Medicare is the federal health insurance program for people age 65 and older. Certain people younger than age 65 can qualify for Medicare, including those who receive Social Security Disability Income and those who have permanent kidney failure. Because Medicare is health insurance, you share the costs of your care.
Traditional Medicare is also called Original Medicare or “Fee-For-Service” Medicare. This federal program starts with Part A and Part B. For most people, Original Medicare Part A and Part B is a starting point for assembling more complete coverage.
- If you are turning 65 and have already applied for or already receiving Social Security or Railroad Retirement Board benefits, you should get a Medicare card and packet in the mail about three months before your birthday.
- If you have not applied for Social Security benefits, you need to contact Social Security to sign up for Medicare, even if you are still working. Online Medicare enrollment is available at socialsecurity.gov; however, if one-on-one assistance is needed, SHIBA suggests visiting a Social Security field office in person for assistance. You can do this up to three months before your birthday month.
- If you have questions about eligibility or enrollment in Medicare, call Social Security at 800-772-1213. Always keep a record of the date, time, and name of the service representative, and take careful notes. You may have to call ahead to set up an appointment with Social Security.
Your initial enrollment period is the seven months surrounding your 65th birthday. In this period you can enroll in Parts A, B, C, and D. Your seven months are:
- The three months before your birthday month.
- The month of your 65th birthday.
- The three months following your 65th birthday month. If you sign up during these last three months, your start date will be delayed one to two months.
If you receive Medicare due to Social Security disability, your Parts A and B automatically start in your 25th month of disability income. The initial enrollment for Parts C and D starts in the 21st month and ends in the 28th month.
Note: If your birthday falls on the first day of a month, you start Medicare a month early. Your enrollment period moves up a month, as well. Example: If your birthday is Jan. 1, you can start Medicare on Dec. 1. You can sign up as early as Sept. 1. See the deadlines page.
If you receive your red, white, and blue
Medicare card in the mail, you will be set up to start Parts A and B
beginning the first of the month you turn 65. You must decide:
- Whether to keep Part B coverage (see next question) and
- What, if any, other Medicare insurance you want,
especially if you are not working. Parts A and B do not include
prescription drug coverage. You are responsible for deductibles, 20
percent of medical bills, and other costs. Many people buy additional
coverage. It might be a Medicare supplement (also called Medigap) plus a
prescription drug plan or it might be a Medicare Advantage plan.
Unless you qualify to delay enrollment in Parts B and D, you could face
lifetime penalties later for not enrolling during the seven-month period
surrounding your 65th birthday.
If I am covered by my employer coverage, do I need to bother with Medicare?
Yes, you have choices to make as you turn 65. Some people who are actively working and have insurance (but not COBRA) can delay enrollment in Parts B and D without a penalty. However, if you don’t qualify for a penalty-free delay, you’ll pay higher premiums for the rest of your life. Key points:
- Most people take Part A because it is premium-free. Even if you delay your Part B, signing up for your Part A now makes it simpler whenever you start your Part B.
- However, if you are participating in a Health Savings Account (HSA) as part of your employer’s High Deductible Health Plan (HDHP) coverage, signing up for any part of Medicare will prohibit you from contributing further to the HSA. You can still use the HSA funds to pay medical expenses, but once your Medicare begins, tax-free contributions must end.
- You or your spouse’s employer is key to whether you need Medicare Parts B and D at this time. First, you need a letter from your employer stating whether your prescription drug coverage is determined to be "creditable" – as good as Medicare’s.
- Additionally, you need to ask your or your spouse’s employer how your group insurance works with Medicare and whether you may want to buy Part B. Employer group plans with less than 20 employees only pay 20 percent or charges as if they were secondary to Medicare.
- Once you have this information, you can decide whether you need Part B and/or Part D. If you plan to delay enrollment in Part B, visit Social Security (not Medicare) to make sure you won’t be penalized later. Document the conversation by writing down the name of the person you spoke with, the date, the time, and what was said.
If you decide to delay enrollment in Part B, your Welcome to Medicare packet contains an explanation on how to do this. If you delay enrollment in Part B, Part D, or both, you have enrollment deadlines soon after your employer-provided coverage ends.
- Part A or Part B eligibility and enrollment questions are answered by Social Security, 800-772-1213, which has local offices.
- Part C (Medicare Advantage) or Part D (Rx) enrollment questions go to Medicare, 800-633-4227.
- In all cases, document your call – save information on the date, time, the name of the person you spoke with, and the key parts of the conversation.
- Contact your benefits administrator or group plan if you have other insurance, or questions about what happens when you turn 65.
- Contact the Senior Health Insurance Benefits Assistance (SHIBA) program by calling 800-722-4134 or visit the SHIBA website to find an office in your area. The state of Oregon SHIBA program offers free information to help you make your Medicare choices.
What if I act on wrong information?
- If you get wrong enrollment information from federal officials (Social Security or Medicare) and you documented the conversation (date, time, name of person you spoke with, and the key information provided), you may get “equitable relief” from any resulting problems or penalties.
- If you get information from any other sources – whether it is insurance agents, human resources benefits administrators, volunteer counselors or news articles – you may not be able to fix the problem. Example: You missed the deadline to enroll in Part B because someone other than Social Security erroneously said you didn’t need it. You probably will have a lapse in coverage and be stuck with the lifetime penalty.