New to Medicare? Aaagh!

What now?
So, this is the year I reach age 65 and go on Medicare. What am I supposed to do now? Is this an automatic thing that will just happen, or do I need to make all kinds of preparations and plans? Will my doctor still see me, or do I need to find a new one? What about prescriptions? Is Medicare all I will need, or do I need to carry additional coverage? Do I need to take Medicare Part B? What are Parts C & D?
Relax and take a deep breath. Help is here.

Medicare Classroom

Apply for Medicare

If you are already receiving Social Security, you will not need to apply for Medicare. Your card will automatically come three months before your Medicare effective date.
If you are not already receiving Social Security, then you will need to apply either online or by appointment with your local Social Security office. You may do this anytime within three months of your Medicare effective date. Your Medicare effective date will be the 1st of the month that you turn 65 unless your birthday is on the first of the month, then it will be the first of the prior month. I recommend doing this as early as possible in the month that you are eligible to apply (for example, if your Medicare effective date will be August 1, you should start your application as early as possible in May).
You can apply for Medicare either through Social Security’s website, Medicare’s website or by making an appointment with the local Social Security office (if you plan to go to the Social Security office to apply, I recommend calling Social Security a month in advance as they are usually booked up about a month out).

Apply for Medicare Through Social Security Website

Go to https://www.ssa.gov/medicare/.
Click on “Sign up for Medicare,” then “Start application.”

Apply for Medicare through the Medicare Website

Go to www.medicare.gov.
Click on the box that says “Get Started with Medicare,” and follow the prompts.

Apply for Medicare through Social Security

Call Social Security (800) 772-1213 to make an appointment at the local office. If you choose this option, you should try to make the appointment at least three months before you wish to enroll (I have heard that it sometimes takes three months to get an appointment). For example, if you will be going on Medicare in January, you will need to have an appointment in October, which means you should call to make the appointment in July.

Elderly people

Do I Qualify for Medicare?

There are only two conditions you need to meet to qualify for Medicare benefits:
You must have paid money (taxes) into the Medicare system for at least ten years.
You must be age 65 or older, unless you have a disability or permanent kidney failure.
If you meet the above criteria, you are eligible for both Medicare Parts A & B. Part A will not cost you anything (the money you have paid into FICA over the years was for this).

Do I need Parts A & B?

Part B, however, is optional and does have a premium. The cost of Part B is dependent upon your income. Medicare looks back 2 years, so if you made less than $97K ($194K for couples) in 2021, your premium would be $164.90 (in 2023). If your income is above those thresholds, your premium will be higher.
Whether you are retired or still working, you should sign up for Medicare Part A when you first become eligible. For most people, there is no premium required (you already paid for it in your taxes). It might help pay some of your group deductibles or co-insurance if you are hospitalized.
Almost everyone who is eligible for Part B should enroll. There are a few exceptions (i.e., either you or your spouse is still working, and you have group coverage with a minimum of 20 employees). If you don’t sign up for Part B when you are first eligible and change your mind later, you will possibly have a late enrollment penalty. If you are covered under your or your spouse’s group health insurance plan, you will not have a late enrollment penalty. Not all group plans are a better option than signing up for Medicare Part B. You should consider what the cost is to you (for premiums) and what the deductibles and out-of-pocket exposure are.

Medicare Classroom

What is Part C?

Medicare Part C is also known as Medicare Advantage.
In short, Medicare Advantage Plans are an alternative to traditional Medicare. You should make sure you fully understand how they work before you sign up for one.
For more information on these plans, go to Comparison of Traditional Medicare & Medicare Advantage page.
If you think a Medicare Advantage Plan is best for you, or if you would like more information, contact me.

Part D?

Medicare Part D is prescription drug coverage. It is also optional, and whether you need to participate depends on several factors.
If you already have prescription coverage through a group plan, you probably don’t need Part D.
If you are a Veteran and are currently receiving your health care through the VA, you might not need to take Part D. However, if you are not already receiving care from the VA, be aware that you might not be eligible to receive treatment through them. To find out if you are eligible for VA benefits, go to http://www.va.gov/. You will need to fill out a form and submit it for consideration.
If you would like help researching which prescription drug plan is best for you, contact me, and I will do the research for you. There is no charge for me to do this, nor does it obligate you to purchase anything. However, I will need your zip code, prescription list (including dosages and frequency), a preferred local pharmacy, and either a phone number or email. I will then contact you with the results of the search (or if I have any questions).

What is Traditional Medicare?

If you intend to enroll in traditional Medicare (meaning you don’t plan to enroll in a Medicare Advantage Plan), you should enroll in a Medicare Supplement Plan.

Before purchasing a Medicare Supplement, you should obtain a “Guide to Health Insurance for People with Medicare.” This publication is put out by the National Association of Insurance Commissioners, and anyone who attempts to sell you a Medicare Supplement must provide you with a copy of the guide. If you would like a copy, contact me, and I will see that you get one.

If you currently have a primary care physician, you should contact him/her to be sure he/she will continue to see you if you go on traditional Medicare. You might also ask which Medicare Advantage Plans he/she will accept.

Finally, if you have access to a computer, you should go to https://mymedicare.gov/ and sign up for MyMedicare.gov.

Mymedicare.gov/ is a secure online service where you can access your personal Medicare information 24 hours a day, every day. Here’s what you can do with MyMedicare.gov:

  • Complete your Initial Enrollment Questionnaire (IEQ)
  • Track your health care claims
  • Order a duplicate Medicare Summary Notice (MSN) or replacement Medicare card
  • Check your Part B deductible status
  • View your eligibility information
  • Track your preventive services
  • Find information about your Medicare health or prescription drug plan, or search for a new one
  • Keep your Medicare information in one convenient place
  • Sign up to get the “Medicare & You” handbook electronically

You can find a plethora of other information about Medicare and your rights options and entitlements from my website https://medicareclassroom.com/.
If you don’t find an answer to your question, you may contact me, and I will try to find the answer for you.
I can be reached at (303) 690-3280, or you can email me at [email protected].
Disclaimer:
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
I am not affiliated with the U.S. Government or the federal Medicare program. This is a solicitation for insurance.