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Medicare Insurance Plans
Initial Enrollment Period (IEP)
If you are almost 65 and not yet receiving retirement benefits: It is important to note that not all beneficiaries are automatically enrolled in Medicare. If you are not yet receiving retirement benefits, and close to turning 65, you will need to enroll in Medicare Part A and/or Medicare Part B during your Initial Enrollment Period (IEP), It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. You can apply for Medicare Part A and/or Part B through Social Security (if you worked for a railroad, you need to apply through the Railroad Retirement Board). The start of your coverage will depend on which month you sign up during your IEP, and you should receive your Medicare card within 30 days of being approved.
Medicare Resource Center
Medicare Insurance FAQ’s
Medicare benefits start once you reach the age of 65 (unless you qualify by disability). You’re automatically enrolled at age 65 if you’re already receiving Social Security or Railroad Retirement Board benefits.
What if you want to switch to a different Medicare Supplement Insurance plan, but you’re a little concerned that you might be stuck with the new plan and you might not like it as much as your old one? That’s where the Medicare Supplement free look period comes in.
Before getting into the Medicare Supplement free look period, let’s start with a brief summary of Medicare Supplement (Medigap) insurance. As you may know, Medicare Supplement plans are offered by private insurance companies and are designed to fill in some of Medicare’s coverage “gaps” – that is, some of your out-of-pocket expenses, such as Medicare Part A deductibles, coinsurance and copayments.
How does the Medicare Supplement free look period work?
The free look period is a 30-day period during which you have the new Medicare Supplement plan and your old plan at the same time. The Medicare Supplement free look period lets you try out the new plan and see if it meets your coverage and customer service expectations before you commit to keeping it. This free look period typically begins when you receive your new Medicare Supplement plan coverage.
Using the Medicare Supplement free look period while switching plans
If you’re happy with the coverage and customer service you receive from your Medicare Supplement plan, and you think it’s worth the premium that you pay, you don’t need to take any action to renew your plan. You simply keep your Medicare Part A and Part B coverage, paying your Medicare Part B premium (and your Part A premium if applicable) as well as your Medicare Supplement policy’s premium to keep your coverage in effect year after year. However, if you’re considering a switch to a different Medicare Supplement plan, you may be able to take advantage of the Medicare Supplement free look period.
More about the Medicare Supplement free look period
Contrary to what its name suggests, the Medicare Supplement free look period is not free of charge. During this 30-day period you pay two premiums (besides your Part B and/or Part A premium): one to the insurance company that provides your old Medicare Supplement plan, and the other to the insurer offering the new Medicare Supplement policy.
As you approach the end of the 30-day Medicare Supplement free look period, decide which of the two Medicare Supplement plans you wish to cancel. If you cancel the new Medicare Supplement plan, in some states you might be entitled to a refund for the premium you paid during the free look period. You might want to contact your State Health Insurance Assistance Program ( SHIP) for more information.
When you use the Medicare Supplement free look period, you may want to mark your calendar so that you remember to cancel the policy you don’t want after the end of the period. You may want to keep your old policy until after you’ve had the new one for a full 30 days. After you cancel the old plan, you generally can’t get it back.
It may benefit you to take advantage of the Medicare Supplement free look period
Why might you want to have the coverage –and the cost—of two Medicare Supplement plans the first month of your new plan? The free look period may help you to be sure that you want to make this change before it becomes final, so you can “look before you leap.”
Unless you’re within the first six months of your Medicare Supplement Open Enrollment Period or meet other special circumstances where you have guaranteed-issue rights, you usually don’t have the safety net of guaranteed Medicare Supplement plan coverage. Without this guarantee, insurance companies may require you to complete a health questionnaire or examination before making a decision whether or not to provide coverage to you. As a result:
You may not be able to return to your Medicare Supplement plan if you cancel it.Your application for the new Medicare Supplement plan may be turned down.You may have to pay a higher premium for your Medicare Supplement plan.
Help is available if you are considering replacing your Medicare Supplement plan
The Social Security Administration calls employment quarters by several names, such as “quarter of coverage” and “Social Security credits” or simply “credits.”
How credits for Social Security retirement benefits (and thus, Medicare benefits) have been calculated has changed over the years. Today, Social Security credits are based on your total income during the year, and the year is divided into four employment quarters.
The dollar amount needed to earn credits may go up slightly each year, according to the Social Security Administration, as average earnings increase. For more information on the current earnings needed to earn Social Security or Medicare work credit, visit the Social Security website.
