Q: I turn 65 this winter. Do I have to sign up for Medicare or does it happen automatically? I am still working so I really do not need Medicare yet because I have insurance through my work. What do I need to do?
A: Generally, most people must initiate Medicare enrollment through the Social Security Administration. Medicare enrollment only happens automatically in certain situations, for instance if you are already receiving social security retirement or disability benefits. It is great that you are looking into this ahead of your 65th birthday, as you do have a limited timeframe to enroll in Medicare. This timeframe is called the initial enrollment period and if you sign up on time, you will likely avoid Medicare late enrollment penalties.
Medicare is the federal health insurance program for people aged 65 or older or certain younger people with disabilities. It is comprised of Medicare part A (hospital insurance), Medicare part B (medical insurance) and Medicare part D (prescription drug coverage).
First, it is important to let you know of a wonderful resource to help you with your specific enrollment needs. The Health Insurance Counseling and Advocacy Program (HICAP) is a national program funded through the Older Americans Act to provide free and unbiased counseling and comparisons on all Medicare Health Insurance and Medicare Prescription Drug Plans. The HICAP program also resolves Original Medicare, Medicare Advantage and Prescription Drug complaints for Medicare beneficiaries.
Locally, you can reach the HICAP program in Ventura County by calling 805-477-7310 or in Los Angeles County by calling 213-383-4519. You can schedule an appointment to discuss your specific health care and insurance needs and receive unbiased advice and guidance.
The initial enrollment period starts 3 months before your birthday month and ends 3 months after your birth month. When you are new to Medicare, there are several decisions to be made. Will you enroll in both Medicare part A and Part B? Will you need to select a Medicare Prescription Drug Plan and which one? Will you opt to buy a Medicap policy or a Medicare Advantage Plan, or keep original Medicare?
To understand the best answers, contact your local HICAP office to review your individual needs. The answers will be different for every person based on your healthcare or physician preferences, medication lists and your budget. I often hear of people enrolling in plans based on their friend’s experience. Unfortunately, this can sometimes guide people to a plan that does not cover their prescriptions or allow them to keep the doctors they like. It is best to make decisions based on your personal situation.
If you miss enrolling during your initial enrollment period, then you may not only have to wait to sign up, but you may have to pay a monthly late enrollment penalty. The penalty goes up the longer you wait to enroll, and that monthly fee is for the rest of your life. For this reason, it is very important to understand how and when to enroll.
You mentioned you are on an employer health insurance plan and may not need Medicare right now. You can opt out of Medicare if you are covered by your employer. However, you want to make sure you are documenting this correctly so that you do not end up with any penalties later. You can talk to HICAP and also to your employer’s benefits department.
I encourage you to look at the Medicare website https://www.medicare.gov/ and review what Medicare covers. Once you enroll, it is important to take advantage of all the preventative healthcare services that are covered. You want to stay on top of preventative screenings to stay healthy and manage your medical needs.
While this may seem overwhelming it is mostly the initial decisions to be made that can cause stress. Reach out and use the resources that are available to you to make the best decision possible for your healthcare.
Martha Shapiro can be reached at Senior Concerns at 805-497-0189 or by email at email@example.com