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Whether you’re new to Medicare, getting ready to turn 65, or preparing to retire, you’ll need to prepare to make important decisions about your health coverage. Waiting to enroll, may cause you to pay a penalty, or have a gap in your coverage.
The different pieces of Medicare help cover specific services.
There are only certain times when people can enroll in Medicare. Depending on the situation, some people may get Medicare automatically, and others need to apply for Medicare. The first time you can enroll is called your Initial Enrollment Period.
Your 7-month Initial Enrollment Period usually:
Get an estimate of when you can enroll in Medicare
If you don’t enroll when you’re first eligible, you may have to pay a late enrollment penalty, and you may have a gap in your coverage.
Most people should enroll in Part A when they turn 65, even if they have health insurance from an employer. This is because most people paid Medicare taxes while they worked so they don’t pay a monthly premium for Part A. Certain people may choose to delay Part B.
In most cases, it depends on the type of health coverage you may have. Everyone pays a monthly premium for Part B. The premium varies depending on your income and when you enroll in Part B.
If you decide you want Part A and Part B, there are 2 main ways to get your Medicare coverage.
Some people get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap). Most people who are still working and have employer coverage don’t need additional coverage.
Some people automatically get Part A and Part B. It’s important to find out if you’ll get Part A and B automatically. If you're automatically enrolled, you'll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability. If you don't get Medicare automatically, you’ll need to apply for Medicare online.
A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn't cover such as medical care when you travel outside the U.S.
If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Some types of insurance aren't Medigap plans, they include:
If you decide to drop your entire Medigap policy, you need to be careful about the timing. You may want a completely different Medigap policy—not just your old Medigap policy without the prescription drug coverage. Or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.
You have to pay a late enrollment penalty when you join a new Medicare drug plan if:
Your Medigap policy may offer additional coverage for health care services or supplies that you get outside the U.S.
If you have Medigap Plan C, D, E, F, G, H, I, J, M or N, your plan:
Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.
Before you travel outside the U.S., talk with your Medigap plan or insurance agent to get more information about your Medigap coverage while traveling.
Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.
If you apply for Medigap coverage after your open enrollment period, there's no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you're eligible due to one of the situations below.
In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. If you buy a Medigap SELECT policy, you have rights to change your mind within 12 months and switch to a standard Medigap policy.