There are special rules for certain types of jobs, such as domestic work, farm work, and work for a church or similar organization that does not collect Social Security and Medicare taxes. Employment of this sort may count towards your employment quarters for retirement and Medicare benefits, but you should contact the Social Security Administration to confirm. Conversely, some people may not qualify for Social Security retirement credits, such as federal employees hired before 1984, railroad employees with more than 10 years of service, and employees of some state and local governments. Other factors may be used to determine their eligibility for premium-free Medicare Part A.
Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare, Part A and Part B.. There are currently 10 standardized Medigap plans and one high-deductible plan available in most states. Each plan is named with a letter: Plan A, B, C, D, F, G, K, L, M, N, and a high-deductible version of Plan F.
Quick facts about Medigap policies
All insurance companies that sell Medigap policies must offer Plan A. If a company offers any Medigap plan besides Plan A, it must also offer either Plan C or Plan F.Each standardized Medigap plan option must provide the same basic benefits. For example, a Plan A policy sold by a company in Texas will have the same basic benefits as a Plan A policy from a company in New York.Plans E, H, I, and J are no longer available. However, if you already have one of these plans, you can keep using it.Not all Medigap policies may be available in your state (for example, Massachusetts, Minnesota and Wisconsin have different standardized plans).In some states, you can purchase a type of Medigap policy called Medicare SELECT. Medicare SELECT can be any standardized Medigap plan. Unlike other Medigap plans, a Medicare SELECT plan may require you to use certain network providers and hospitals.
Benefits covered by Medigap policiesAll Medicare Supplement plans cover coinsurance on hospital costs, up to an additional 365 days after your Medicare Part A hospital benefits have run out.
All Medigap policies also cover at least part of these costs:
Medicare Part A hospice coinsurance or copaymentMedicare Part B coinsurance or copaymentThe first three pints of blood received as a hospital inpatients
Plan A is the most basic Medigap policy because it covers only these benefits.
Medicare Part A costs covered by Medigap plans
Coinsurance for hospital stays, as noted above.Coinsurance for skilled nursing facility (SNF) stay.Copayment or coinsurance for hospice care—Medigap plans cover 50 to 100% of your copayments and coinsurance for Part A hospice care expenses, depending on the plan option you choose.Medicare Part A deductible—although Medigap Plan A doesn’t cover this deductible, the remaining plans cover 50 to 100% of this cost.
Medicare Part B costs covered by Medigap plans
Copayment or coinsurance—Medigap plans cover 50 to 100% of your Medicare Part B copayment and coinsurance amounts, based on the chosen plan.Medicare Part B deductible—only two plans cover the deductible: Plan C and Plan F. This is one reason why these are two of the most popular plans.Medicare Part B excess charges—Medicare Part B excess charges occur when a health care provider declines to accept Medicare assignment (a payment agreement with Medicare) for a particular procedure or visit. Excess charges are covered by two Medigap plans: Plan F and Plan G.
Blood transfusionsAlthough hospitals often get blood at no cost from subsidized blood banks, you will likely be charged if a hospital must purchase additional blood for you. Medigap plans cover 50 to 100% of the cost for the first three pints of blood; Original Medicare will start paying after the third pint.
Skilled nursing facilitiesMedicare covers certain limited care at skilled nursing facilities. Most Medigap plans cover 50 to 100% of the coinsurance for this type of care, but Medigap Plan A and Plan B don’t include this benefit.
Foreign travelBecause Medicare generally provides coverage only in the United States and its territories, a number of Medigap plans cover foreign travel emergencies (up to plan limits). If you travel on a regular basis, you may want to consider one of these plans: Plan C, D, F, G, M, or N.
What Medigap policies don’t cover
Long-term care (care in a nursing home)Routine vision or dental careHearing aidsEyeglassesPrivate-duty nursing
For more Medigap coverage details
You can manually enroll in Medicare Part A and/or Medicare Part B in the following ways:
Online through the Social Security website.By calling Social Security toll-free at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7AM to 7PM. If you worked at a railroad, call the Railroad Retirement Board at 1-877-772-5772 (TTY users 1-312-751-4701), Monday through Friday, from 8AM to 3:30PM.By visiting your local Social Security office.
