In some cases, a person automatically qualifies for Original Medicare. In other instances, a person must apply for Medicare and will need certain documents, such as a birth certificate and driver’s license.
Individuals who sign up to receive retirement or disability benefits from Social Security (SS) or the Railroad Retirement Board (RRB) are automatically signed up for Medicare Part A upon approval.
Individuals who begin receiving SS or RRB benefits at least 4 months before their 65th birthday will be automatically signed up for both Part A and Part B when they reach 65 years old. They can choose to keep or opt out of Part B.
This article examines Medicare plans and how and when to enroll. It also discusses the documents needed and costs.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Enrollment in Medicare is based on several eligibility factors and individual circumstances, including a person’s age and whether they already receive Social Security or Railroad Retirement Board benefits.
For example, to be eligible for Medicare, a person must be 65 years old or older, or under 65 and living with a disability. However, a person of any age is eligible for Medicare if they have end stage renal disease (ESRD) or permanent kidney failure that needs treatment or dialysis.
In addition, a person must either be a United States citizen or have been a permanent legal resident for a continuous period of 5 years, be eligible for Social Security benefits, and have been making Medicare tax payments for at least 10 years (40 quarters).
The documents needed to enroll in Original Medicare (parts A and B) include:
- a birth certificate
- driver’s license
- proof of U.S. citizenship or legal residency
There are several Medicare enrollment periods.
Initial enrollment period
The initial enrollment period (IEP) is 7 months, which includes the 3 months before a person is 65 years old, the birthday month, and the following 3 months.
Many people are automatically enrolled in Medicare when they turn 65 years old and have had Social Security benefits or Railroad Retirement benefits for at least 4 months.
However, if a person is not automatically enrolled, they can sign up online on the Social Security Administration website or in person at their local Social Security office.
A person can also call the Social Security Administration at 1-800-772-1213, or mail a signed letter to the Social Security office that includes the applicant’s name, the date for enrollment to start, and the person’s social security number.
If a person wants proof of their Medicare enrollment, they can print the online confirmation page, ask for a receipt if they apply in person, or use certified mail.
Open enrollment period
The general enrollment period (GEP), or open enrollment period (OEP), is annually from October 15 to December 7, and coverage generally starts on January 1 of the following year. If a person did not enroll during the IEP, they can enroll during the OEP.
During the OEP, a person can enroll in Original Medicare, and, if they have an Advantage plan, can switch to another plan or to Original Medicare. However, a person with Original Medicare cannot switch to an Advantage plan during the OEP.
Medicare Advantage open enrollment period
The Medicare Advantage OEP is from January 1 to March 31 annually.
During the Medicare Advantage OEP, a person can switch from Original Medicare to an Advantage plan, or from an Advantage plan to Original Medicare.
A person may also switch between Advantage plans, or enroll in or cancel a Part D prescription drug plan.
Special enrollment period
During the special enrollment period (SEP), a personcan enroll in Medicare in specific circumstances, such as when moving in or out of a skilled nursing facility or after losing other health insurance such as through an employer.
A person can enroll in Original Medicare Parts A and B during the SEP, which generally lasts for 8 months.
The cost of enrolling in Medicare depends on a few factors, such as income and calendar quarters a person has accumulated while working.
Part A
Premiums for Part A depend on how many quarters a person has worked. If a person has worked 40 quarters in their lifetime, Part A is premium-free.
However, if a person has between 30–39 quarters, the monthly premium is $285. The cost of the monthly premium increases to $518 for people who worked less than 30 quarters.
A person will also have to pay a deductible of $1,676, and coinsurance.
If a person is 65 years old, they could be eligible for premium-free part A based on their spouse’s work history. This eligibility applies to the following people:
- A person who is married for at least 1 year and their spouse is eligible for social security benefits.
- A single person who is divorced but was married for at least 10 years and the divorced spouse is eligible for social security benefits.
- A widowed single person who had been married at least 9 months before the spouse died.
Part B
The basic Part B monthly premium is $185. However, if a person’s annual income is more than $106,000, the monthly premium may increase.
The deductible is $257, and a person generally pays 20% coinsurance.
Part C
Premiums for Part C (Medicare Advantage) plans vary depending on the plan and the provider. A person can check online to find plans and costs.
Part D
The cost of Part D plans depends on the individual plan, the drugs available in the plan, and a person’s income. A person can compare Part D costs using this online tool.
Medigap
Medigap plans also vary in cost and coverage. The plans are identified by a letter and are standardized across most states.
This online tool can help a person compare Medigap plans.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Some people automatically qualify for Original Medicare. However, a person may need to enroll in the various Medicare parts, including Original Medicare (Part A and Part B), Part C (Medicare Advantage), and Part D. There are several enrollment periods throughout the year, plus a special enrollment period.
The documents needed to enroll in Medicare Part A and B include a birth certificate, driver’s license, and proof of U.S. citizenship or legal residency.