When Should You Apply for Medicare?

You become eligible for Medicare when you turn 65. If you are already receiving Social Security benefits at that time, you will be automatically enrolled in Medicare Parts A and B on your 65th birthday. To sign up for other Medicare programs, such as Part C (Medicare Advantage) or Part D (prescription drug coverage), you will need to consult with an insurance professional.

If you have not yet started receiving Social Security benefits by the time you turn 65, you will need to actively apply for Medicare. The Initial Enrollment Period (IEP) begins three months before your 65th birthday, includes the month of your birthday, and extends three months after your birthday, giving you a total of seven months to enroll.

There is an exception: if your birthday falls on the first day of the month, your IEP starts one month earlier.

         Medicare Part C

Medicare Part C, or Medicare Advantage is designed to roll the coverage of Parts A and B into one plan, offered by a private health insurance company that contracts with Medicare.. By law, Advantage plans must offer at least the same coverage as Original Medicare. Other rules may differ, or the network might offer additional benefits. Many Advantage plans also include Part D, or prescription drug coverage.

Common types of Part C plans include:

• Health Maintenance Organization (HMO) plans
• Preferred Provider Organization (PPO) plans
• Private Fee-for-Service (PFFS) plans
• Special Needs Plans (SNPs)
• HMO Point of Service Plans (HMOPOS)
• Medicare Medical Savings Account (MMSA)

If you opt for a Part C plan, you will have the opportunity to compare plans, benefits, and rates each year during an Annual Election Period.

       Medicare Part A

Medicare Part A is commonly considered hospitalization insurance. Part A covers costs related to:

• Inpatient care in a hospital
• Skilled nursing home care Inpatient care in a skilled nursing facility that is not custodial or long-term
• Hospice care
• Home health care

         Medicare Part B

Medicare Part B provides for the rest of your non-hospitalization healthcare needs. Under Part B you receive coverage for:

• Medically necessary services such as doctor visits, tests, and other services as needed to diagnose or treat your condition
• Preventive services like routine screenings, check-ups, vaccinations, and more
• Clinical research
• Ambulance services
• Durable medical equipment
• Mental health services
• Limited outpatient prescription drugs

Together, Medicare Parts A and B are called Original Medicare.

                    Who is Eligible for Medicare?

Eligibility for Medicare primarily begins at age 65 for all U.S. citizens. Non-citizen permanent residents can also qualify at 65, provided they have resided in the United States for at least five consecutive years.

Individuals under 65 may be eligible for Medicare if they meet specific criteria, including:

• Being permanently disabled and having received Social Security Disability benefits for a minimum of 24 months.
• Having a diagnosis of end-stage renal disease (kidney failure).
• Being diagnosed with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's disease) and receiving Social Security Disability benefits.

Medicare can initially seem complex due to its extensive regulations and procedures. To assist you, we have developed this guide to simplify the application process, annual enrollment periods, and other important aspects of Medicare.