SIGNING UP FOR MEDICARE
Medicare Is Not Nearly As Scary Or Intimidating As It Seems If You Work With A Licensed Medicare Broker. Just remember to keep your sense of humor. After all, the government came up with Medicare, so it is most likely going to be confusing as you learn more about it.
As soon as you turn 64 years of age, you should start researching Medicare. The first step is to learn how to sign up for Medicare, when to sign up for Medicare, and whether you qualify to sign up for Medicare online.
Signing up for Medicare is easy. The easiest way to sign up for Medicare is to do so online through the Social Security website https://www.ssa.gov/benefits/medicare/.
ENROLLING IN MEDICARE HAS NO IMPACT ON YOUR SOCIAL SECURITY INCOME
Because Medicare is a subset of Social Security law, your Medicare enrollment is managed through the Social Security Administration.
However, it is important to understand that enrolling in Medicare does not trigger your Social Security income. They are entirely separate enrollment processes. To enroll in both Medicare Part A & Medicare Part B, just scroll down to the bright blue button “Apply for Medicare Only”. Clicking the button will open a pop-up window to start the application. You will be brought to a Checklist:
You may enroll in either Medicare Part A, Medicare Part B, or both in one of 3 ways:
- Apply online using the Social Security Administration’s Website at https://www.ssa.gov/benefits/medicare/.
- Call your local Social Security Office and set up an Appointment in person.
- You can call either your local SSA office or the National Toll-Free number for the Social Security Administration and apply over the telephone. Plan on starting the enrollment process early, as it usually takes 6-8 weeks to receive your Medicare Card in the mail.
MEDICARE IS THE NATIONAL HEALTHCARE PLAN FOR AMERICANS 65 & OLDER
Of course, we cannot discuss how to sign up for Medicare without using some of Medicare’s terminology. So, let’s start by briefly reviewing what you need to know about Medicare. Once you enroll in Medicare, you will receive a red, white, and blue card as proof of enrollment in Medicare Part A and Medicare Part B. We will cover Medicare Part A and Part B very shortly. One of the most confusing features of Medicare is terminology.
Medicare is made up of “Parts” and those parts are referred to by a letter. There is Medicare Part A, Medicare Part B, Medicare Part D, and lastly Medicare Part C (aka Medicare Advantage Plans), which is a privatized replacement of Medicare Parts A & B. In this article, we will focus solely on Medicare Part A and Part B, also known as Original Medicare.
WHAT IS MEDICARE PART A?
Medicare Part A is that part of your Medicare health insurance that is used when you are an inpatient in a medical facility. I can be a hospital, skilled nursing facility, or hospice. Or, if you are unable to travel and must have home healthcare. That is all covered under Medicare Part A. In the simplest of terms, Medicare Part A is your inpatient Medicare coverage. Medicare Part A is also that portion of your Medicare that you pay for through payroll taxes. Have you ever looked at your pay stub and noticed a deduction for Medicare? Those payroll deductions pay for Medicare Part A. If you or your spouse has paid that tax for at least 40 quarters, then your Medicare Part A should be fully paid for.
If you or your spouse have not paid that tax for at least 40 quarters, then you may be able to buy Medicare Part A.
You must be a U.S. citizen or legal resident, and for Part A, you will have a monthly premium.
WHAT IS MEDICARE PART B?
Medicare Part B is health insurance for Outpatient and Physician services. This is the Medicare health insurance you use when you visit a doctor or get tests done. Medicare Part B is not free. It was not paid for by your Medicare payroll tax. You will have a monthly premium for Medicare Part B. That monthly premium is based on adjusted gross income as of 2 years ago. I will go into more detail on that next.
HOW MUCH WILL MEDICARE COST YOU?
As mentioned above, for most people, Medicare Part A should already be paid for by the time a person starts Medicare. In that case, there will be no monthly premium due for Medicare Part A. However, you will pay a monthly premium for Medicare Part B.
HOW WILL I BE CHARGED FOR MEDICARE PART B?
The amount you pay for Medicare Part B each month is referred to as your
Medicare Part B Premium. The exact amount of your premium for Medicare Part B will depend on your income. More accurately, it will depend on your income as it was two years ago. The Medicare Part B premium is made up of two parts, the base premium and the IRMAA surcharge.
The majority of Medicare beneficiaries will pay $187.00 per month in 2025 for Medicare Part B. Everyone has to pay this amount, regardless of whether you want to join Original Medicare, Medicare Part C (Also most commonly referred to as Medicare Advantage), or purchase a Medicare Supplement or Medigap Policy. You cannot avoid the $187.00 Per Month Part B monthly Premium.
WHAT IS IRMAA?
