for Medicare Part B? When to Sign Up

If you are eligible for automatic enrollment in Medicare Part A, you will start getting it the first day of the month you turn 65, or, if you are disabled and under 65, after you have been receiving disability benefits from Social Security or Railroad Retirement Board for 24 months. If you are not eligible for automatic enrollment, you should sign up when you’re close to 65.  However, if you miss your initial enrollment period, there are some other times when you may be able to enroll.

Starting January 1^st and running until March 31^st each year, the General Enrollment Period is the next best thing.  When you sign up during the General Enrollment Period, your coverage will start on July 1^st. The drawback for waiting until the General Enrollment Period, of course, is that you may be responsible for paying a late-enrollment penalty.  Unfortunately, you might need to pay the late-enrollment penalty for as long as you have the plan. 

Another time you might be able to enroll is during a Special Enrollment Period.  You may be eligible for a Special Enrollment Period if your or your spouse have a group health plan based on your current work.  You can then sign up for Part B at any point during your workplace coverage or in the eight-month period that starts when the employment (or group health plan coverage) ends.  Finally, if you didn’t enroll in Medicare Part B during your initial enrollment period because you were volunteering in a foreign country and already had health insurance for that reason, you may qualify for a Special Enrollment Period For International Volunteers.  Usually, when you are enrolling during a Special Enrollment Period, you won’t need to worry about a late-enrollment penalty.

While there are, then, ways for you to enroll in Medicare Part B outside of your initial enrollment period, the optimal time is, of course, when you are first eligible.

Retirement Age and Medicare

In the past, Social Security benefits began at 65.  Currently, however, your full retirement age depends on the year you were born.  A question this raises for many of us is – “how will this affect my Medicare coverage?”

The changes to the age of Social Security retirement benefits took place in 2003.  Now, your retirement benefits begin at age 65 only if the date of your birth is 1937 or earlier.  If you were born after 1937, your full retirement age will vary according to the year you were born.  For instance, if you were born between 1938 and 1959, your retirement age (for full benefits) ranges from age 65 and 2 months to age 66 and ten months.  If you were born in 1960 or later, your full retirement age is 67. 

Does this mean, then, that if you were born after 1937, you can’t retire at 65 with benefits?  Of course not!  But if you do retire before your full retirement age (after age 62) and begin to receive your Social Security benefits, your benefits will be reduced.

Fortunately, even with the changes to full retirement age and Social Security, the Medicare eligibility age has not changed.  If you have paid into Medicare for the required amount of time (ten years or more), you are eligible for Medicare benefits when you turn 65.  To enroll, the ideal time to contact Social Security is three months before your birthday month to three months after. The earlier you sign up, the sooner your Medicare Coverage can begin. 

To enroll in Medicare or to find out your full retirement age, contact Social Security at 1-800- 772-1213

How to Enroll in Medicare Part A

Medicare Part A is the component of a Medicare Plan that deals with your Hospital Insurance.  It helps to cover your inpatient care, skilled nursing facility care, hospice care, and some home health care.  Most people enrolled in Medicare Part A don’t pay premiums for this insurance.

Depending on what circumstances surround your enrollment, how you sign up for Medicare Part A will vary.  For the majority of people, enrollment is automatic. 

One of the most common situations in which automatic enrollment takes place is if you are currently receiving retirement benefits from Social Security or the Railroad Retirement Board.  In such cases, enrollment will begin at the start of your 65th birthday month.  Your Medicare card will be mailed out approximately three months before, and will indicate the coverage start date.

Another situation in which you will be automatically enrolled in Medicare Part A is if you are under 65 and disabled, and are receiving disability benefits from Social Security or the Railroad Retirement Board, and have been for 24 months.  Approximately three months before your 25th month of disability benefits, you will be mailed your Medicare card.  In the case of ALS, the process is much faster; you will receive Medicare Part A the first month of your disability benefits.

There are situations, of course, in which enrollment in Medicare Part A is not automatic, like if you haven’t yet filed for Social Security or Railroad Retirement benefits and are nearing 65.  You will also need to apply if you have ESRD, and may apply upon diagnosis.  To enroll, call Social Security Administration at 1-800-325-0778.

Look at your personal situation and decide whether or not you qualify for automatic enrollment, or if you will need to take steps to sign up.  Be proactive.  After all, your health matters!

