Medicare is a national health insurance program that the federal government provides to those 65 and older or with specific disabilities. The methods to apply for Medicare will depend on the situation and when a person wants to start their Medicare benefits. Many people do not know how to apply for Medicare when it is their time. Keep reading to find out who can apply, how to apply, and when to apply for Medicare Part A and Part B.
Who is Eligible to Apply for Medicare?
Most Medicare beneficiaries become eligible for Medicare benefits at age 65. Medicare is available to any U.S citizen or permanent resident of at least five years. You can also qualify for Medicare before 65 if you’ve been receiving Social Security Disability Income (disability benefits) for at least 24 months, or have End-Stage Renal Disease (ESRD) and need dialysis or a kidney transplant, or have Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig disease). You will be automatically enrolled in Medicare when you qualify early due to disability.
If you have worked at least 40 quarters or ten years in the United States, you qualify for premium-free Part A, your hospital insurance. However, if you have not worked 40 quarters, you will have a premium for Part A that you must pay each month. If your spouse has worked at least 40 quarters and paid payroll taxes, and you have been married for at least one year and are at least 62 years old, you can use their work history to qualify for premium-free Part A coverage.
Along with Part A, you will have Part B, which is your outpatient medical insurance and that has a monthly premium that everyone must pay when they are enrolled in Medicare Part B coverage. Your income can affect your Medicare Part B and Part D premiums. If you are a high-income earner, you will be subject to Income Related Monthly Adjustment Amount (IRMAA), and you will pay more for Part B and Part D.
How Can I Apply for Medicare?
Suppose you’ve been receiving Social Security benefits, Survivor benefits, or Railroad Retirement Board benefits for at least four months before your 65th birthday month. In that case, you will be automatically enrolled in Medicare Parts A and B. You do not have to worry about applying for Medicare online if you are automatically enrolled. You should receive your Medicare card in the mail before your benefits are effective. Once you have your card, you can use your benefits starting on your effective date. This means you can use Medicare anywhere in the country for hospital and medical services if the provider accepts Medicare.
However, if you are not automatically enrolled in Medicare, you must apply for Medicare yourself. There are several ways to apply for Medicare.
Applying for Medicare Online
The most common way to sign up for Medicare is online. A common misconception is you must apply through the Medicare website. However, that is not the correct website. You will apply through the Social Security Administration (SSA) website. Once you have created an SSA account, you can apply for Medicare Part A and Medicare Part B through the website.
Once you apply, you can track your application status through your account. When your Medicare application is approved, you can view your Benefit Verification letter and find your Medicare number and your Medicare effective dates. Your Medicare card should arrive in the mail about four weeks after your application for Medicare has been approved.
Many enrollees find this the most convenient way to apply since you can be put on hold via telephone for hours with Social Security. However, if you have any questions on the application or need more information, you can call Social Security at 1-800-772-1213 or 1-800-325-0778 for TTY users.
Although there is a Medicare account that you can create, you would not do this to apply for Medicare. Instead, once you have your Medicare number, you can register for a Medicare account through the Medicare website. You can view claims, track premiums, and your cost-sharing in that account.
Applying by Phone
Additionally, you can call the toll-free number above and apply over the phone. You would be able to speak with a representative that can walk you through the steps. They may mail you the application you would complete and then send it back. However, be prepared to sit on hold for some time if the call volume is high.
If you receive Railroad Retirement Board benefits, then you can call 1-877-772-5772.
When Can I Apply for Medicare?
As stated above, you may be automatically enrolled in Medicare, depending on your situation. If you are automatically enrolled, then you will only need to focus on enrolling in additional Medicare plans such as a Medigap plan (Medicare Supplement insurance), Medicare Advantage plan, or Part D prescription drug plan. Those supplemental plans can help with your Medicare costs. For example, when you are only enrolled in Medicare, you are still responsible for prescription drugs, home health care costs, hospice care costs, durable medical equipment, visits with doctors, and more. Medicare does not cover those services 100%, so that those plans can help. However, it is essential to know that Medigap and Medicare Advantage plans are optional, so it is your choice if you’d like to enroll in an additional policy.
If you are not automatically enrolled in Medicare Part A and B, you will have specific enrollment windows.
Initial Enrollment Period Window
Every beneficiary has an Initial Enrollment Period (IEP). It is a 7-month window that starts three months before your 65th birthday month and ends three months after. If you don’t have creditable coverage from a large employer, you will want to apply for Medicare during this window.
When you apply during the first three months, your Medicare benefits will start on the 1st of your 65th birthday month. However, if you apply the month of your 65th birthday month, then your benefits should start the 1st of the following month. When you apply one month after your 65th birthday month, your benefits should start two months later, and if you apply two or three months after your 65th birthday month, your benefits should begin three months after you apply. So, it is important to know that your benefits could be delayed if you apply after your 65th birthday month.
You can apply online or via phone when you apply during this window.
Special Enrollment Period Window
Suppose you have creditable coverage and delay Medicare past your IEP. In that case, you can use the Special Enrollment Period (SEP) window to apply for Medicare once you retire or lose creditable coverage. Creditable coverage is as good as Medicare’s, which is usually a group health plan provided by an employer with 20 or more employees. This is an 8-month window that starts the day you lose coverage or employment (whichever comes first). During this window, you can apply for Medicare. However, you will need to provide documentation to apply for Part B. The Part B application (CMS 40B form) and the proof of creditable coverage form (CMS L564 form) are the two documents you will need. Since you need to complete those documents, there are a few ways to submit them. You can upload the forms online, fax them, or mail them to a local Social Security office.
General Enrollment Period Window
The third window is the General Enrollment Period (GEP). This window is from January 1 – March 31 of each year. If you did not enroll during your IEP and did not qualify for a SEP, then you will use this window to apply for Medicare. Your Medicare benefits would be effective July 1. You will also have a late enrollment penalty since you did not apply when first eligible and did not have creditable coverage.
Many people are unaware of how to apply for Medicare and if you can apply online. The simple answer is yes. You can sign-up for Medicare online, but it does depend on your situation and when you apply. You will want to do this research ahead of time, so you are prepared and know the process before you start. In addition to applying for Medicare, you will want to consider applying for additional plans, which you can apply for through a Medicare broker or insurance agent.