Medicare Part A (along with Medicare Part B) make up what is commonly known as Original or Traditional Medicare. Part A specifically covers hospital care, skilled nursing facility care, hospice care and home health care. While Part B cover such things as doctor services, outpatient care, and preventive services.

The various “parts” can be what makes Medicare confusing at first, but that’s actually what makes Medicare rather smart if you think about it. It was created with these different parts so that you can build a coverage plan that fits your unique needs and lifestyle. No “one-size-fits-all” here, and that’s where Healthpilot cracked the code of being able to show your recommended plan in minutes and where you can also complete your enrollment online, fast, and securely – but more on that later.

Part A and Part B are foundational to your Medicare program. You have to be at least 65 years old (or younger if you have certain medical conditions) to qualify. If you don’t have private insurance, such as an employer, but want more coverage, you can add Medicare’s other parts to support the medical coverage you need.

Eligibility for Parts A and B (Original Medicare) are the same. You don’t have to have Part B to get Part A, so if you do choose to sign up for Medicare A without enrolling in Medicare Part B, know that the eligibility requirements do not change. Just be aware that if you choose to delay Part B coverage because you already have credible coverage, you have 8 months after that credible coverage ends to enroll in Part B before penalties kick in.

Original Medicare Eligibility and Enrollment

There are a few ways to check if you are eligible to receive Medicare Part A and/or Part B coverage, or if you may have already been automatically enrolled.

Want an easier way? When you use Healthpilot to find your Medicare plan, we will verify for you to confirm you’re eligible as one of the first steps to enrolling.

If you are already receiving Social Security benefits or the Railroad Retirement Board (RRB), then you have been or will be auto-enrolled in Medicare Parts A and B upon the first day of your 65th birthday month (unless you live in Puerto Rico, you don’t automatically get Part B and must sign up for it). You will receive your red, white and blue Medicare card in the mail 3 months before your 65th birthday or the 25th month of receiving disability benefits. On the other hand, if you aren’t yet receiving your Social Security benefits, you will have to enroll actively in Medicare.

How do I get in touch with Social Security?

While it is Medicare that covers you, you have to sign up for it through the Social Security Administration (SSA). This is because the SSA manages some eligibility requirements on behalf of Medicare, such as if you’ve paid Medicare taxes long enough to get Part A for free, a.k.a. Premium-Free Part A.

Signing up is easy. You can do it online at Social Security. It’s the easiest and quickest way to sign up and get help if you need it. Or if you prefer the phone, just call 1-800-772-1213 to talk to Social Security. (TTY: 1-800-325-0778).

If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772. (TTY: (312) 751-4701)

Now, here comes the word problem. You may contact the Social Security Administration to file for Medicare enrollment 3 months before you turn 65 and up to 3 months after your 65th birth month. We created a quick visual to simplify everything.

It is also possible to qualify for Medicare Part A before you are 65 if:

• You have a qualifying medical condition
• A doctor has diagnosed you with a condition that qualifies as a disability that prevents you from working

Still here? Good. Knowing when to sign up during your Medicare Initial Enrollment Period (IEP) is one thing you don’t want to be fashionably late to. Mark your calendars, set an alert on your phone, or just avoid the stress altogether and start working with Healthpilot now. You’ve already read most of this page – it’s time to put your newfound knowledge to work.

What Happens If You Miss Your Initial Enrollment Period?

What if you didn’t sign up when you first could and don’t have other creditable coverage (such as health insurance through an employer)? You’ll have to wait until the next General Enrollment Period, which runs from January 1 to March 31 every year.

Your coverage will start July 1 of that year, and you may have to pay a late enrollment penalty on your Medicare Part B premium for as long as you have Part B coverage. Your premium will go up 10% for every year you weren’t enrolled.

Knowing what each part of Medicare covers will ensure you not only get the best coverage for yourself while making a very informed choice, but also prevent any billing-related surprises in the future.

Hospital stays. Part A helps cover the tests and treatments you may need once you have been admitted to the hospital. This also includes services like nursing services, physical therapy, meals, and most medications that your doctor prescribes for your care.

Short-term skilled nursing facilities. Medicare Part A will help cover your inpatient stay and services in a skilled nursing facility for a certain amount of time if you need it.

