Mapping Out Your Medicare Route

Brooke Phillips, CWCMS
Editor | Shield HealthCare
02/12/24  3:00 PM PST
About Ostomies

Medicare is the federal health insurance program for people who are 65 and over. If you are under 65, you may be eligible to get Medicare earlier if you have a disability or certain qualifying illnesses. But when and how should you apply?

Navigating your way through Medicare can be confusing. If you become familiar with the complicated system before you reach age 65, you may feel more comfortable when it’s time for you to enroll.


How Medicare Works

Medicare is divided into four parts:


How to Apply for Medicare

If you are already collecting Social Security when you reach age 65, you will be automatically enrolled in Medicare Part A and Part B. Otherwise, you’ll need to pay close attention to the strict enrollment deadlines, or you may face a gap in your health care coverage.

If you retire at age 65, you have a total of seven months to enroll in Medicare, beginning three months before your 65th birthday. If you continue working past age 65, you can switch at the time of your retirement from your employer’s health care plan to Medicare. Once you stop working, however, you only have eight months in which to sign up for Medicare Part B. This eight-month window applies even if you stay enrolled in your employer’s health care plan through COBRA.

If you miss your enrollment period, you will have to wait to sign up until the general enrollment period from January 1 through March 31. You’ll also have to wait until the following July to start receiving Part B benefits. And your Part B premium may be increased permanently.

If you apply for Social Security between 3 months before you turn 65 and 3 months after you turn 65, you can sign up for Medicare when you apply for Social Security. The Initial Enrollment Period to sign up for Medicare begins 3 months before you turn 65 and ends 3 months after the month you turn 65–a total of 7 months. You may have to pay a penalty if you miss your Initial Enrollment Period.

If you are not ready to receive Social Security benefits at 65 because you are still working, you can apply online for Medicare only. Or you may be able to wait until you retire to sign up during a special enrollment period.


Receiving Medicare Under Age 65 if You Have a Disability

If you receive Social Security disability benefits, you will automatically begin receiving Medicare Parts A and B after 24 months.

If you have Lou Gehrig’s Disease (ALS), you will receive Medicare Parts A and B immediately when you enroll in Social Security disability benefits. Find and contact your Social Security Office to apply.

If you have End-Stage Renal Disease (ESRD), learn about Medicare coverage and enrollment.


Choices in Coverage

Medicare Part A helps cover hospitalization, skilled nursing facilities, hospice, and home health care. Part B helps cover doctors’ services, outpatient care, and home health care. You’ll pay a premium based on your income for Part B coverage. Medicare Part C (Medicare Advantage plans) is a health care coverage option run by private insurance companies that are approved by and under contract with Medicare. Medicare Part D allows enrollees to purchase prescription drug coverage from private insurance companies approved by and under contract with Medicare. The premiums charged and drugs covered by these plans can vary significantly.

You have two main choices in how you get your Medicare coverage. You can choose original Medicare with Part A and Part B, and decide if you want to add Part D prescription drug coverage and any supplemental coverage or Medigap plan. Or you can choose a Medicare Advantage plan, which often is like a health maintenance organization (HMO) or preferred provider organization (PPO). Medicare Advantage plans combine Part A, B, and D benefits. These plans also may offer dental, vision, and wellness coverage.


Making a Switch

After you enroll in Medicare, you may be able to switch your coverage. Before you make a switch, consider your costs, doctor and hospital choices, prescription drug needs, quality of care, and the convenience of the services.

After you join a Medicare Advantage plan, you generally must stay enrolled for the calendar year starting with the date coverage began. In certain situations (e.g., you move out of your plan’s service area), you are permitted to switch plans. In most cases, you can join a plan between November 15 and December 31 each year and your coverage will begin on January 1 of the following year. Between January 1 and March 31, you can join a Medicare Advantage plan and coverage will begin the first day of the month after the plan receives your enrollment form. (Restrictions apply.) Once you enroll in a new plan, you’ll be automatically dis-enrolled from your old plan when your new plan’s coverage begins.


Find a Doctor, Healthcare Provider, or Hospital That Accepts Medicare

Many types of healthcare providers accept Medicare. This includes doctors, hospitals, nursing homes, and in-home care providers.

Medicare’s Find & Compare tool allows you to search through various providers to identify the providers closest to you that are the right fit for your needs. Types of providers include:

  • Doctors & clinicians
  • Hospitals
  • Nursing homes, including rehab services
  • Home health care
  • Hospice care
  • Inpatient rehabilitation facilities
  • Long-term care
  • Dialysis facilities
  • Medical equipment and suppliers

Use this Medicare tool to find a Medicare-certified provider near you. Enter your zip code to begin a search.





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