What is Medicare?
Medicare - FAQ
Medicare is a federal health insurance program for people age 65 and older and certain people with a disability.
Medicare can be complicated and confusing. Not knowing the Medicare basics and when to enroll can lead to increased costs and missed opportunities.
Medicare has four parts:
Part A: Hospital Insurance Inpatient hospital care, including psychiatric hospitals, critical access and long-term care hospitals.
Part B: Medical Insurance – Doctors' services and outpatient care when medically necessary.
Part C: Medicare Advantage Plans – Medicare health plans that include Medicare Part A, Part B and in most cases Part D.
Part D: Prescription Drug Coverage – Available as a stand-alone plan or as part of Medicare Advantage.
The basic qualifications that make you eligible for health insurance through Medicare are:
You are a United States citizen or a legal resident who has lived in the U.S. for at least five years, and:
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You are 65 years of age, or
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Have a disability based on the Social Security’s definition of total disability, or
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Have ALS, or
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Have ESRD (permanent kidney failure requiring dialysis or transplant)
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You worked and paid Medicare taxes for at least 10 years
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Most people sign up for Part A (hospital insurance) and Part B (medical insurance) when they're first eligible, typically at age 65.
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It's important to sign up promptly to avoid gaps in coverage or late enrollment penalties. However, if you're already covered through an employer group health plan, it might make sense to sign up for Medicare later or delay Part B.
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If you are age 65 or older and receive Social Security benefits, you will be automatically enrolled in Part A.
Premium Penalty
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If you’re not eligible for premium-free Part A and don’t enroll at the right time, you may have to pay a penalty.
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If you don’t enroll in Part B at the right time, you will have to pay a 10% premium penalty for each 12-month period you delay enrollment.
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In most cases, the penalty is ongoing, permanent and added to the monthly Part B premium.
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This penalty does not apply to people who have their own health insurance or their spouse’s current active employment.
Part D late enrollment penalty
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The Part D late enrollment penalty is an amount that can be added to your Medicare drug coverage (Part D) premium.
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You may have to pay a late enrollment penalty if at any time after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Medicare drug coverage or other
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creditable prescription drug coverage.
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.You’ll generally have to pay the penalty for as long as you have Medicare drug coverage.
There are many different Medicare Enrollment Periods. Failing to enroll at the right time can lead to premium penalties in the future.
Initial Enrollment Period (IEP)
A seven-month period when you can first enroll in Medicare
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Turning Age 65: three months before the month you turn age 65, the month of your 65th birthday and three months later
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If your birthday is on the 1st of the month, your coverage can begin on the first day of the previous month.
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Disabled Under 65: a seven-month period surrounding the 25th month you begin receiving Social Security Disability payments.
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Enrollment time frames are different for people who become eligible
because of end-stage renal disease or Lou Gehrig’s Disease (ALS).
General Enrollment Period (GEP)
GEP occurs annually from January 1 - March 31, coverage begins July 1. If you
miss your IEP and are not eligible for a Special Enrollment Period, you can
enroll during the GEP. Late enrollment premium penalties may apply.
Special Enrollment Period (SEP)
Special circumstances may allow you to enroll in Medicare outside your IEP,
including, moving out of your plan’s service area, losing employer-based
coverage or having Medicare Part D Extra Help. Each SEP has an enrollment time frame.
Open Enrollment Period (OEP)
OEP occurs annually, October 15 - December 7. Coverage begins January 1
of the following year. During this time, you can:
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Change from Original Medicare to a Medicare health plan
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Change from a Medicare health plan to Original Medicare
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Join, drop or switch Medicare Part D prescription drug plans
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Change to a different Medicare health plan
Medicare Advantage Open Enrollment Period
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New to Medicare: Those who enrolled in a Medicare Advantage Plan during their IEP can change to a different Medicare Advantage Plan or return to Original Medicare one-time only during the first three months of enrolling in Medicare Part A and Part B.
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Annually: January 1 - March 31. If you are enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or return to Original Medicare.
In general, if you have coverage through MNsure or Medical Assistance (MA), you must enroll in Medicare when you are first eligible.
If you plan to keep working or you have employer health coverage through a spouse, you have some options to consider when signing up for Medicare. Depending on your situation, you may or may not be able to delay Medicare enrollment.
Once you're enrolled in Original Medicare (Part A and/or Part B), you may be eligible to enroll in a Medicare Advantage plan or Part D prescription drug plan or apply for a Medicare Supplement insurance plan.
When making your decision, consider:
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Cost – what can you afford?
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Convenience – can you be flexible?
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Coverage – how much health care do you need?
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Locations – what plans are available where you live?