Home healthcare. You will have help with coverage if it is deemed that you need medical care from a home health professional while you recover from an inpatient hospital stay.

Hospice care. When yourself and doctor have chosen to seek hospice care for a terminally ill condition, Medicare Part A will help cover most of your healthcare costs for comfort care (palliative care) instead of care to cure your terminal illness.

It is important to note that Medicare Part A will help cover an ER visit if it results in your being admitted to the hospital by a physician. However, if you return home without being admitted to the hospital, Medicare Part B or your private insurance may be able to help pay the costs, but not Medicare Part A.

Because Medicare Part A is meant to provide care during a critical injury or illness, it is vital to understand that Medicare Part A doesn’t provide coverage over all hospital costs. Here are the most common incidents that Part A won’t cover:

Private Rooms. While your hospital stay includes a semi-private room, Medicare Part A does not entitle you to a private room during your inpatient care.

Blood. Medicare Part A will not cover it, and you may have to pay out of pocket if the hospital has to get blood for you. The good news is that if the inpatient facility receives blood from a blood bank or is donated by you or someone else, you likely won’t have to pay for it.

Long-term hospital stays. In the event you require long-term care needs (on average more than 25 days), Medicare Part A won’t pay for your care, and you may have to rely on your private insurance or pay out of pocket.

This is why it is important to know exactly what you currently want or will need in the future from your healthcare plan. Make a list of those wants and needs, like medications, and physician information, so you can make sure you know which parts of each Medicare plan cover what you require or what may end up coming out-of-pocket.

As you age, picking the best healthcare plan—Medicare or not—becomes even more critical. But finding a health plan that meets your unique demands and falls within your budget can also be a) time-consuming and b) challenging to manage. To ensure that everyone who qualifies for Medicare can discover the best plan for their needs, the Healthpilot team cuts through all the cumbersome information and provides a recommendation that’s tailored for your specific healthcare needs.
Keep reading for an easy, comprehensive guide to Medicare Part B from some experts who actually love the subject.

Medicare, both Parts A & B, make up what is typically referred to as Original or Traditional Medicare. Where Part A covers inpatient expenses, Medicare Part B covers medical services like doctors’ costs, outpatient care, and some preventative services. While Part B is optional, it covers certain things that Medicare Part A doesn’t, like lab tests and preventative screenings that help manage your health care.

The “parts,” otherwise known as the Medicare Alphabet, can be what makes Medicare confusing in the first place, but it’s the Parts of Medicare that make this government-run healthcare plan kind of genius. These various components, whether stand-alone or used in combination, provide you the freedom to create a coverage plan that best suits your needs and way of life.

Because there isn’t a simple “one-size-fits-all” answer to people’s health insurance needs, Healthpilot successfully untangled the complexities of the Medicare program. We provide you a recommended plan in just a few minutes, and if you choose to enroll, may be done in its entirety, quickly and, most importantly, securely, online.

While Medicare Part A is foundational to any Medicare program, there’s a reason Part B is also considered Original Medicare. Part B is thought of as the yin to Part A’s yang.

Medicare Part B eligibility depends on whether you are already eligible for Medicare Part A. While you don’t have to have Part A to get Part B, if you do choose to purchase Medicare B without enrolling in Medicare Part A, the eligibility requirements are still the same. Just be aware that if you choose to delay Part B coverage because you already have credible coverage, that you have 8 months after that credible coverage ends to enroll in Part B before penalties kick in.

Original Medicare Eligibility and Enrollment

There are a few ways to find out if you qualify for Original Medicare (Medicare A and B) coverage or if you were perhaps automatically enrolled.

Prefer a simpler way? As one of the initial stages of joining Healthpilot, we make sure to verify your eligibility before we discover the best Medicare plan recommendation for you.

At age 65, if you receive benefits from Social Security or the Railroad Retirement Board (RBR), you will be auto-enrolled in Medicare Parts A and B (unless you live in Puerto Rico, you don’t automatically get Part B and must sign up for it). You will receive your red, white and blue Medicare card in the mail 3 months before your 65th birthday or the 25th month of receiving disability benefits. On the other hand, if you are not currently receiving Social Security benefits, you must actively enroll in Medicare. This election period in which you are eligible to sign up for Medicare is called the Initial Enrollment Period (IEP).

