Medicare

Who’s Eligible

Medicare eligibility generally includes individuals who are 65 or older, those with qualifying disabilities, or individuals with End-Stage Renal Disease (ESRD). Eligibility details vary by Medicare part.

Understanding Medicare Parts A, B, C, D

• Part A: Part A is hospital insurance, often premium-free if eligibility criteria are met.
• Part B: Medical insurance, optional with a monthly premium.
• Part C: Medicare Advantage Plans that combine Parts A and B and often extra benefits.

Medicare Enrollment Checklist

Step-by-step guidance for those approaching 65 or reviewing current plans.

1. Understand Medicare Parts A, B, C, and D

   Familiarize yourself with the different parts of Medicare to determine which coverage suits your needs. Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) are available to individuals who meet any of the following criteria:

   • Are 65 years of age or older
   • Have a qualifying disability
   • Have End-Stage Renal Disease (ESRD)

   For detailed information, please contact us directly.

2. Check Your Eligibility

   Ensure you meet the eligibility criteria for Medicare enrollment.

   Premium-Free Medicare Part A Eligibility Based on Age

   • Age 65 or older
   • Eligible to receive monthly Social Security or Railroad Retirement Board (RRB) benefits.

   If someone is already receiving Social Security or RRB benefits at least four months before their 65th birthday, they will automatically be enrolled in premium-free Part A when they turn 65—no separate application is needed.

   Those who are not receiving monthly Social Security or RRB benefits must apply for Medicare by contacting the Social Security Administration directly.

   Coverage under Part A begins the month an individual turns 65, as long as the application is submitted within six months of their 65th birthday. If the application is submitted more than six months after turning 65, coverage will be retroactive for up to six months.

   Note: If an individual’s 65th birthday falls on the first day of the month, Part A coverage begins on the first day of the month prior. For example, if the birthday is December 1, coverage would begin on November 1.

   Medicare Part B (Medical Insurance)

   Individuals who are receiving Social Security or RRB benefits at least four months before their Medicare eligibility date (and reside in the U.S. excluding Puerto Rico) are automatically enrolled in both premium-free Part A and Part B. They can choose to keep or decline Part B. Individuals in Puerto Rico must actively enroll in Part B to receive that coverage.

   Those not already receiving Social Security or RRB benefits must apply for Part B during designated enrollment periods. Anyone who initially declines or cancels Part B and wishes to re-enroll must wait for an eligible period. Late enrollment typically results in a monthly penalty.

   Part B is optional and requires a monthly premium. To enroll in Part B:

   • Individuals eligible for premium-free Part A may enroll in Part B upon entitlement to Part A.

   • Individuals who must pay a premium for Part A must also:

     • Be age 65 or older
     • Be a U.S. resident
     • Be either a U.S. citizen or a lawfully admitted permanent resident with five continuous years of residency

   Note: Individuals who lose Part A coverage 36 months after a kidney transplant may still qualify for the Part B Immunosuppressive Drug Benefit.

   For detailed information, please contact usdirectly.

3. Review Enrollment Periods

   Individuals eligible for premium-free Medicare Part A who are not enrolled automatically may sign up for Part A at any time once they become eligible.

   Those who wish to enroll in premium-based Part A, Part B, or both must do so during specific enrollment periods defined by federal regulations. These designated periods include:

   • Initial Enrollment Period (IEP)

     The IEP is a 7-month window that starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. For individuals under 65 qualifying by disability, the IEP begins 3 months before the 25th month of receiving disability benefits and ends 3 months after. Coverage typically begins the month after enrollment. Individuals with ESRD or ALS may have different timelines. Those who don’t enroll in Part B or premium Part A when first eligible may face a permanent late enrollment penalty.

   • General Enrollment Period (GEP)

     The GEP runs from January 1 to March 31 each year. If you enroll during this time, your Part B or premium Part A coverage will start the following month.

   • Special Enrollment Period (SEP)

     Certain life events allow you to enroll in Part B or premium Part A outside the standard windows, without penalty. SEPs are time-limited and situation-specific. If missed, you must wait for the GEP and may face a late penalty. Coverage begins the month after you enroll.

   For detailed information, please contact us directly.

4. Assess Prescription Drug Coverage

   Evaluate if you need a Part D plan for prescription drugs and compare formularies.

5. Consider Additional Coverage

   Explore Medigap policies or Medicare Advantage Plans for extra benefits like dental, vision, or hearing.

6. Review Plan Ratings

   Check Medicare Star Ratings published by CMS to assess plan quality and performance.

7. Seek Assistance if Needed

   Contact a licensed insurance agent for free information and comparison of Medicare plans available in your area, including details on coverage, costs, and provider networks. Gratus Healthcare Choices LLC offers guidance to help clarify options and support informed decisions. Contact us to get started.

Annual Medicare Plan Review Tips

For current Medicare beneficiaries evaluating their coverage:

1. Review the Annual Notice of Change (ANOC)

   Examine any changes in your plan’s costs, coverage, or provider network for the upcoming year.

2. Evaluate Your Healthcare Needs

   Consider any changes in your health status or medication requirements that might affect your coverage needs.

3. Compare Current Plan with Other Options

   Use the Medicare Plan Finder to see if other plans offer better coverage or lower costs.

4. Check Provider Networks

   Look beyond premiums; consider deductibles, copayments, and out-of-pocket maximums.

5. Assess Total Costs

   Look beyond premiums; consider deductibles, copayments, and out-of-pocket maximums.

6. Verify Prescription Drug Coverage

   Confirm that your medications are still covered under your current plan’s formulary.

7. Consider Additional Benefits

   Some plans offer extra benefits like fitness programs, transportation, or over-the-counter allowances.

8. Mark Enrollment Deadlines

   Remember, the Annual Enrollment Period runs from October 15 to December 7 each year.