Enrolling in Medicare Part A or B
Medicare has four parts: Part A, called hospital insurance; Part B, medical insurance; Part C, Medicare Advantage managed care plans; and Part D, prescription drug plans. Most people are eligible for any of these Medicare programs at age 65.
Some people may want to sign up for only one part of Medicare or for several. But each part has a different enrollment procedure, and the processes differ depending on whether she's already receiving Social Security or other federal pension benefits or is a member of a managed care plan and wants to continue. When and how to enroll can get confusing, so the procedures and timing for each situation and Medicare program are described below.
Automatic enrollment in Medicare Part A if the person is already receiving Social Security or other federal pension benefits
If the person is approaching age 65 and is already receiving Social Security, Railroad Retirement, or federal civil service pension benefits -- retirement, disability, or dependents' or survivors' benefits -- she doesn't need to do anything to enroll in Medicare Part A. The Social Security Administration will do it for her. About three months before her 65th birthday, she'll receive an initial enrollment period package in the mail. Included will be notification of her enrollment in Medicare Part A. Because she is eligible for Social Security or other federal pension benefits, she's also eligible for free Part A coverage. That means she won't have to pay any monthly premium for Part A. Her coverage will begin on her 65th birthday. If she doesn't receive these documents by two months before she turns 65, she should contact the Social Security Administration at 800-772-1213.
If she's under age 65 but has been eligible to receive Social Security disability benefits for at least 24 months, she's also eligible for free Medicare Part A and will be automatically enrolled. The Social Security Administration will mail Medicare enrollment documents to her when she reaches her 24th month of collecting disability benefits.
How and when to enroll in Medicare Part A if someone isn't receiving Social Security or other federal pension benefits
If the person isn't collecting Social Security or other federal pension retirement, disability, or dependents' or survivors' benefits, she has to apply for Medicare Part A at a local Social Security office. She should file her application as early as three months before she turns 65, to ensure that the paperwork is completed by her 65th birthday.
If she's eligible for Social Security or other federal pension benefits but hasn't yet started collecting them, she will receive free Part A coverage, with no monthly premium. If she is 65 and a citizen or legal resident but doesn't qualify for Social Security or other federal pension benefits, she can still apply for Medicare Part A. However, she will have to pay a monthly premium for it; the amount is determined by how many Social Security work credits she has accumulated.
If she applies for Medicare Part A within six months after she turns 65, her coverage will date back to her 65th birthday. If she applies more than six months after her birthday, her coverage will date back only to six months before the date she applied.
How and when to enroll in Medicare Part A and Part B if someone wants to continue in a managed care plan
The person may be one of the many people under age 65 enrolled in a managed care health plan. The company that runs that plan may also have a Medicare Part C Medicare Advantage managed care plan that she could switch to when she turns 65. That would let her continue with all the same doctors and other providers from whom she receives care now. If she's happy with her managed care plan, and the same company offers a Part C Medicare Advantage version, she can simply notify the plan of her intention to switch to this Medicare Part C version. If she does so and isn't already receiving Social Security or other federal pension benefits, the managed care plan will help her enroll in Medicare Part A and Part B.
Automatic enrollment in Medicare Part B if someone is already receiving Social Security or other federal pension benefits
If the person is already receiving Social Security, Railroad Retirement, or federal civil service pension benefits -- retirement, disability, or dependents' or survivors' -- when she turns 65, Social Security will automatically enroll her in Medicare Part B. About three months before she turns 65, Social Security will mail her an initial enrollment period package, including notification of her enrollment in Medicare Part B. If she doesn't want to enroll in Medicare Part B, there's a place on the form where she can decline Part B coverage.
Her Part B coverage will begin on her 65th birthday. If she doesn't receive the documents by two months before she turns 65, she should contact the Social Security Administration at 800-772-1213.
Everyone who enrolls in Medicare Part B must pay a monthly premium for Part B coverage. In 2008, the basic monthly premium most people pay is $96.40. However, if she has over $82,000 in income (over $164,000 for a married couple), the amount is higher. Part B premiums are automatically deducted from her monthly Social Security check. If she isn't receiving Social Security benefits, Medicare will send her a bill every three months.