How do I get in touch with Social Security?

While it is Medicare that covers you, you have to sign up for it through Social Security Administration (SSA). This is because the SSA manages some eligibility requirements on behalf of Medicare, such as if you’ve paid Medicare taxes long enough to get Part A for free. (They also handle applications to join Medicare Part B.)

Signing up is easy. You can do it online at Social Security. It’s the easiest and quickest way to sign up and get help if you need it. Or if you prefer the phone, just call 1-800-772-1213 to talk to Social Security. (TTY: 1-800-325-0778).

If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772. (TTY: 1-312-751-4701).

We know. A lot, right? Don’t worry. While the following can read a bit like a word problem for the period when you will want to contact Social Security. We included an easy visual aid to show just how simple it really is. Your IEP to file for Medicare starts 3 months before you turn 65, during the month you turn 65, and up to 3 months after your 65th birthday. More of a visual person? Please see the visual aid below to better understand.

It is also possible to qualify for Medicare Part A and Part B before you are 65 if:

• You have a qualifying medical condition
• A doctor has diagnosed you with a condition that qualifies as a disability that prevents you from working

Medicare Part B Enrollment

If you have looked into anything to do with Medicare enrollment, then you have undoubtedly heard of your Initial Enrollment Period (outlined above) but did you know that it is possible for people who receive Medicare Part A to delay Part B? To delay Part B coverage, one of the following factors must apply to you to avoid paying a late enrollment penalty:

• Currently have employer or union coverage through your own or your spouse’s job
• Have COBRA coverage
• Are receiving Social Security disability benefits
• Have health care benefits from Veterans Affairs
• Have Tricare coverage as an active-duty service member or active-duty family member
• Currently receiving retiree health coverage

If you don’t qualify through an above scenario to delay Part B, you will need to enroll during your Initial Enrollment Period to avoid paying any sort of penalty. However, if you do end up waiting until the Annual Election Period (AEP), please note that it starts on October 15 and only runs until December 7, not leaving much time to do research, determine your eligibility, compare and decide on the perfect Medicare plan for you.

Unless you turn to Healthpilot. Once you are properly enrolled in your Original Medicare plan, we do the rest of the work, so you don’t have to. And you won’t find anyone who can do it all like Healthpilot does.

Often when you Google this, you will read that “Medicare Part B covers 80% of the Medicare-approved costs of certain services”, but what does that mean? Becoming familiar with what each area of your Medicare plan covers will ensure you not only find the finest coverage for yourself but it will also hopefully deter billing surprises later.

Medicare Part B has two distinct types of coverage, and these include preventative services and those that are medically necessary.

Preventative services include things like:

• Vaccines
• Annual cancer screenings
• Yearly “wellness” visits
• Lab work
• Mental health counseling

Medically necessary can mean something different depending on the patient, is defined as healthcare services or supplies needed to diagnose or treat an illness, injury, condition, disease or symptoms that meet the accepted standards of Medicine. Let us break it down for you, the following outpatient services that you may receive are examples of common Medicare B coverages:

• Doctors service and mental health services
• Outpatient Care or Surgeries
• Home health services
• Durable Medical Equipment
• Diagnostic imaging
• Chemotherapy
• Dialysis

Also, for any medications that are given to you while at the hospital, Medicare Part B will cover those as long as you are still considered an outpatient. While most medications are covered under Part D (more on that later), Part B will also cover some medications (such as injections provided in a doctor’s office), certain oral anti-cancer drugs, drugs used with some types of durable medical equipment and immunosuppressant drugs.

Medicare Part B was written to cover treatments considered medically necessary and/or preventative. While Medicare Part B walks hand in hand with Medicare Part A, it is important to know what isn’t covered to avoid any unexpected out-of-pocket costs. These include but are not limited too:

• Most dental care
• Cosmetic surgery
• Eye exams for prescription glasses
• Hearing aids and exams for fitting them
• Prescription drug coverage

You can see, it is important to know exactly what you currently want but also to consider what you may need in the near future from your healthcare plan. Make a list of those wants and needs, medications, physician information, and so on, so you can make sure you know which parts of each Medicare plan cover exactly what you require or what you may end up having to pay out-of-pocket for. Sound like a lot of work? It doesn’t have to be. You can see your recommended plan and even check eligibility and enroll in minutes with Healthpilot.

