If you are new to Medicare, there are several questions you should consider while approaching or within your Initial Enrollment Period (IEP) or a Special Enrollment Period (SEP) Special Enrollment Periods (SEPs) are periods of time outside normal enrollment periods when you can enroll in Medicare or change your health and/or drug coverage. One example is the Part B SEP, which allows you to enroll in Part B without penalty while you have job-based insurance and for eight months after you lose the insurance or stop working. SEPs triggered by specific circumstances may also allow you to switch or disenroll from Part D and Medicare Advantage Plans. For example, if you moved out of your plan’s service area, you would receive an SEP to switch to another plan. . Use this guide to consider your options when preparing to enroll in Medicare or after you have already enrolled.
What are the basics?
Medicare is a complex program and can sometimes be confusing. The best place to start when you are new to Medicare is by familiarizing yourself with the differences between it and the health insurance you have now. Learn what makes a person Medicare-eligible, the different parts of Medicare insurance and what those parts cover, times to enroll in Medicare, and how putting off enrollment can result in penalties. These initial steps will help smooth the transition from your current insurance to Medicare once you are eligible.
What are your coverage options?
Everyone has different health care needs, meaning the coverage that is right for your friends or family may not be right for you. Will you enroll in Original Medicare or would you prefer a Medicare Advantage Plan that may limit your provider networks or have different costs but that offers additional coverage? If you have current employer insurance, you may decide not to enroll in Medicare until you have retired. If you are already retired, you might find that Original Medicare plus retiree insurance Retiree insurance is health insurance provided by employers to former employees who have retired. Retiree insurance almost always pays secondary to Medicare. See also: Secondary Insurance. works better for you than Original Medicare plus a Medigap (or vice versa). Find out the full range of your coverage options.
Should you enroll in Part D?
While you should make sure you enroll in Part D prescription drug coverage when you become Medicare-eligible (assuming you do not have other creditable drug coverage), there are many Part D options for you to explore. Keep in mind, too, that sometimes retiree insurance offers prescription drug coverage that is as good as or better than Medicare Part D. If that is the case, you might decide not to take Part D because you are already covered. Finally, if you have difficulty affording your drug costs, you may want to consider applying for programs that can help pay these costs.
Are you eligible for programs that help lower Medicare costs?
There are several programs for people with low incomes that help pay for Medicare-related costs, such as premiums and copays. Some of these programs are federal while others are state-specific. Find out whether you meet the eligibility requirements and take full advantage.
What resources exist to help you navigate Medicare?
Medicare is a complex and beneficial program, and a variety of trusted sources can help you navigate your rights and options. A few are listed here:
- 1-800-MEDICARE (1-800-633-4227)
- Social Security Administration
- State Health Insurance Assistance Program (SHIP)
- Medicare Rights Center