What is the Best Medicare Plan? - Explore Medicare Options with Go Avila Insurance Brokers

What is Medicare?

Medicare is the federal health insurance program for people age 65 and older, certain younger people with disabilities, and people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Original Medicare has two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

How to get Medicare?

Automatic Enrollment

If you already receive Social Security or Railroad Retirement Board (RRB) benefits, you will automatically get Part A and Part B beginning on the first day of the month in which you turn 65 (if your birthday is on the first day of the month, Part A and Part B will begin on the first day of the previous month).

If you are under age 65 and have a disability, you will automatically get Part A and Part B after you receive Social Security disability benefits or certain RRB disability benefits for 24 months.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you will automatically receive Part A and Part B the month your Social Security disability benefits begin. If you are automatically enrolled, you will receive your red, white and blue Medicare card in the mail 3 months before your 65th birthday or 25 months of disability benefits. If you do nothing, you will keep Part B and will have to pay
Part B premiums through your Social Security benefits. You can choose not to keep Part B, but if you decide you want Part B later, you may have to wait to enroll and pay a penalty as long as you have Part B.

Important Note

If you live in Puerto Rico and get Social Security or RRB benefits, you will automatically get Part A on the first day of the month you turn age 65 or after you get disability benefits for 24 months. However, if you want Part B, you must enroll by completing an "Application for Enrollment in Part B Form" (CMS-40B).

Download form CMS-40B in English

Manual Enrollment

If you are close to age 65, but do not receive Social Security or Railroad Retirement Board (RRB) benefits, you must enroll in Medicare by contacting Social Security 3 months before your 65th birthday, or you can also apply online. If you worked for a railroad, you must contact the RRB. In most cases, if you don't sign up for Part B when you are first eligible, you may have a delay in getting Medicare coverage in the future (in some cases, more than a year) and you may have to pay an enrollment penalty for as long as you have Part B.

If you have end-stage renal disease (ESRD) and want Medicare, you will need to sign up. Contact Social Security to find out when and how to enroll in Part A and Part B.

When can I enroll in Medicare?

If you are not automatically enrolled in premium-free Part A, you can enroll in Part A once your Initial Enrollment Period begins. Your Part A coverage will begin 6 months before the month you apply for Medicare (or Social Security/RRB benefits), but no earlier than the first month you turn 65. However, you can only enroll in Part B (or Part A if you have to buy it) during the times listed below.

Initial enrollment period

You can first enroll in Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

If you enroll in Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage begins on the first day of the month of your birthday. However, if your birthday is on the first day of the month, your coverage will begin on the first day of the previous month.

If you enroll in Part A (which you must pay for) and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date of your Part B coverage will be delayed.

Special enrollment period

After the Initial Enrollment Period is over, you may have the opportunity to enroll in Medicare during a Special Enrollment Period. If you did not enroll in Part B (or Part A if you have to buy it) when you were first eligible because you are covered by a group health plan based on current employment (yours, a spouse's or a family member's (if you have a disability), you may be able to enroll in Part A and/or Part B:

As long as it is covered by the group health plan.

During the 8-month period beginning the month after termination of employment or coverage, whichever occurs first

Generally, you do not pay a late enrollment penalty if you enroll during a special enrollment period. This special enrollment period does not apply to people who are eligible for Medicare because of End-Stage Renal Disease (ESRD). It also does not apply if you are still in your Initial Enrollment Period.

Important notes

If you have a disability and group health plan coverage is based on the current employment of a family member (other than a spouse), the employer offering the group health plan must have 100 or more employees for you to get a Special Enrollment Period.

COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, retiree health plans, Veterans Administration (VA) coverage, and individual health coverage (such as through the Health Insurance Marketplace) are not considered coverage based on current employment. You are not eligible for a Special Enrollment Period to enroll in Medicare when that coverage ends. To avoid paying a higher premium, be sure to enroll in Medicare when you are first eligible.

General registration period

If you did not enroll in Part A (if you have to purchase it) and/or Part B (for which you must pay premiums) during your Initial Enrollment Period, and you do not qualify for a Special Enrollment Period, you can enroll between January 1 and March 31 of each year. Your coverage will not begin until July 1 of that year and you may have to pay a higher Part A and/or Part B premium for late enrollment.

Medicare