Medicare Part B premiums

Medicare Part B has a set monthly premium once you are enrolled. For 2023, the standard Medicare Part B premium is $164.90 each month, but your personal premium may differ because it is based on your income bracket and the Income Related Monthly Adjustment Amount (IRMAA). Some individuals may be able to get help from their state to pay for Medicare costs depending on certain conditions.

If you are currently receiving Social Security or Railroad Retirement Board (RRB) benefits, then your premium is likely being automatically withheld from your monthly Social Security check. If you aren’t or won’t be receiving Social Security benefits at the time of your Medicare enrollment, your bill will be mailed to you monthly instead.

Medicare Part B deductibles

In 2023, Medicare Part B’s deductible is $226. Once that is met, Medicare will cover 80% of your Medicare Part B expenses. Here is where the 20% coinsurance comes in as your out-of-pocket responsibility. There are other Medicare plans, such as Medicare Supplement (or Medigap) plans, that can be added to help lower these out-of-pocket costs.

There is also an additional Medicare Savings Program that your income may qualify for if you are dual-eligible. This means you have both federal Medicare coverage and qualify for your state Medicaid program. These Medicare Savings Programs may pay some or even all of your Medicare Part B premium, deductibles, coinsurance and copays and are certainly worth checking out.

As we get older, we will spend more on our healthcare, it’s unavoidable. But luckily, it’s possible to find a Medicare insurance plan to fit your lifestyle. It’s even easy if you know who to go to. (Hint: It’s Healthpilot, you should come to us. We make it easy.)

Once you are on that search, you may notice that finding the right Medicare plan can also be a) confusing and b) dull as dishwater. Unless you are a total nerd about it all, like we are at Healthpilot. How shall we put it? We want to help you understand the different parts of Medicare and choose the best Medicare plan to fit your needs, we aim to go where “no one has gone before.”

Keep reading our guide to Medicare Advantage (also called Medicare Part C) from some Healthpilot experts who actually love this stuff.

While Medicare Parts A and B are considered Original Medicare, Medicare Part C is known as Medicare Advantage, a.k.a MA plans. The “advantage” is that Medicare Part C provides coverage through Medicare-approved private insurance companies, becoming your principal source of health coverage, and includes the same benefits as Medicare Part A and Part B, with additional perks. If Medicare Part C covers the same stuff as Original Medicare, why get a Medicare Part C plan? Because you will likely have lower out of pocket costs for these covered services. Plus, Medicare Part C offers an array of plans that can include coverage for additional benefits. There are several different Medicare Part C plan types available, costs can vary from plan to plan.

Just when you thought you knew the Medicare Alphabet and what to expect, Medicare Part C proves to be quite different and has a variety of plan types, much like private insurance…because it is private insurance. Medicare Advantage plan types may include but are not limited to the following:

Health Maintenance Organization (HMO) – HMO plans offer care from a network of medical health care providers for a set fee per service. There are a few exceptions to keep in mind, such as emergency care, out-of-area urgent care and temporary out-of-area dialysis.

Preferred Provider Organization (PPO) – Similar to an HMO, a PPO also has a network of providers that have agreed to a set fee per service; however, you are welcome to see an out-of-network provider. A PPO plan doesn’t require you to have a primary care physician (PCP), and you typically aren’t required to obtain a referral if you would like to see a specialist. This flexibility does come at a higher cost if you decide to go outside of the network, such as paying more for premiums and copays.

Health Maintenance Organization Point of Service (HMO POS) – An HMO POS is a bit of a hybrid between an HMO and a PPO. You will have to designate a PCP, but like a PPO, you may go outside the network for a higher copayment or coinsurance.

Private Fees for Service (PFFS) – PFFS plans are offered on a fee-for-service basis and do not restrict beneficiaries’ choice among providers, if the provider agrees to treat you. The plan determines how to pay the providers for services you use and how much you may owe when you get that care.

