Medicare is for 3 basic groups of people:
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Individuals Age 65 and Older: Most people become eligible for Medicare when they turn 65. This group includes senior citizens who have reached the age of 65 and are U.S. citizens or permanent residents.
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Certain Disabled Individuals: Medicare also provides coverage for individuals under the age of 65 who have been receiving Social Security Disability Insurance (SSDI) benefits or Railroad Retirement Board disability benefits for at least 24 months. This group includes people with disabilities who meet specific criteria.
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Individuals with End-Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS): In some cases, Medicare provides coverage for individuals of any age who have End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant, as well as those with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease.
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Many beneficiaries who are new to Medicare get confused by its complexity. Medicare includes four major parts: Part A, Part B, Part C, and Part D. Part A covers in-patient hospitalization while Part B covers outpatient services and other medical care provided by doctors and other healthcare professionals, as well as durable medical equipment. Part C is offered by private insurance companies contracted with Medicare to deliver Medicare Part A and Part B benefits to plan enrollees which may include additional benefits such as routine vision, dental, and hearing coverage. Some plans may include prescription drug coverage as well.
If you are already receiving Security benefits, you will be automatically enrolled in Medicare Part A (hospital insurance) and usually Medicare Part B (medical insurance) when you turn 65. You should receive your Medicare card in the mail about three months before your 65th birthday.
If you are not already receiving Social Security benefits when you turn 65, you will need to actively enroll in Medicare. To do this, contact the Social Security Administration about three months before your 65th birthday to initiate the enrollment process.
For individuals who worked for a railroad, the enrollment process may differ slightly, and they should contact the Railroad Retirement Board for guidance on enrolling in Medicare.
Here's a summary of the key enrollment periods for Medicare:
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Initial Enrollment Period (IEP): Most people become eligible for Medicare when they turn 65. The Initial Enrollment Period (IEP) is the primary enrollment window. It spans seven months, including the three months before your birth month, your birth month, and the three months after your birth month. This provides ample time to enroll in Medicare.
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If you enroll during the three months before your birth month, your coverage will start the month you're first eligible.
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If you enroll the month you turn 65, your coverage will start on the first day of the following month.
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General Enrollment Period (GEP): If you miss your Initial Enrollment Period, you have another opportunity to enroll during the General Enrollment Period (GEP), which runs from January 1st to March 31 each year. If you enroll during the GEP, your coverage will start on the first day of the month after you sign up. It's important to note that enrolling during the GEP may lead to late enrollment penalties and gaps in coverage.
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Special Enrollment Period (SEP): In certain circumstances, individuals may be eligible for a Special Enrollment Period. SEPs are granted for various reasons, such as losing employer-based coverage or moving to a new area with different Medicare options. During an SEP, you can enroll in Medicare outside of the typical enrollment periods without incurring late enrollment
If you do not enroll in Medicare during your Initial Enrollment Period (IEP) and you are not eligible for a Special Enrollment Period (SEP), you may be subject to late enrollment penalties, which can result in higher Medicare premiums. These penalties are designed to encourage people to enroll in Medicare when they first become eligible, to ensure the financial stability of the program, and to avoid adverse selection.
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Evaluate Your Options: When you're still working and have access to employer group insurance, you have the choice to enroll in Medicare or delay enrollment. It's essential to weigh the benefits of both options to determine which is better for your specific healthcare and financial needs.
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Compare Plans: Compare your employer's group health insurance plan with Medicare coverage side by side. Consider factors like premiums, deductibles, copayments, and the scope of coverage. Determine which plan offers the best overall value and coverage for your specific situation.
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Consult with Experts: Discuss your situation with your employer's benefits administrator, insurer, or plan provider. They can provide you with information about how your employer's plan coordinates with Medicare and help you make an informed decision.
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Be Cautious About Timing: Be aware that in most cases, if you decide to leave your employer's group plan and enroll in Medicare, you may not be able to return to the employer plan. Therefore, timing is critical, and you should carefully consider the long-term implications of your decision.
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Consider Future Changes: Think about your future plans, including retirement. If you anticipate retiring soon and losing access to your employer's coverage, enrolling in Medicare during your Initial Enrollment Period (IEP) can ensure a smooth transition to Medicare coverage.