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Index | Medicare | Enrolling in Medicare

Enrolling in Medicare

Enrolling in Medicare may present a difficulty as there are special requirements you are expected to meet to become eligible for Medicare plans. Knowing these requirements as well as the designated terms for enrollment, you can become entitled for the suitable parts of Medicare with regard to the benefits different plans offer.

Here are some guidelines that will help you sign up for Medicare as they outline the conditions and terms you should be aware of.

Legally, to enroll in Medicare you are to be either a U.S. citizen or a lawfully admitted non-citizen with at least a five years term of residence. You can automatically become a Medicare enrollee to Part A (Hospital Insurance) if you have turned 65 and you are already receiving Social Security retirement or disability benefits. You also automatically qualify for Medicare Part A if you receive or you are eligible to receive railroad retirement benefits upon turning 65.

You qualify for Medicare if you or your nearest relative (your spouse, including a divorced spouse, or your child you are dependent on) has worked long enough in a Medicare-covered federal, state or local government employment and has paid the Medicare part of the Social Security tax.

You may be eligible for Medicare due to medical reasons even if you are under 65. Thus you qualify for Medicare if you have been getting Social Security disability benefits for 24 months or if you have the end-stage renal disease and require maintenance dialysis or a kidney replacement.

Even if you are not planning to retire at 65 you still can sign up for Medicare. But you should remember that in this case your enrollment will not be automatic, so you should contact your Social Security Administration to submit an application.

Medicare Part A is normally free. No monthly premium is required for the benefits you receive. If you do not qualify for Medicare Hospital Insurance (e.g. you are not entitled to Social Security or Railroad Retirement benefits or if you are disabled but have lost your Medicare privileges due to a substantial income) and you have reached the age of 65, you can buy this insurance policy and become a voluntary enrollee. In this case a premium will be charged.

Eligibility for Medicare Part B (Medical Insurance) does not essentially differ from eligibility for Part A. The same categories of citizens qualify for Medical Insurance. As a general rule, three months before your 65-th birthday you will get a notification of your eligibility for Medicare Parts A and B from Social Security Administration. You will get a special card marking you as a Medicare enrollee. You return the card only if you do not want to sign up for Medicare Part B. The cards may differ in color thus showing what parts of Medicare you have signed up for: red, white or blue for hospital insurance, medical insurance or both correspondingly. Your Medical Insurance will automatically go into effect on the first day of the month when you turn 65, unless you opt out of it. (It is the average situation, of course, and in case you are disabled, you can apply for Medicare benefits at any time provided you have been eligible for Social Security disability benefits.) Enrolling in Part B normally requires a monthly premium which is based on your income.

Signing up for a Medicare Advantage Plan (Part C) is possible if you are already receiving Medicare benefits from Part A and Part B. You will receive a special card from your provider in accordance with which you will get all the services offered in your plan.

Enrollment in Part D (Prescription Drug Coverage) is optional. If you have decided to apply for it, you will have to join a Medicare private drug coverage plan. The Part D premium depends on the drug coverage plan you choose. Like in other types of insurance, if you do not sign up for Medicare Part D within the initial enrollment period, you will have to pay penalties.

The date of your enrollment in Medicare can become a decisive factor granting timely health care and determining your convenience. That is why it is important to know that there are special Enrollment Periods when you may sign up for Medicare.

If you are not getting Social Security benefits you should apply to Social Security office three months before you turn 65 - this is the beginning of your seven months initial enrollment period. If you start three months before your 65-th birthday you have seven months to enroll in Medicare without having to pay penalties.

The date when your insurance becomes effective depends on the date of your enrollment. Remember that the date when you enroll is important for Part B and Part D beneficiaries and for the applicants who are not automatically entitled for Medicare Part A. Accordingly, if you do not turn down acceptance to Medicare Part B within the first three months of your initial enrollment period, your medical insurance protection (both parts - A and B) becomes effective right when you become eligible, i.e. on the first day of the month when you turn 65. If you enroll during the month when you turn 65, your coverage goes into effect on the first day of the month following the month of your 65th birthday. If you enroll within three months following the month of your birthday, your coverage becomes effective two months after the enrollment.

Besides the seven months initial enrollment period, there is the general enrollment period which opens one more opportunity to submit an application for Medicare from January 1 through March 31 of any year following the year when you turn 65. In this case your coverage will come into force on July 1.

You should remember, though, that late enrollment is fraught with penalties. When it comes to Medical Insurance (Part B), your monthly premium increases 10 percent for each 12 months you qualified for but did not enroll in Medicare Part B. If you delay enrolling in Prescription Drug Coverage (Part D) you generally pay 1 percent of the average national premium for each month of the delay.

If you have insurance through your employer, you can enroll in Medicare at any time while you have the company health insurance and during seven months after the termination of work. It is the special enrollment which has its own peculiarities and thus requires special treatment. You should know that if the company you are working for has 20 or more employees (100 employees if you are disabled) your employer health insurance will pay for you. And you needn't worry about signing up for Medicare while your employer health insurance is valid. You can do it at any time. But if there are fewer than 20 employees (fewer than 100 in case of your disability) your employer insurance will pay only after Medicare provides its coverage. In the latter situation it is strongly recommended to sign up for Medicare within the initial enrollment period.