IRMAA stands for Income-Related Monthly Adjustment. It is an extra charge for Medicare Part B and Medicare Part D based on your income. Medicare uses your income as reported two years ago. For example, to see if there are any charges due in 2025, Medicare looks to your income as reported to the IRS for tax year 2023. In 2025, Medicare will look at your 2023 tax return, and so on. The IRMAA charge is levied by Medicare. IRMAA levels and charges change each year. The table that defines the level of income required to be obligated to pay extra can change annually. For 2024, the Medicare Part B premium and IRMAA charges are shown below.
Keep in mind that IRMAA charges are based on a rolling two-year history of your Modified Adjusted Gross Income. Medicare looks at your taxes. In addition, the tables defining the level of income required can change each year as well.
IS THERE A CERTAIN TIME WHEN SOMEONE CAN ENROLL IN MEDICARE?
Most people will want to enroll in Medicare during their Initial Medicare Enrollment Period (IEP). This is a seven-month window that includes the calendar month they turn 65, the three calendar months prior to the month they turn 65, and the three calendar months after the month they turn 65.
This time period is when a person can enroll in the various parts of Medicare without a penalty. Not surprisingly, there are exceptions to this rule. That exception is for those whose birthday lands on the first day of the month. If your birthday lands on the first day of a month, your Medicare start date and entire initial enrollment period are moved forward by one full calendar month.
ONCE I HAVE ENROLLED, HOW LONG BEFORE
MEDICARE STARTS?
For most people, the earliest your Medicare can start is the first day of the month you turn 65. If you turn 65 on the 31st day of the month, your Medicare can start on the first day of that month, 30 days before your 65th birthday.
As mentioned above, if your birth date is the first day of the month, your earliest Medicare start date will be the first day of the month before you turn 65. Your entire Initial enrollment Period is adjusted forward by one month to accommodate the earlier start. There is also a time penalty for enrolling during your initial enrollment period, but after your birthday month. This is how it works:
TIMING IS EVERYTHING
If you sign up for Medicare before your birthday month, your Medicare start date will be the first day of your birthday month. The exception to this is if your birthday is the first day of the month. If so, your entire enrollment period moves forward by one month. When you sign up for Medicare during the month you turn 65, your Medicare will start the first day of the next month. Submitting your Medicare Application, the month following your birthday month pushes your start date out. Your Medicare will start on the first day of the second month after your application is submitted. If you sign up for Medicare during the last two months of your seven-month initial enrollment period, your Medicare will start on the third month after the month you applied for Medicare. This is very important if you are trying to time the start of your Medicare to a specific month. This often happens to match a spouse’s Medicare start date or a specific retirement date.
DOES MEDICARE HAPPEN AUTOMATICALLY?
Contrary to what many believe, Medicare enrollment is not automatic. Most people will have to physically sign up for Medicare, just as you must apply for Social Security Income. There are two exceptions to this rule. First, any person who is already receiving Social Security Income or Railroad Retirement income at least four months before their Initial Enrollment Period begins will automatically be enrolled in Medicare. Medicare will start on the first day they are eligible per the start dates detailed above. You will then have the option of opting out of Medicare Part B. The second exception is for people who are under 65 and on Social Security Disability Income. These people will automatically be enrolled in Medicare Part A and Part B on the 25th month of their income. For some disabilities like ALS, enrollment in Medicare will be automatic and start as soon as your Social Security benefits begin.
SO……. AT 65, DO I HAVE TO ENROLL IN MEDICARE?
If you are planning to work past age 65, great, a lot of people are working as long as they can or until they decide to actually begin receiving their Social Security benefits. You do not have to join Medicare; however, sometimes it makes sense to do so. But the best thing you can do is have a conversation about it. Before you do anything, take a look at your current Employer’s Health plan. Write down how much you pay in deductions each week/month, and know how much your deductible is for both your healthcare and your prescription medications. Then, compare that to Medicare, and you may be surprised by what you find out.
Medicare considers Employer Health coverage credible, as long as your company has more than 20 employees; if they have fewer than 20, that coverage will not be credible. So, if you work for a small company, you may not have a choice.
Many companies offer separate Health plans for those over 65. Many municipalities and Federal agencies offer Medicare Supplement or Medicare Advantage plans. If they don’t, it is a good idea to meet with your benefits administrator or HR representative to see what they have to offer.
Employers are not allowed to enroll you in Medicare. And your employer cannot pay your Medicare bills. But what they can do is pay you a stipend each month in lieu of providing you their Employer Healthcare plan, and you can reimburse yourself for Original Medicare, a Medicare Supplement Plan G, and a Medicare Stand-Alone PDP.
More and more companies are willing to reimburse you for the cost of your Medicare Part B Premium, your Medicare Supplement Premium, and your PDP premium in exchange for you coming off of their company health plan. It helps the, and in most cases, reimbursing you is better coverage at a lower cost than your employer can offer. Plus, it usually costs them less to reimburse you than to have you on their plan.
THE BIGGEST MISTAKE IS MISSING YOUR INITIAL ENROLLMENT WINDOW
Your guarantees, your rights to get certain Medicare coverage, are anchored to the date your Medicare Part B starts. This is referred to as your Medicare Effective.
