Preparation for Medicare Enrollment

The United States government offers numerous social service programs to help its population. Medicare is one of the nation’s largest health insurance programs and includes benefits for medical needs, hospital costs and prescription drugs. For some of the benefits, there may be some cost involved.

To be eligible to receive benefits through Medicare, you must meet one of these requirements:

• be age 65 or older;

• Have certain disabilities or illnesses established as eligible for coverage. (Some of these conditions include severe kidney disease, Lou Gehrig disease and disabilities which qualify you for Social Security disability payments.)

If your age and status qualify you to receive Social Security benefits, automatic enrollment in Medicare is a possibility. Generally a Social Security recipient will receive a Medicare card three months before his or her birthday, with benefits beginning on the first day of the 65th birthday month.

For those not automatically enrolled for Medicare benefits, the process is not complicated. The Social Security Administration (SSA) is the starting place for Medicare enrollment. To initiate the enrollment process, you can contact the SSA through their online website, through SSA’s national telephone number, or by visiting your local SSA office.

Once enrolled, you’ll be informed about the two basic parts of Medicare benefits, Part A and Part B.

• Part A helps cover costs for inpatient hospital care, hospice services and home health care. Usually there is no cost to individuals for Part A if their employment years included payment of Medicare taxes.

• Part B of Medicare helps cover expenses from medical services such as care from a doctor, outpatient expenses from a hospital, and home health care. Some preventative medical care is also covered. Most people must pay for Part B coverage with the amount being based on adjusted gross income.

Because Medicare Parts A and B do not cover all medical expenses, Medicare recipients may purchase additional coverage through “Medicare Advantage” or Part C programs. These are health insurance plans sold by private providers but approved by Medicare.

Medigap plans also help cover the “gap” between the coverage Medicare provides and costs which must be paid out of pocket. This additional coverage is purchased from private insurance companies and may cover co-payments for medical and hospital expenses as well as additional services.

Part D of Medicare involves coverage for prescription medications. Again Medicare works with private insurers to offer a variety of plans. It requires some research to determine the most appropriate options.

It’s important to note that deadlines play a big part in Medicare enrollment. As do private health insurance companies, the government limits the time periods during which individuals can add or drop coverage options. You’ll want to pay attention to these deadlines.

• For age-based eligibility, benefits begin on the first day of the month in which an individual turns 65. The seven-month or “Initial Enrollment” period begins three months before your 65th birthday month and extends through the third month after. During these specific months you may select any Medicare option based on your personal preference. It is highly recommended to research ahead of time and decide on coverage that best fits your needs.

• Once enrolled, opportunities to make changes to your plan come only at certain times. In order to make changes to a Part B (medical insurance) plan, the general enrollment period occurs at the first of each calendar year, from January 1 through March 31. General enrollment for the prescription coverage, Part D, is at the end of the year and is brief: from November 15 through December 15.

• If you select optional Medicare Advantage (Part C) or Medigap coverage, be prompt to enroll in the plan after you have enrolled in Part B. It is possible to incur Medicare penalties for late enrollment.

For every step of the Medicare enrollment process, you will fare better if you have done your research. The U.S. government publishes a multitude of information sources, both online and in print. Take your time to read and understand your options, and be prepared to act in a timely fashion when your window of eligibility opens. The decisions you make for Medicare coverage will be a significant part of your health plans for years to come.