Applying online through the Social Security website is the easiest and fastest way to request a new Medicare card. You may be asked to provide the following:
Your full legal name as it is printed on your Medicare cardYour Social Security number (even if you are receiving Medicare benefits through a spouse)Your date of birthYour phone number or email address, in case Social Security needs to contact you regarding your request
You may also be asked to provide information to verify your identity, such as your place of birth or your mother’s maiden name. The Social Security website relies on encrypted data to ensure that beneficiary information transmitted online is kept confidential. For security reasons, there is a 30 minute time limit to complete each page on the online application. After 30 minutes, you will be prompted by the website and can request more time to finish if needed.
Call Social Security at 1-800-772-1213. TTY users can call 1-800- 325- 0778. Representatives are available Monday through Friday, from 7AM to 7PM.
You may be able to receive benefits from Social Security and Medicare before you turn 65 if you’re permanently disabled. You might also qualify if you have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) or permanent kidney failure (end-stage renal disease, or ESRD). Generally, your doctor must confirm that you are unable to work for at least 12 consecutive months in order for you to qualify for Social Security disability benefits.
If you have a disability, you can apply for disability benefits from the Social Security Administration (SSA). If you worked for a railroad, you might qualify for disability benefits from the Railroad Retirement Board (RRB). If the SSA or RRB determines that you qualify for benefits, you may be eligible for Medicare benefits, but not right away in most situations.
Who qualifies for Medicare under the age of 65?
To be eligible for Original Medicare (Part A and Part B) benefits before you turn 65, you must meet one of the following criteria:
You have received SSA or RRB disability benefits for 24 consecutive monthsYou have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)You have end-stage renal disease, also known as ESRD. This is permanent kidney failure requiring a kidney transplant or a regular course of dialysis
Who is automatically enrolled in Medicare Part A and Part B?
If you are approved for SSA or RRB benefits because of your permanent disability, Medicare enrollment may be automatic. Once you have been receiving SSA or RRB disability benefits for two years (24 consecutive months), you will be automatically enrolled in Medicare Part A (hospital insurance) during the 25th month. If you live in any of the 50 United States or the District of Columbia, you will also be automatically enrolled in Medicare Part B (medical insurance).
If you have Lou Gehrig’s disease, you will be automatically enrolled in Medicare Part A and Part B during the first month that you start receiving your SSA or RRB disability benefits.
Who needs to enroll manually?
In some cases, Medicare enrollment doesn’t happen automatically. For example, if you:
Have end-stage renal disease (ESRD), which is permanent kidney failure requiring regular dialysis treatments or a kidney transplantLive in Puerto Rico and qualify for automatic enrollment in Medicare Part A (you still typically need to enroll in Part B manually)Have reached your 25th month in a row of receiving disability benefits (or your second month, if you have Lou Gehrig’s disease) and haven’t received Medicare enrollment information
– then sign up for Original Medicare through Social Security (or the RRB, if you worked for a railroad) as described below.
When is my Medicare enrollment period?
In most cases, if you receive SSA or RRB disability benefits, your Medicare Initial Enrollment Period (IEP) starts the 22nd month of receiving these benefits, continues through your qualifying month (the 25th month), and goes until the end of your 28th month of receiving benefits. That’s a total of seven months.If you have to enroll in Medicare manually, you can begin the enrollment process anytime during your IEP.If you have Lou Gehrig’s disease (ALS), your Medicare enrollment period may vary depending on your situation. Your enrollment should happen automatically if you receive disability benefits, but if you have questions you can contact Social Security (contact information below).If you have end-stage renal disease (ESRD), again, your Medicare enrollment period may vary depending on your situation. Call Social Security for details (or the RRB if applicable – contact information for both agencies is below).
How to apply manually for Original Medicare
The Social Security Administration (or Railroad Retirement Board, if you worked for a railroad) handles Medicare enrollment. You can apply in any of the following ways.
Apply online at https://www.ssa.gov/forms/apply-for-benefits.html.Call 1-800-772-1213 Monday through Friday between the hours of 7AM and 7PM to make an appointment. TTY users should call 1-800-325-0778.Visit your local Security Service office.If you worked for a railroad, contact the RRB or visit the agency’s website. Call 1-877-772-5772 (TTY users call 1-312-751-4701) Monday through Friday, 9AM to 3:30PM, to speak to an RRB representative.
Call Social Security at 1-800-772-1213. TTY users can call 1-800- 325- 0778. Representatives are available Monday through Friday, from 7AM to 7PM.