Medicare is a Government-offered healthcare plan that covers the medical costs of people over 65 years/older or people under 65 years with disabilities or end-stage renal disease. There are different types of Medicare plans, with each covering different services, so people may have several questions concerning Medicare, from when they should enroll in a plan to which plan is best for them and whether it is mandatory.
Here are the answers to 7 common Medicare enrollment questions you may have:
I Will Turn 65 Soon,When Should I Apply for the Plan?
You can apply for the Medicare plan three months before turning 65 years. This is your initial enrollment period, which lasts for 7 months, including those three months before your birthday, your birthday month, and after three months of your birthday.
If you are getting Railroad Retirement Board or Social Security benefits, you will be automatically enrolled in Medicare Part A, and Part B plans, and you will receive your Medicare card through the mail. If you are not receiving such benefits, you can either enroll online or visit your Social Security office.
If you enroll during the three months before your 65th birthday, your coverage will begin as soon as you have turned 65 (that is from your birthday month). If you sign up later, your coverage will start accordingly.
I Am Nearing My Retirement, Do I Need Other Health Insurance Between Now and Retirement?
If you retire or lose your employer-sponsored health plan before turning 65, you will need other health insurance coverage until you reach the Medicare eligibility age. However, if you retire after 65 years, you may qualify for a Special Enrollment Period (SEP), which includes 8 months, and it begins when you retire or lose employer coverage (whichever comes first).
During the SEP period:
You have 8 months to enroll in Medicare Part A or Part B plans without being penalized for a late signup.
You have only the first two months to enroll in Medicare Part C or Part D plan without penalty. If you miss out on this period, you will have to pay the penalty for late enrollment, which is added to your monthly premium as long as you have the coverage.
You must talk with your employer coverage benefits administrator before deciding on Medicare, as you will require written notice for “creditable coverage” from the plan to be eligible for a SEP and avoid penalties.
I Am Above 65 and Retiring in 3-6 Months. I Have Medicare Part A, but How Do I Sign Up for Part B?
If you qualify for a SEP period, you will have 8 months to enroll in Part B without penalty. Otherwise, you will incur a penalty for late enrollment. You can enroll in Part B with your Social Security Number either online, over the phone, or in person.
If you have an employer-sponsored retirement plan, talk with your employer benefits administrator to learn how Medicare works with that plan and act accordingly.
I Plan to Keep Working Even After Turning 65. Is It Good to Keep My Employer’s Health Insurance or Get Medicare?
You must enroll in both Part A, and Part B plans at 65 years if your company has less than 20 employees. If your company has 20 or more employees and your coverage is deemed creditable, you can delay Medicare without penalty.
However, if you have health insurance through your spouse’s employer, you must meet their requirements. For example, you may need to enroll in Medicare at 65 if your spouse’s employer requires you to do so to stay on the plan.
You should discuss with your employer benefits administrator to determine whether you can delay Medicare.
Is Medical Compulsory?
No! However, if you have decided to enroll after your initial enrollment period and don’t qualify for a SEP, you will incur late enrollment penalties.
Can’t I Choose the Doctors I Want to See? Do I Need Referrals with Medicare?
Whether or not you can choose doctors of your choice depends on your Medicare plan type. If you have Parts A and B coverage, you can see any doctor that accepts Medicare. In the case of advantage plans, some plans have provider networks, while other plans may require referrals to specialists.
What Is Included in Medicare Part A? Does It Cover Outpatient Visits and Custodial Care?
Generally, Medicare Part A Covers:
- A semi-private room
- Skilled nursing services
- Some blood transfusions (in a skilled nursing facility or hospital)
- Hospice care
- Recovery room and operating room services
- Lab tests, medical supplies, X-rays, drugs, and medical equipment when you’re hospitalized
- Home healthcare if you’re homebound and only need part-time care
- Hospital meals
- Intensive care
- Rehab services, such as physical therapy received through home healthcare
Medicare Part A does not pay for custodial care and outpatient visits. However, some Medicare Advantage plans cover some of the custodial services, and Medicare Part B covers outpatient visits.