How to Apply for Medicare
We pride ourselves in helping you discover the very best plans and options when it comes to your healthcare, but some people would prefer to go through this process on their own without taking advantage of our help. No hard feelings!
We would love to help you or your loved ones with the Medicare application process, but we’ve put this page together to let you know what to expect if you decide to go at it on your own.
Applying for Medicare can be tricky, and you could end up with a suboptimal plan, but if you want to go through the process all on your own, here’s what you need to know…
Applying for Medicare: Where to go
Medicare is a national health insurance program in the United States for people:
- over the age of 65
- under the age of 65 with certain disabilities (and receiving disability benefits for a minimum of 24 months)
- diagnosed with End-Stage Renal Disease
It is managed by the Centers for Medicare and Medicaid Services (CMS) with Social Security assisting with enrolment.
If you are ready to apply for Medicare coverage, there are a few ways to start the application process:
- In-person: Through your local Social Security office – hours of operation may vary.
- By Phone: You can reach Social Security at 1-800-772-1213 (TTY users 1-800-325-0778) Monday to Friday, between the hours of 7 AM to 7 PM
- Online: www.SocialSecurity.gov
- With our guidance: Would you like us to help you with this entire process? You can reach out to us.
When should I apply for Medicare?
If you are receiving retirement benefits like Social Security or Railroad Retirement Board (RRB) benefits, you will be automatically enrolled in Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) when you turn 65.
If you aren’t receiving retirement benefits and you are 65 or older (or turning 65 within three months) you will have to sign up for Medicare Part A and Medicare Part B on your own, it will not happen automatically.
There are two windows where you can apply for Medicare without facing a penalty or loss of coverage.
The first window is called the Initial Enrollment Period (IEP) which begins three months prior to your 65th birthday, includes your birthday month, and ends three months after you turn 65 for a total of seven months.
The second enrollment window is Medicare’s General Enrollment Period which runs from January 1 to March 31 of every year. During this time you may enroll in Medicare or make changes to an existing plan.
It’s recommended that you apply for Medicare during your Initial Enrollment Period (IEP) even if you don’t need health benefits right away. This way, you won’t be denied coverage and you won’t face late enrollment penalties.
Things to Know Before You Apply
- If you are under 65 and receive certain disability benefits from Social Security or the RRB you will be automatically enrolled in Medicare Part A and Part B, after receiving disability benefits for 24 months.
- Medicare Part B is optional, but you might pay a penalty and/or risk being denied coverage if you enroll outside of the designated enrollment times.
- If you live in Puerto Rico you will not be automatically enrolled in Medicare Part B, you will need to manually enroll during your IEP or Medicare’s General Enrollment Period.
Special Enrollment Period
If you don’t enroll during your Initial Enrolment Period, you may qualify for a Special Enrollment Period (SEP).
To qualify you must be age 65 or older, employed (or have a spouse who is employed), and have coverage through a group health plan based on current employment. During this time you can apply for Medicare Part A and/or Part B without penalty.
There is an additional 8-month SEP to sign up for Part A and/or Part B that starts (whichever comes first):
- The month after employment ends
- The month after group health plan insurance ends
Apply for Medicare Coverage Options
You can apply for coverage directly through Medicare or you can choose to work with a private insurance company.
If you apply through Medicare, you will receive a “Welcome to Medicare” package that outlines your options including coverage and pricing.
Private insurance companies offer similar packages to Medicare, but the cost may vary, so it’s a good idea to shop for the best deal before committing to a plan.
The two main types of Medicare coverage are Original Medicare (Part A and Part B) and Medicare Advantage.
- Includes Part A and Part B
- Prescription drug coverage is not included (but you can enroll in a separate Medicare Prescription Drug Plan – Part D)
- Can be used at any hospital or doctor’s office in the United States that accepts Medicare
- If you need help covering out-of-pocket expenses, you can buy supplemental coverage called Medigap.
- The “all in one” alternative to Original Medicare
- Includes Part A and Part B, usually Part D, and other benefits like vision and dental
- Might have lower out-of-pocket costs than Original Medicare
- Coverage may be limited to doctors within plan’s network