Medicare Advantage Special Needs Plans (SNP) – Special Needs Plans provide coverage for special health care or financial needs. Prescription drug coverage is included in all SNPs, but the plans’ accessibility will vary depending on where you live. Special Needs Plans come in four different variations.

• For persons who are both Medicare and Medicaid eligible, there are dual special needs plans (D-SNPs)
• C-SNPs (Chronic Special Needs Plans) are for those with certain severe or incapacitating chronic diseases
• Plans are available for institutionalized individuals with special needs (I-SNPs) who reside in skilled nursing facilities for 90 days or longer
• Individuals who reside in an assisted living facility under contract and require care comparable to that provided in a skilled nursing facility who can remain at home may be eligible for Institutional-Equivalent Special Needs Plans (IE-SNPs)

Medicare Advantage Eligibility Rules

In general, to be eligible for Medicare Part C, you must fulfil both of the following requirements:

1. Already signed up for Original Medicare (Medicare Parts A and B)
2. Live in a service area where private insurance companies offer a Medicare Advantage/Medicare Part C plan

It is also important to keep in mind that Part C coverage is not offered automatically. You must actively enroll in a Medicare Advantage plan. These plans are sold by private insurance companies, and just like any other insurance product, the enrollment process is similar to buying any health insurance policy.

Original Medicare Eligibility

Since you have to be enrolled in Original Medicare first in order to qualify for Medicare Part C, we thought we would quickly include the basics of Medicare Part A and B eligibility.

If you receive Social Security benefits, you will be auto enrolled into both Medicare Parts A and B when you turn 65. On the other hand, if you aren’t yet receiving Social Security benefits, you’ll need to sign up for Medicare on your own.

When can I enroll in Original Medicare?

With your Initial Enrollment Period (IEP), everything begins. From three months prior to becoming 65, through your birthday month, to three months after the month you turn 65, you have a seven-month opportunity to join Medicare Parts A and B.

It is also possible to qualify for Medicare Part A and Part B before you are 65 if:

• You have a qualifying medical condition
• A doctor has diagnosed you with a condition that qualifies as a disability that prevents you from working

If you qualify for Medicare before you are 65, your IEP will start three months before your first month of eligibility and last for seven months.

This part’s important: You may be subject to fines in the form of higher premiums if you choose not to enroll in Medicare Parts A, B, or D when you become initially eligible.

How do I get in touch with Social Security?

While it is Medicare that covers you, you have to sign up for it through Social Security Administration (SSA). This is because the SSA manages some eligibility for Medicare, such as if you’ve paid Medicare taxes long enough to get Part A for free, a.k.a. Premium-Free Part A. (They also handle applications to join Medicare Part B.)

Signing up is easy. You can do it online at Social Security. It’s the easiest and quickest way to sign up and get help if you need it. Or if you prefer the phone, just call 1-800-772-1213 to talk to Social Security. (TTY: 1-800-325-0778).

If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772. (TTY: 312-751-4701)

Medicare Part C Enrollment

The Initial Coverage Election Period (ICEP)

The Initial Coverage Election Period (ICEP) is when the majority of those newly eligible for Medicare who are interested in a Medicare Advantage plan make their decision to sign up for Medicare Part C. This election period is the same timeframe as the Initial Enrollment Period, as described above, if you get Medicare Parts A and B when you are first eligible. (See above graphic).

If you do not enroll in a Medicare Advantage plan during your ICEP, you may have to wait for the fall Medicare Open Enrollment Period, a.k.a Annual Enrollment Period (AEP) or go through the process of qualifying for a Special Enrollment Period (SEP).

If you chose to delay your enrollment in Medicare Part B, you will have an ICEP to enroll in a Medicare Advantage plan once you get Medicare Part B. The important thing to note here is, the eligibility period is only 3 months prior to the Part B effective date (not a full 7 months as a newly eligible individual).

 

Medicare Annual Enrollment Period (AEP)

AEP or Medicare’s Annual Enrollment Period is the official time when everyone who is eligible for Medicare can enroll in a new Medicare plan(s). That’s why it’s so important to have all your ducks in a row when it comes to knowing your eligibility and being prepared for enrollment. October 15 through December 7 is another guaranteed opportunity during the year that you have to assess your own Medicare eligibility, evaluate plans and insurance carriers, and ultimately choose, hopefully, the best Medicare plan for you. There is, of course, a better way.