Date. For example, you can get any Medicare supplement you want without medical questions asked and without pre-existing conditions, as long as you sign up for the Medicare supplement within six months of your Medicare Part B effective date. After that six-month period, you are no longer guaranteed to get a supplement. This is why it’s important not to get your Medicare Part B until you expect to be using Medicare as your primary health insurance.
WHAT IS CREDIBLE COVERAGE?
If your healthcare is expected to pay as much as Medicare on average, it may be considered creditable coverage.
You can have healthcare that is creditable for Medicare Part A & Part B and /or Medicare Part D. If you are eligible for Medicare and have insurance coverage other than Medicare, you should receive an annual notice disclosing if the insurance is not creditable.
When you are 65 or older, in order for your group health insurance to be creditable coverage for Medicare Part B, your employer must have at least 20 employees. If you are under 65, your employer must have 100 employees for the insurance to be considered creditable. COBRA is not considered creditable coverage.
HOW DO I GET SIGNED UP FOR MEDICARE PART A?
The language of the application refers mostly to Medicare Part B. If you are eligible for premium-free Medicare Part A, you will automatically receive Medicare Part A when you enroll in Part B.
Helpful Hint – If you haven’t already, you should create an online Social Security account at https://www.ssa.gov/. It not only helps you monitor your Social Security benefits, but you will also be able to view your Medicare number.
ARE YOU OVER 65 NOW?
If you are over 65 and outside of your seven-month Medicare Initial Enrollment Period, you must prove to Social Security that you have had creditable employer health coverage since you turned 65. You do so by having your employer acknowledge that you have had creditable healthcare since you turned 65. They will do so using the CMS-L564 form. Without this form, you may be subject to a permanent financial penalty of 10% of the Medicare premium for every 12months without coverage for the rest of your life. In addition, you may be limited to enrolling in Medicare only during the Medicare General Enrollment Period (January 01 through March 31) for a July 01 start date.
Because you need to provide proof of creditable coverage, enrolling in Medicare when over 65 and outside your initial enrollment period is a different process than enrolling in Medicare when turning 65. To enroll in Medicare when you are over 65 and outside your Medicare Initial Enrollment Period, go to https://www.ssa.gov/benefits/medicare/, then scroll down about halfway down the page until you see the heading “Already Enrolled in Medicare.”
Under the Already Enrolled in Medicare heading, you will find detailed instructions and links to the application and forms you will need to enroll in Medicare. The instructions allow you to FAX or mail in these forms. Of course, if the Social Security offices are open, you will be able to physically deliver these forms to the Social Security office as well.
DID YOU KNOW?
You will be able to select your Medicare Part B start date. Medicare can only start on the first day of the month. However, you can choose any month you would like for your Medicare Part B to start. Just be careful not to choose a month that is not within your 7-Month Initial Enrollment Period!
MEDICARE START DATES
Medicare starts on the 1st day of your birth month when you turn 65. Unless you were actually born on the 1st? If you were lucky enough to be born on the 1st day of the month, then your Medicare start date will be the 1st day of the month before your birth month!
Your Medicare Part A will start retroactively if you are 65 or over and outside your Initial Enrollment. It will start either six months retroactive to your enrollment in Medicare Part B, or on the first day of the month you turned 65 (whichever is soonest).
AFTER YOU HAVE SUCCESSFULLY ENROLLED IN MEDICARE
Once your application for Medicare benefits is received by Social Security, you can expect it to take about 20-30 days before you receive your new Red, White, and Blue Medicare Card.
If you have created a Social Security Benefits account, you may be able to see your Medicare number and monitor the progress of your application online. While problems with your Medicare enrollment are rare, we encourage everyone to monitor the progress of their application. If, after 45 days, you have not yet received your Medicare card, it is advised that you contact a local Social Security office and request that they investigate the progress of your application.
THERE ARE CERTAIN THINGS YOU SHOULD DO AND SOME THINGS YOU HAVE TO DO EVERY YEAR
- If you choose to join a Medicare Advantage plan you need to review your Plan each year in the fall and either decide to keep you existing plan for the coming year (provided it is still available), or you need to enroll in a new/different plan each year during the Medicare Annual Enrollment Period which takes place between October 15th and December 7th each year.
- If you have a Stand-Alone Medicare Part D Prescription Drug plan, you need to review your current plan, compare it with the new premium the plan will have for the next year, and/or enroll in a different plan by December 7th each year. We recommend having your Broker review your Medications and your PDP for you every year. This is a free service and does not cost you anything.
- If you choose a Medicare Supplement or Medigap plan, your plan automatically renews unless you cancel it. You do not have to enroll in a new plan every year, like you have to do with an MA plan.
- Once you enroll in Medicare, you are done, and you will never have to reenroll in Medicare ever again.
Michael “Mike” Braden