How and when to enroll in Medicare Part B if someone isn't yet receiving Social Security or other federal pension benefits
If she's turning 65 but isn't yet collecting any Social Security or other federal pension benefit, she needs to sign up for Medicare Part B at a local Social Security office. (She can do it at the same time she files for Social Security benefits at age 65, if she's doing that, too.) In the months immediately before and after her 65th birthday, she has what's called an initial enrollment period. This allows her to sign up for Medicare Part B as early as three months before the month she turns 65, and anytime within three months after the end of the month she turns 65. If she doesn't sign up for Part B by the end of this initial enrollment period, she has to wait until the general enrollment period of January 1 through March 31 each year.
The timing of her enrollment in Part B determines when her coverage begins and can affect how much it costs:
If she signs up for Medicare Part B within the three months before the month in which she turns 65, her coverage will begin on her 65th birthday.
If she signs up within three months after the month she turns 65, her coverage will be delayed one to three months; there's no retroactive Part B coverage back to her 65th birthday.
If she signs up for Part B in the general enrollment period January through March, after her initial enrollment period is over, her coverage won't begin until July 1 of that year. Also, her monthly premiums for Part B coverage will be higher -- 10 percent higher for each year she delayed enrolling.
How and when to enroll in Medicare Part C or Part D
Part C Medicare Advantage
Part C Medicare Advantage managed care plans combine Medicare Part A and Part B coverage within a managed care framework. Medicare doesn't control the amount a plan charges for this coverage, but it does regulate who may enroll in such a plan and when.
Within six months of enrolling in Medicare Part A and B. Once your friend or relative enrolls in Medicare Part A and B, she has a six-month period in which she may join any Medicare Advantage managed care plan that is operating in the county where she lives. In this period, a plan must accept her enrollment without any medical screening and on the same terms as for anyone else of her age, regardless of her medical history.
During the plan's open enrollment period. Every Medicare Advantage managed care plan designates at least one month a year for open enrollment, if it's accepting any new enrollees at all. Some plans have open enrollment for more than one month. During the open enrollment period, she can join the plan regardless of her medical history. Most plans pick November for open enrollment, with coverage beginning the following January 1.
If dropped by another managed care plan. Unfortunately, Medicare Advantage managed care plans regularly drop out of geographic areas that they don't feel are profitable enough for them. If her plan is dropping out of the area where she lives, it will notify her by October 1, effective the following January 1. She then has two options. She can rejoin traditional Medicare Part A and Medicare Part B; if she does, she is also guaranteed the right to buy a medigap supplemental insurance policy to fill gaps in Medicare coverage. Or she can enroll in any other Plan C Medicare Advantage managed care plan that's operating in the county where she lives and that isn't closed to all further enrollment. She can join one of these plans from October 1 through December 31. If moving out of the plan's service area. Managed care plans operate within geographic areas. They aren't required to continue covering someone enrolled in the plan who moves out of the area it serves. If she's in this situation, she's guaranteed the right to join any Medicare Advantage managed care plan operating in the new area where she lives, during that plan's yearly open enrollment period. If there's a gap between when she moves and the open enrollment period for the new plan she'd like to join, she'll have to use traditional Medicare Part A and Part B in the meantime.
Medicare Part D prescription drug plan
Anyone eligible for Medicare is guaranteed the right to enroll in any Medicare Plan D prescription drug plan sold in the state where she lives during an initial enrollment period. This period begins three months before the month she turns 65, and continues until three months after the month she turns 65. If she doesn't sign up for a Part D plan by the end of this period, she has to wait until the Plan D yearly general enrollment period of November 15 through December 31.
There's a financial penalty if she doesn't enroll in a plan during her initial enrollment period but later decides to join a plan. For each month she delays enrolling after the close of her initial enrollment period, she must pay a 1 percent penalty on the premium price of any plan she eventually joins.
Medicare enrollment application
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