Let Healthpilot do all the work. In minutes, you will be able to figure out your eligibility, see our best Medicare plan recommendation for your needs, and enroll in your Medicare plan in minutes…not months.

We know. So much information, right? But good for you for sticking it out…maybe you secretly love Medicare coverage as much as we do.

Now onto the best part: what does Medicare Advantage cover anyway?First things first, Medicare Part C coverage must include the same basic services provided by the U.S. government under Medicare Part A and Medicare Part B, also known collectively as Original Medicare. A Medicare Advantage plan typically offers hospital coverage, medical insurance coverage, and some additional coverages. You might also be covered for the following, depending on the type of plan that you select:

Prescription drug coverage. Prescription drug coverage is a feature of all Medicare Advantage Prescription Drug (MAPD) plans, even though it is not covered by Original Medicare. If you have other creditable drug coverage, there are Medicare Advantage (MA Only) plans without drug coverage. If you’re solely looking for standalone prescription drug coverage, read up on Medicare Part D plans.

Once a Medicare Advantage plan satisfies its requirement to provide coverage that is equal to what you could get from Original Medicare, it’s then up to the private insurance company to determine what additional services may be covered.

Medicare Part C may or may not cover prescription drugs, depending on the plan you choose. This can be a common oversight, but if this is the case for you, you will want to make sure to secure alternate prescription drug coverage. It is important to know that if you have your Part C coverage through an HMO or PPO plan, a separate Medicare Part D prescription drug plan will not be available.

What to do when something isn’t covered

If you need a service that is not covered by your plan, you can request a prior authorization. Prior authorization (PA) requests are applicable to pre-service requests only. So in other words, if the service is not covered (as communicated in a Summary of Benefits or Evidence of Coverage) and you haven’t gotten it yet, you may request prior authorization.

These are common, so don’t worry if you find this is your first option. You can also file an appeal for a medical service, item, or prescription medication cost that your doctor believes you should have or even that you already possess. You can even appeal to pay less than what was initially billed to you.

As we age, picking the best healthcare coverage, including prescription medication insurance like Medicare Part D, is crucial. It can also be challenging to choose and unclear to understand prescription drug plans in particular. The Healthpilot team cuts through the noise to help you find the best plan for your circumstances. This includes determining whether or not you even need Medicare Part D and, if so, which prescription drug plan best fits your needs.

Read on for a clear and simple explanation of Medicare Part D.

Medicare Part D is a prescription drug plan offered through private insurance carriers that is approved by Medicare and works with your Medicare Part A and B coverage. This prescription drug benefit provides coverage for outpatient prescription medications.

Maybe you haven’t heard of Medicare Part D until recently. It’s possible. These prescription drug plans have only been around since 2006, while Original Medicare has been around since the 1960s. Medicare Part D came about because there was a deficit in how the different Medicare programs covered prescription drugs. We know. We are Medicare nerds. We’ve accepted this.

It’s important to note that Medicare Part D is completely optional. Even so, most Medicare recipients opt for prescription drug coverage. If you take few or no prescription drugs, you might be debating whether it is worthwhile to enroll in Part D because you would be paying a premium to your plan while receiving nothing in return at the moment. While Medicare prescription drug coverage is a government benefit, it is actually insurance too, and like all other types of insurance, its purpose is to safeguard you from expensive prescription drug costs should you ever need it, now or later. Because of this, not to mention the possible late enrollment penalties you could incur, you may want to enroll in a Part D plan with the lowest premium, providing coverage for the lowest price.

Medicare Part D Eligibility

Medicare Part D keeps eligibility pretty simple. In general, to be eligible for Medicare Part D, you must fulfil both of the following requirements:

1. Already signed up for Medicare Part A and/or Part B
2. Live in a service area where private insurance companies offer a Medicare Part D plan

Original Medicare Eligibility

Since you have to be enrolled in Original Medicare first in order to qualify for Medicare Part D, we thought we would quickly include the basics of Medicare Part A and B eligibility.

