Applying for MediCare

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Many find the online information on signing up for MediCare confusing. Even some descriptions on the Social Security and Medicare sites are not up to date!


What are the proper steps to apply for the federal MediCare program? 

First – reaching 65 and becoming "eligible"

  The Medicare system states the month a person becomes 65 they are eligible to apply. 

      Note: A person under 65, receiving Social Security disability, also becomes eligible after 24 months. 

      [They have until month 28 to decide what to do.]


When a person wants to apply at 65 they submit an application through the Social Security system not the MediCare system.

     Note: When the application is complete the MediCare system considers the person entitled. They are then covered by:

     + Part A for inpatient hospital services.

     + Part B for medically necessary outpatient services.



Federal regulations limit the times to apply for MediCare to the following eligibility periods:

Initial Eligibility Period (IEP)

When turning 65 a person becomes eligible the month of their birthday and they have this 7 month period to complete an application through Social Security. If they want to sign up it can be done during: 


● Either of the three months before eligible. If apply in one of these months coverage will be effective the first day of their eligible month. 

    Note: If a persons birthday is the 1st day of a month coverage begins the first day of the previous month.


● The month of turning 65.  Coverage is effective the first day of the next month.


The months after eligible. If apply:

     + One month after 65 –  coverage will be the first of second month after application. 

     + In second or third month after 65 –  coverage will be the first of third month after application.  

Special Enrollment Period (SEP)

A special time for the person who worked past age 65. When do decide to sign up they have an up to 8 month period


What are the rules? If apply for Part B while still on the employer plan or in the first month after leaving the employer's plan coverage can start (you decide ) the first day of: 

● Month you apply or 

● Any of following three months.


What to do? When leaving employer coverage after 65 its important to call the Local Social Security office for an appointment with a Retirement person. 

 

Why an appointment? During the meeting some special things need to be done to qualify for a SEP: 

● Ask for Form CMS-L564. 

● Take the form to your employer to fill in the dates covered by the company medical benefit plan, get it signed, and take it back to the SS office.  

● Having prior coverage qualifies a person for a SEP to sign up for Part B and B's late enrollment penalty will be eliminated. 

   [If no proof - 10% is added to Part B's cost for each 12 months of not having enrolled.] 


Effective dates -  When applying after 65 SS will activate Part A and then adjust it's effective date retroactive six months from Part B's date. 

     Alert - if enrolled in an employer's HSA contributions must stop 6 months before the date they elect for Part B coverage. 

General Enrollment Period (GEP)

If a person did not apply during their IEP or had a situation to qualify for a SEP the GEP is a special 3 month time each year to apply for Part B. 


The GEP sign up rules are different:

  An application for Part B can only be completed between Jan 1st and March 31st each year.

  B's effective date will not be until July 1st! 

  A person in this situation: 

       + Would be able to activate Part A [can apply anytime ] and: 

             - can sign up for a Medicare Prescription Drug Plan to have medication coverage.

             - would not have any MD or outpatient treatment coverage.

Send a note with any questions on the sign up rules or about other details!

Feel free to contact - Learn@JohnCParker.agency