And other common questions about the Medicare enrollment process.

Am I eligible for Medicare?

Eligibility for Medicare can be broken down into three categories:

1. People who are 65 or older.
2. People who have received Social Security Disability benefits for 24 months.
3. People with End-Stage Renal Disease (ESRD) – Permanent kidney failure requiring dialysis or a transplant.

If you fit into one of these 3 categories, you are eligible for Medicare.

Do I need Medicare?

If you already have health insurance, you may ask yourself, “Do I need to switch to Medicare?” and the answer is… maybe, maybe not.

If you are getting health insurance from an employer and you plan to continue working past the age of 65; if you can answer YES to all the following questions, you DO NOT need to start your Medicare.

• Are you happy with your coverage?
• Is it affordable when compared to Medicare? (see next section for breakdown of costs)
• Is your employer larger than 20 employees?

Again, if you are getting coverage from an employer plan and can answer yes to all the above questions, you do not need to enroll in Medicare until you retire and lose your employer health coverage. You will not have any late enrollment penalties when you enroll. If the answer to any of the questions is no, you need to leave your employer coverage and enroll in Medicare when you are eligible. Also, if you are getting coverage from anywhere else (not from a job) you also need to leave that coverage and enroll in Medicare when you become eligible.

You may also think, “I am healthy and have no need for insurance, why would I enroll in Medicare right now?” The reason you need to enroll in Medicare as soon as you are eligible is because there are financial penalties if you enroll later down the road. You will pay an extra 10% for each year you could have signed up for Part B but didn’t. You will also pay an extra 1% for each month you don’t have a Medicare drug plan (Part D). None of us know what the future holds, and the older you get, the more likely you are to have medical needs, so it is best to enroll in Medicare as soon as you are eligible.

How much does Medicare cost?

Medicare is broken down into different parts that cover different things. Please see the table below to understand the different parts and their associated costs.

PART	COVERAGE	COST
Part A	Hospital – Inpatient Hospital, Skilled Nursing Care, Hospice Care, some home health	$0/month as long as you or your spouse have worked and paid taxes in the USA for at least 10 years
Part B	Medical – Doctors, Outpatient Care, Durable Medical Equipment, some home health	$174.70/month in 2024 – Could be more or less depending on income*

*If you qualify for Medicaid, your Part B premium is paid for by the state Medicare Savings Program. If your income was above a certain threshold, you could be subject to an Income Related Monthly Adjustment Amount (IRMAA) which looks at your income from 2 years prior and is reevaluated each year.

Part A and Part B make up what is referred to as Original Medicare and it is what everyone starts with. There are significant coverage gaps left by Part A and B, for example they don’t include drug coverage or a maximum out of pocket amount. Because of these gaps, it is recommended to enroll in additional Medicare coverage. The costs for the different options for additional Medicare coverage are broken down below:

• Medicare Advantage plan – As low as $0/month depending on plans available in your area
• Medicare Supplement plan with Prescription Drug Plan (PDP) – Around $200/month for a supplement and as low as $0.50/month for a prescription drug plan at the time this article was written.

When do I need to start this process?

Even though people turning 65 will start to receive endless calls and mailers telling them they need to enroll in a plan 6 months before their 65^th birthday, the truth is you don’t have all your options available to you until 3 months before. This is when we advise people to begin the process of enrolling in Medicare and either a Medicare Advantage plan or Medicare Supplement with PDP.

When turning 65 you have an Initial Coverage Enrollment Period (ICEP) of 7 months which includes 3 months before your 65^th birthday, the month of your birthday, and 3 months after your birthday.

How do I start my Medicare?

Okay, so now that you are ready to start your Medicare, what steps do you need to take? The first step is, if you are not already working with an agent/broker, find one! Our assistance costs you nothing and our job is to help you make sense of the Medicare world, so please reach out to us. We are here to help you!

Now, after that shameless (but true) plug, the process to start your Medicare depends on whether you are receiving Social Security benefits or not. If you are receiving Social Security retirement or disability benefits at least 4 months before turning 65 you don’t need to do anything to enroll in original Medicare. Your Part A and Part B will start automatically, and you will get your Medicare ID card 3 months before your Medicare coverage starts. Then you can meet with your agent/broker to decide on a Medicare Advantage or Medicare Supplement plan.

If you are not receiving Social Security retirement or disability benefits, you will need to manually enroll in original Medicare. This can be done online at https://www.ssa.gov/benefits/medicare/, over the phone (1-800-772-1213), in person at your local Social Security Office, or by mailing in an application to Social Security. You can enroll manually 3 months before your 65^th birthday and you should get your Medicare ID card in about a month or so.

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Starting Medicare can be a confusing and frustrating process for a lot of people. Our agency has been helping people with this process for over a decade and this article has answered some of the most common questions we have received over the years. Hopefully this has answered some of your questions, and for the questions we didn’t answer, please reach out to us!