If you receive Social Security benefits or the Railroad Retirement Board (RRB), then you have been or will be auto-enrolled into both Medicare Parts A and B upon the first day of your 65th birthday month. You will receive your red, white and blue Medicare card in the mail 3 months before your 65th birthday or the 25th month of receiving disability benefits. On the other hand, if you aren’t yet receiving your Social Security benefits, you will have to enroll actively in Medicare.

How do I sign up for Medicare?

While it is Medicare that covers you, you must sign up for it through Social Security Administration (SSA). This is because the SSA manages some eligibility requirements on behalf of Medicare. For example, they determine if you’ve been paying Medicare taxes long enough to get Part A for free, a.k.a. Premium-Free Part A. (They also take care of requests to join Medicare Part B.)

Signing up is easy. At Social Security, you can do it online. It’s the quickest and easiest way to sign up and get help if you need it. You can also call 1-800-772-1213 to talk to Social Security if you’d rather. (TTY: 1-800-325-0778).

If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772. (TTY: 312-751-4701)

You may apply for Medicare enrollment up to 3 months before you reach 65, during the month of your 65th birthday, and up to 3 months after that date. Initial eligibility and enrollment windows can feel like they rush by, so don’t be late. Set reminders on your phone or mark your calendar to avoid missing these enrollment windows.

Enrolling in a Prescription Drug Plan

Because Part D is completely optional, it is a good idea to consider enrolling in a Part D prescription drug plan even if you do not currently use any prescription medications.

The most important detail to keep top of mind is that if you have Medicare Part A or Part B and you don’t have any other creditable drug coverage (other coverage that is as good as Medicare Part D), you may be subject to a Late Enrollment Penalty (LEP) if you do not enroll when you are first eligible and have to pay drug expenses out of pocket.

The enrollment periods for Medicare plans are pretty strict and offer few exceptions, so if you delay enrollment in Part D for and find that you need drug coverage later, you may incur an ongoing Late Enrollment Penalty.

The Initial Enrollment Period (IEP)

The initial enrollment period (IEP) is when the majority of those interested in a Medicare plan can sign up. This spans the three months prior to and three months following your birth month. So if your birthday is September 9th, your IEP starts June 1st (see above graphic).

People who become eligible for Medicare due to a disability have an IEP that starts three months before their Medicare Part A and/or B becomes effective and lasts for seven months. People who are disabled and then turn 65 can get a second initial enrollment period (IEP2) that lasts 7-months.

Annual Enrollment Period (AEP)

AEP or Medicare’s Annual Enrollment Period is the official time when everyone who is eligible can add, modify, or discontinue their Medicare Part D plan or Medicare Advantage coverage for the upcoming year. That’s why it’s so important to have all your ducks in a row when it comes to knowing your eligibility and being prepared for enrollment. October 15 through December 7 is the one guaranteed opportunity during the year that you have to assess your own Medicare eligibility, evaluate plans and carriers, and ultimately choose, hopefully, the best Medicare plan for you.

There is, of course, a better way.

Let Healthpilot do all the work during AEP. In minutes, you will be able to figure out your eligibility, see our best Medicare plan recommendation for your needs, and enroll in your Medicare plan in minutes…not months.

As you approach your 65th birthday or if you just found out you are eligible for Medicare benefits, you may have Medicare plans on the brain. And who wants to be thinking about Medicare? Medicare plans can seem complex, but it can be easier than you think.

Part A and Part B are the two parts of Original Medicare. Medicare Part A usually doesn’t charge a premium (if you qualify for Premium Free Part A) and pays for hospital care, skilled nursing facility care, and hospice care. Part B of Medicare pays for medical care (like doctor visits) and preventive services as well as some medical equipment. There is usually a monthly premium for this coverage.

Medicare Supplement plans, a.k.a Medigap plans, provide State Department of Insurance approved-private insurance coverage. It helps by paying some of your health care costs that Original Medicare doesn’t cover like copayments, coinsurance and deductibles, hence bridging the “gaps” in Original Medicare. Clever, right? Keep reading for a quick guide to Medigap insurance.

