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How Does Aging-In to Medicare Work?

With a 65th birthday coming up it’s time for you to get ready to enroll in Medicare for the first time.

By Clover Health

If you’re turning 65 in the next few months, you’ll have a lot of company, as an average of 10,000 Americans turn 65 every day. For most, it also means that you’re eligible to enroll in Medicare for the first time and most likely have a lot of questions. As you prepare for Medicare, there’s a lot to know. So, we’re breaking down the steps and giving you all the information you need to enroll in Medicare for the first time.

Am I Eligible for Medicare?

“Am I eligible for Medicare?” is a commonly asked question. Generally, Medicare is available for people age 65 or older, younger people with disabilities, and people with end-stage renal disease. Medicare has two parts, Part A (hospital insurance) and Part B (medical insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years.

You can also get Part A at age 65 without having to pay premiums if

  • you are receiving retirement benefits from Social Security or the Railroad Retirement Board;
  • you are eligible to receive social security or railroad retirement benefits but you have not yet filed for them; or
  • you or your spouse had Medicare-covered government employment.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your social security, railroad retirement, or civil service retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

Step 1: Do I Need to Be Retired to Get Medicare?

You do not have to be retired to get Medicare. The retirement age for full social security benefits, called “full retirement age” is slowly rising to age 67, but you can still get full Medicare benefits at age 65, even if you’re not going to collect social security benefits.

If you aren’t collecting social security or railroad retirement benefits because you’re still working, you may sign up for Medicare by enrolling online through Medicare.gov or by contacting your local Social Security office or Railroad Retirement Board.

If you are retired and signed up for social security or railroad retirement benefits, you will be automatically enrolled in Medicare Part A (hospital insurance) and can choose to sign up for Medicare Part B (medical insurance).

Step 2: Decide About Medicare Part B

When you enroll in Medicare, you’ll need to decide if you want to enroll in Medicare Part B. This covers medical services, outpatient care, and other routine services. (Learn more about the different “parts” of Medicare and what they mean here.)

Most people should enroll in Medicare Part A and Part B when they’re first eligible. However, some choose to delay Medicare Part B (and paying a premium) depending on their current situation, for example:

  • I’m currently working and have coverage through my job.
  • I have coverage through my spouse who is currently working.
  • I have retiree coverage from my former employer or my spouse’s former employer.
  • I have Tricare and am a retired service member.
  • I have Tricare and am an active service member.
  • I have Veterans’ benefits.
  • I have end-stage renal disease.

If you do not fall into one of the situations above and you do not sign up for Medicare Part B when you’re first eligible, you’ll have to pay a late-enrollment penalty. You’ll have to pay this penalty for as long as you have Part B and could have a gap in your coverage.

However, if you’re covered by employer-based health insurance at the time you’re first eligible for Medicare and do not choose to sign up for Medicare Part B, you’ll qualify for an 8-month Special Enrollment Period that starts either the month your employment ends or the month after employer coverage ends, whichever comes first. This allows you to sign up for Medicare Part B without having to pay a late-enrollment penalty.

Yes, Medicare can be confusing, but Clover Health has trained representatives available to assist you and answer all of your questions. Call us today at 1-888-778-1478 to learn more about aging-in to Medicare.

When Can I Enroll in Medicare for the First Time

Most people enroll in Medicare Part A and Part B when they turn 65, which is called the Initial Enrollment Period. The Initial Enrollment Period is 7 months long and includes:

  • the 3 months before the month you turn 65,
  • the month you turn 65, and
  • the 3 months after your 65th birthday month.

You can enroll by contacting Social Security or the Retirement Benefits Board.

What You Need to Enroll in Medicare

As you’re preparing to retire, you’ll need to have a few documents on hand to enroll in Medicare. These required documents are:

  • your social security card or record of your number
  • your birth certificate or other proof of your age
  • your proof of U.S. citizenship or residence
  • a copy of your last W-2 or self-employment tax forms

If you’re applying online, you can submit your documents online. If you’re applying over the phone, you can mail in your documents or drop them off at your local Social Security office.

Things to Consider When Choosing a Medicare Plan

Once you have signed up for Medicare Parts A and B, you’ll need to choose a Medicare plan. Here are some tips for choosing the plan that best meets your needs:

Ask yourself the following questions:

  • What type of healthcare plan do I currently have?
  • What do I like about my current coverage?
  • How much am I able to pay out of pocket for my healthcare and medicines?
  • What would I add to my current coverage to make it ideal?
  • Who currently helps me make decisions about my coverage?

Once you have answered these questions, you’ll be ready to begin choosing the right plan for you. Here are some additional things to consider when choosing a Medicare plan:

  • Cost
    • What will I pay for premiums, deductibles, coinsurance, and copays? What is the out-of-pocket maximum?
  • Benefits
    • Does the plan have all the benefits I’m looking for, like prescription drug coverage? What about dental care or eyeglasses?
  • Convenience
    • Are my current doctors, primary care physicians and specialists, in the plan’s network? Are the plan’s in-network hospitals near me?
  • Health history
    • Do I have a chronic condition? How many prescription drugs do I take? (Take the time to create a file for your medical history. You can ask your doctor for your medical records and talk about your expected healthcare costs.)

Choosing the right plan can be confusing. Many people work with licensed Medicare representatives who are trained to walk you through choosing a plan. Clover can help you find a licensed Medicare representative in your area.

Step 5: Consider Medicare Advantage Plans

Original Medicare Parts A and B cover all the big stuff, like hospital visits, doctor’s appointments, and some preventive services. But there are a few gaps in Original Medicare coverage. Many Americans choose to enroll in a Medicare Advantage plan, like those offered by Clover Health, when they turn 65. These plans include all the same benefits as Original Medicare but also include several added benefits, like

Medicare Advantage plans offer a cap on what you pay out of pocket each year and give you more comprehensive coverage for greater peace of mind. Click to learn more about Medicare Advantage vs. Medicare.

Learn More About Medicare

Medicare can seem complex, but it doesn’t have to be. Clover Health will help you find out everything you need to know about Medicare and how to enroll in a great plan. It’s never too early to learn about Medicare and discover all your options. Call us today at 1-888-778-1478* 8 am–8 pm local time, 7 days a week to learn more about aging-in to Medicare.