Medicare Part B: How to Enroll

Medicare Part B is an important component in your health care coverage.  It is your Medical Insurance, and helps to cover things like doctor’s services, outpatient services and supplies, some physical or occupational therapy, some home health care, diagnostic tests, durable medical equipment, and various other medically necessary services and supplies.

Depending on what the circumstances surrounding your enrollment are, how you enroll in Medicare Part B will vary.  For example, if you are already getting benefits from Social Security or the Railroad Retirement Board, you are automatically enrolled in Medicare Part B the first day of your 65^th birthday month.  Approximately three months before you turn 65, your Medicare card should come in the mail.  If you don’t want Medicare Part B, you can, at this time, choose not to accept coverage.  There will be instructions on your Medicare Card, detailing how to opt out.

Another situation in which you can be enrolled in Medicare Part B is if you are under 65 and disabled. In most cases, you will be automatically enrolled after 24 months of receiving disability benefits from Social Security or the Railroad Retirement Board.  You should get your Medicare card around three months prior to your 25^th month of disability benefits.  However, if you have ALS, you will be enrolled in Medicare Part B the first month of your disability benefits.

A third situation in which you can enroll in Medicare Part B is if you have End-Stage Renal Disease.  In this case, you can apply at the same time as you apply for Medicare Part A.  Your Part B coverage will begin, in most cases, the fourth month of dialysis treatment or the first month of a kidney transplant.

Finally, if you’re nearing 65 and you don’t get Social Security or Railroad Retirement benefits yet, you can enroll in Medicare Part B when you sign up for Medicare Part A or when you apply for retirement benefits.  If you don’t want Medicare Part A and if you’re not eligible to receive it without paying a premium, it is also possible to enroll in only Medicare Part B.

If your situation doesn’t allow you to receive automatic enrollment in Medicare Part B and you want to sign up, contact the Social Security Administration at 1-800-772-1213.

When You Need Medicare Before Social Security

If you are receiving Social Security benefits, a Medicare enrollment package will be mailed to you three months before you turn 65.  In addition, Social Security will automatically enroll you in Medicare Part A (which is premium free), and Part B. If you choose not to enroll in Medicare Part B, you will need to opt out. 

However, not everybody is eligible for Social Security benefits at 65.  In fact, some people will not be eligible until they are 67.  For these people, enrollment in Medicare is not automatic.

If you will not be receiving Social Security retirement benefits when you are 65 years old, you will need to contact Social Security to sign up for Medicare.  It’s important to do this as soon as possible, so you don’t miss your initial enrollment period.

The earliest you can sign up for Part A is three months before you turn 65.  For up to six months after, coverage can retroactively begin at age 65.  

Your initial Part B enrollment period extends from three months before to three months after your 65th birthday. It’s definitely a good idea to enroll in Part B as soon as possible, to avoid delayed coverage.  If you don’t enroll until you turn 65, your coverage will begin the next month.  If you enroll the month after your birthday, your coverage will begin two months later.  If you enroll in the last two months of your initial enrollment period, your coverage will begin three months after.  If you don’t sign up for Part B during your initial enrollment period (unless you or your spouse are still working), your coverage will be further delayed, and you likely will need to pay a penalty for your Part B premium. 

Signing up for Part D, Prescription Drug Coverage, works much the same way.  Your initial enrollment period is three months before until three months after you turn 65, and late enrollment often results in a premium penalty. 

If you don’t expect to receive Social Security benefits by age 65, contact Social Security to apply for Medicare, at 1-800-772-1213

Eligibility and Enrollment in Medicare for End-Stage Renal Disease

Most people know that Medicare is health insurance designed for people 65 and over, or under 65 with certain disabilities.  What a number of people don’t realize is that Medicare also covers individuals at any age who have End-Stage Renal disease, or ESRD (permanent kidney failure requiring dialysis or a kidney transplant).

In order to receive Medicare coverage for ESRD, if you need regular dialysis or have had a kidney transplant, you must be enrolled in Medicare Parts A and B.  To be eligible to receive Medicare Part A, you or your spouse (or your parent, if you are a dependent child) need to have worked the required time under Social Security, the Railroad Retirement Board, or as a government employee, or you need to be getting or eligible for Social Security, Office of Personnel Management, or Railroad Retirement benefits. You are eligible for Part B if you get Part A.    

To enroll in Medicare due to ESRD, visit your local Social Security office or call them at 1-800-772-1213.  Remember, you must sign up for Medicare Parts A and B in order to receive ESRD coverage.  It’s a good idea to apply for Part B at the same time as Part A to avoid any late penalties. 

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