Private insurance companies offer Medicare Supplement insurance to supplement Original Medicare coverage. Also known as Medigap, Medicare Supplement insurance helps you pay the portion of medical expenses you would traditionally have to pay out-of-pocket, like Medicare deductibles, coinsurance, and copayments. The monthly premiums that various insurance companies charge for the same coverage can vary considerably regarding Medigap policies. Compare the different Medigap plan types using the same letter when looking for a Medigap policy and consider the premiums each insurer charges. As an example, evaluate Plan G from two different companies. You can always turn to your State Health Insurance Assistance Program (SHIP) for guidance or make life a whole lot easier on yourself by letting Healthpilot analyze your unique situation to identify which Medigap policy could be the best fit for you.

The majority of states offer the same 10 standardized Medigap policies to their residents (except Massachusetts, Minnesota and Wisconsin, which use different standards). The plans vary from one another in terms of the services that are covered, coinsurances, the out-of-pocket maximums, and the monthly premiums.

Another important note is that all policies are meant for your individual coverage only, so if you and your spouse need a Medicare Supplement Plan, you will have to purchase plans separately.

Before you begin researching and comparing the different Medigap plan choices, the first thing to keep in mind is to not let yourself get confused by the Medicare Alphabet. Medigap policy letters have nothing to do with the primary Medicare plan you choose. Medigap plans are standardized and consistent in all but three states, though if you happen to be a resident of Massachusetts, Minnesota, and Wisconsin, you will have your own standard policies.

When considering which Medigap policy or combination of policies is best for you, a best practice is to consider the items that could end up costing the most in the long run without proper coverage, like deductibles and coinsurance for lab tests, doctor visits, and hospital stays.

Most plans cover 100% of Part B coinsurance except plans K and L, which cover only a percentage of your Part B coinsurance but limit how much you have to pay out of pocket. Once you’ve paid your Part B deductible and meet your out-of-pocket limit, the insurance carrier will pay of all of your covered services for the rest of the calendar year. Each year, these out-of-pocket maximums may go up because of inflation.

Remember, too, that Medigap does not cover prescription drugs, dental, vision, or most other needs that Original Medicare also doesn’t cover.

These nuances are what can leave people underinsured or confused when unexpected bills come rolling in. There is, of course, a better way.

Let Healthpilot do all the work. Here are the three easy steps:

1. Answer a few questions
2. Review your plan recommendation
3. Enroll online

The best part? It took you longer to read this so far than it would for us to get you enrolled. Time is precious. Why not get started now?

Once you have Medicare Parts A and B, you are eligible for Medigap coverage.

Original Medicare Eligibility

Since you have to be enrolled in Original Medicare Parts A and B first in order to qualify for Medigap coverage, we thought we would quickly include the basics of Medicare Part A and B eligibility.
If you already receive Social Security benefits, or Railroad Retirement Board benefits you will be auto-enrolled into both Medicare Parts A and B when you turn 65. On the other hand, if you aren’t yet receiving Social Security benefits, you’ll need to sign up for Medicare on your own.

How do I get in touch with Social Security?

While it is Medicare that covers you, you have to sign up for it through the Social Security Administration (SSA). This is because the SSA manages some eligibility for Medicare, such as if you’ve paid Medicare taxes long enough to get Part A for free, a.k.a. Premium-Free Part A. (They also handle applications to join Medicare Part B.)

Signing up is easy. You can do it online at Social Security. It’s the easiest and quickest way to sign up and get help if you need it. Or, if you prefer the phone, just call 1-800-772-1213 to talk to Social Security. (TTY: 1-800-325-0778).

If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772. (TTY: 312-751-4701)

You may apply for Medicare 3 months before you turn 65 and up to 3 months after your 65th birth month. The date your Medicare coverage begins depends on when you sign-up. 

It is also possible to qualify for Medicare Part A and Part B before you are 65 if:

• You have a qualifying medical condition
• A doctor has diagnosed you with a condition that qualifies as a disability that prevents you from working

So what happens if you don’t meet the requirements for a Special Enrollment Period (SEP) and miss your Initial Enrollment Period (IEP), as previously explained? Not to worry. The General Enrollment Period, which runs from January 1 to March 31 each year, still allows you to sign up for Medicare Part B, with coverage beginning on July 1.

So that’s the skinny. These are occasions you really don’t want to be fashionably late to because the window to enroll can come and go very quickly.