Your 65th birthday is reason to celebrate — and one of your biggest gifts may be Medicare eligibility.
If you are already collecting Social Security benefits, you will automatically be enrolled in Medicare. If not, you must enroll yourself, but don’t wait for your birthday party to take action.
The clock starts for enrollment three months before your 65th birthday, according to Kathleen Sarmiento, a Miami-Dade liaison for Serving Health Insurance Needs of Elders, known as SHINE, a federally funded, volunteer-based program to help Medicare beneficiaries understand and compare coverage.
“There is a law that you’re penalized for late enrollment,” Sarmiento said. “It is important that you follow that initial enrollment period and do it in that window.”
Initial enrollment period
Pay attention to the dates. The seven-month period starting three months before your 65th birthday and ending three months after your birthday month is called the Initial Enrollment Period. The earlier you enroll the better, because your enrollment date determines when coverage will start, Sarmiento said.
To enroll, go to Social Security’s website, www.ssa.gov., and look for a link that says “Medicare.” You can also call them at 800-772-1213.
Types of Medicare
When you sign up, you are automatically enrolled in Medicare Part A and B, also known as Original or Traditional Medicare. Original Medicare helps cover hospitalization and doctor visits, but not prescription drugs. During your Initial Enrollment Period, you can buy a Part D plan to cover prescription drugs or enroll in a Medicare Advantage Plan.
Medicare Advantage Plans are typically HMOs and PPOs that cover hospitalization, doctor visits and prescription drugs. While they can offer more benefits — in some instances, dental, vision, hearing and fitness programs — they often restrict the doctors, hospitals, rehab centers and nursing homes you can use.
Comparing Medicare, Medicare Advantage plans
In South Florida, there are many plans to choose from. In Miami alone, there are 48 Medicare Advantage Plans, Sarmiento said. Before you compare plans, ask your doctors what Medicare Advantage Plans they accept (large companies such as Aetna and Florida Blue offer multiple plans, so get the specific plan name) and make a list of the prescription drugs you take.
To review plans, go to Medicare.gov and use its Plan Finder tool to compare options, call 1-800-Medicare, contact a local insurance company or call SHINE for free assistance, Sarmiento said.
“Some Advantage plans offer additional benefits like dental, hearing aids or transportation to the doctor,” she said. “It depends on what the person is looking for and what’s valuable to them.”
Because of the COVID pandemic, SHINE counselors offer assistance by phone or Zoom video calls. They can do an insurance comparison and help you understand your choices, she said. Wait until you are eligible to start comparing plans, because your options can change. Sometimes new plans are introduced, existing plans are discontinued and doctors drop or add plans.
Medicare start date
The start date of your Medicare coverage depends on when you enroll. If you enroll before the month you turn 65, coverage starts the first day of your birthday month. Enroll during your birthday month and coverage will begin the following month.
The delay of coverage will continue the longer you wait to enroll.
Enroll one month after your birthday month, and you will wait two months for your benefits to start. Wait two to three months after your birthday month to enroll, and you will wait three months for coverage to start.
The bottom line is the earlier you enroll, the sooner you get coverage.
“If you want Medicare, which most people do, then sign up before your birthday month,” Sarmiento said. “There’s a delay if you sign up afterwards.”
If you miss the Medicare Initial Enrollment Period
If you miss your Initial Enrollment Period, you can enroll during the General Enrollment Period, Jan. 1 – March 31. Your coverage will start in July of that year and you will pay a penalty for late enrollment, depending on how long you waited to sign up.
The penalty will kick in if someone lets 12 months after their 65th birthday go by without signing up. They will pay an extra 10 percent for each 12-month period.
“That penalty is added on to what you normally would pay,” Sarmiento said.
If you work past 65
If you plan to work past age 65, you may be able to delay enrolling in Medicare. If you have what’s known as “creditable” health coverage from your employer or are covered under a spouse’s employer plan, you may qualify for a Special Enrollment Period and be able to delay enrolling without penalty.
Creditable insurance means that it is as good or better than Medicare, Sarmiento said. Your company’s human resources department or your insurance company can tell you if it falls in that category, she said.
In some situations, you may still be required to take full Medicare benefits at age 65 even if you plan to keep working. One example is if your employer has fewer than 20 employees.
In that case, you need to sign up for Medicare Part B during the seven-month window around your 65th birthday. That’s three months before your birthday, your birthday month or the three months after you turn 65.
If you don’t sign up during that seven-month window — and your company has fewer than 20 employees — you will be assessed a penalty, which is 10 percent of your premium for each year that you are late. So, if you sign up at 67 — when you should have signed up at 65 because your company had fewer than 20 employees — your Part B premiums will be 20 percent higher — permanently.
What to do when you stop working
When you leave your job, you are not going to have insurance from your employer anymore and you will want your Medicare benefits to start. Enroll at www.ssa.gov, Sarmiento said.
You have eight months from the time you leave your job and lose your employer’s coverage to sign up for Medicare Part A and B without penalty. But you only have 63 days to sign up for Part D without penalty.
If you’re signing up for Medicare after your Initial Enrollment Period, you will need a form from your employer showing that you’ve had insurance from the time you turned 65, Sarmiento said. Keep in mind that COBRA insurance you take after leaving your job is not considered creditable coverage. If you have COBRA, you should still sign up for Medicare to avoid penalties and coverage delays.
Medicare for immigrants
Immigrants age 65 who have been legal permanent residents for at least five continuous years can purchase Medicare coverage, Sarmiento said.
“If people have questions, SHINE is a good resource to walk them through things,” Sarmiento said. “It is a confusing process. Every year, the insurance pricing changes and the benefits change, so it’s good to get some advice.”
Getting Help with Medicare Questions
Here are resources that can help answer your Medicare questions:
▪ Medicare — www.medicare.gov/find-a-plan allows you to compare costs and coverage, or call 1-800-MEDICARE (1-800-633-4227), for help in multiple languages.
▪ Social Security — www.ssa.gov or call 1-800-772-1213 to find out Medicare eligibility, how to enroll, apply for Extra Help with Medicare prescription drug costs and ask questions about premiums.
▪ SHINE — (Serving Health Insurance Needs of Elders) www.floridashine.org, is a federally funded, volunteer-based program to help Medicare beneficiaries understand and compare coverage. You can make an appointment at a free counseling site, email questions or call 1-800-96ELDER (1-800-963-5337).
The direct number for Miami-Dade and Monroe counties is 305-671-6356. The Broward County number is 954-745-9779. Leave a message and a counselor will return your call.
Information from the Rate.com supplemented this report.