How To Sign Up For Medicare For The First Time

By Grace Vitaglione

Turning 65 tin beryllium daunting successful much ways than one. For galore North Carolinians, nan weeks earlier their day are accompanied by a deluge of advertisements and mailings for various Medicare plans.

The onslaught of caller accusation and lingo tin beryllium daunting, arsenic good arsenic making decisions astir which scheme to choose.

Over 2.2 cardinal North Carolinians are enrolled successful nan national programme that covers astir group complete nan property of 65. It besides covers immoderate group younger than 65 who person disabilities aliases definite conditions. 

Everybody’s business is different erstwhile it comes to Medicare, said Rhonda Narron, southeastern location head pinch nan Seniors Health Insurance Information Program, aliases SHIIP.

“It’s ne'er 1 size fits all. That’s why it’s truthful confusing for people,” Narron said.

Anyone tin sojourn a section SHIIP counsellor for free, unbiased accusation astir nan various Medicare options available. But for a wide primer, NC Health News compiled nan pursuing accusation astir Medicare from respective SHIIP counselors and authorities resources.

SHIIP counselors counsel everyone to reassess their medicine supplier scheme each twelvemonth during nan open enrollment period from Oct. 15 to Dec. 7.

What is Medicare?

Medicare is made up of respective parts denoted by letters. Original Medicare includes Parts A and B, and you tin besides subordinate a abstracted Medicare Part D scheme to get supplier sum arsenic good arsenic Medigap, a supplemental plan.

Medicare Advantage plans, aliases Medicare-approved plans from a backstage company, usually “bundle” Parts A, B and D and often connection other benefits for illustration dental, imagination and proceeding coverage, which Original Medicare does not offer.

The first point to know? Medicare isn’t free, said Jeanne Chamberlin, coordinator for SHIIP astatine nan Orange County Department connected Aging. 

While Part A mostly has a zero-dollar premium for astir people, nan standard monthly premium for Part B successful 2025 is $185 a month. On apical of that, galore group salary an further premium for their Part D, aliases medicine drug, plan.

During nan unfastened enrollment play (again, that’s betwixt Oct. 15 to Dec. 7) , anyone pinch Medicare sum tin alteration their Part D plan, arsenic good arsenic move to a Medicare Advantage scheme if they choose. If personification is already enrolled successful a Medicare Advantage plan, they tin move to a different 1 during this clip window. 

Pharmacy benefits

Plans tin alteration nan database of prescriptions they screen each year. They tin besides alteration premium prices and covered pharmacies, making it harder for patients to spell to their preferred pharmacy. 

That’s why it’s important to publication nan specifications of nan yearly change of notice missive that insurers nonstop to beneficiaries each twelvemonth and spot if there’s a amended option, said Narron.

Three months earlier turning 65…

People tin motion up for Medicare starting 3 months earlier turning 65, during their day month, and for 3 months after. If they neglect to motion up during this seven-month play — called nan first enrollment period — they whitethorn look life penalties if they don’t autumn nether a fewer exceptions. 

“Timining is everything pinch Medicare,” Narron said.

That’s why she recommends preparing for nan process earlier, moreover astatine property 64. She recalled 1 female who called her past twelvemonth asking for thief pinch Medicare. The female was turning 65 nan adjacent week, truthful Narron had to bring her up to velocity arsenic quickly arsenic possible.

“I spent an hr and a half connected nan telephone pinch her, and I could almost perceive her caput spinning during our conversation,” she said.

When personification signs up for Medicare for nan first time, they spell done Social Security either online, via telephone aliases an in-person appointment. Once that’s done, they will person their Medicare paper and number. 

At that point, Narron said, they’re only enrolled successful Parts A and B. 

Medigap

Once they person their Medicare number, they tin spell to a section SHIIP counsellor for thief signing up for a Part D scheme that useful for them. 

This is besides a bully clip to motion up for a supplemental scheme to thief screen their wellness attraction costs, often known arsenic a Medigap plan. 

Why motion up for a Medigap plan? If you request an costly outpatient wellness attraction service, Medicare only covers 80 percent of nan costs after you’ve paid your deductible. You’re near connected nan hook for nan different 20 percent. That’s wherever Medigap plans travel in. 

Created successful nan 1980s, Medigap security will screen nan out-of-pocket costs associated pinch Original Medicare, for illustration copayments, deductibles and coinsurance. It doesn’t sound for illustration much, but if you extremity up, say, needing chemotherapy infusions for cancer, nan measure tin easy adhd up to tens of thousands of dollars aliases more, perchance leaving you connected nan hook for a lot. A emblematic Medigap scheme will costs betwixt $100 and $300 a period for astir group and location are different types denoted by letters.

Here’s nan point that brokers won’t show you: all of them are nan same. That’s because of a rule Congress passed successful nan early 1990s. So, you tin look for your champion value connected a Medigap scheme pinch confidence. 

Again, according to nan national Medicare website: The premium magnitude is nan only quality betwixt policies pinch nan aforesaid scheme missive sold by different companies. 

The national Medicare website has a measurement to search for policies that screen your area.

Here’s nan catch: There’s only a six-month model to motion up for a supplemental scheme aft nan Part B security becomes effective — aft that, it tin beryllium much much difficult — and much costly — to bargain a Medigap plan.

Even personification who doesn’t person immoderate prescriptions should still motion up for a Part D scheme pinch a debased monthly premium astatine first, Chamberlin said. That way, if they do request medicine supplier sum down nan line, it’s already group up. If personification waits until later to motion up for nan Part D plan, they besides whitethorn beryllium fined a late enrollment penalty for nan remainder of their life.

What if I aliases my spouse will support moving aft 65? 

Many group activity past property 65, said Narron, and arsenic agelong arsenic they’re covered nether an employer group wellness scheme that meets definite qualifications, they tin hold enrolling successful Medicare Part B without immoderate penalties. That’s besides nan lawsuit if they’re covered nether their spouse’s employer group wellness scheme and their spouse is actively moving full-time.

For those moving past property 65, it’s champion to consult pinch nan employer’s quality resources section to corroborate that nan employer scheme is considered “creditable coverage” and that you won’t beryllium penalized for delaying enrollment successful Medicare, Narron said.

Chamberlin recommended still signing up for Part A arsenic soon arsenic you move 65 (as agelong arsenic you don’t person a wellness savings account, thing offered by galore employers). This portion of Medicare has zero-dollar premiums and tin thief salary for immoderate leftover infirmary costs aft nan employer wellness security pays their portion. 

Once you determine to extremity working, you tin past motion up for nan remainder of Medicare.

But if your employer has little than 20 employees, that wellness security doesn’t count — you must motion up for Medicare arsenic soon arsenic you’re eligible, moreover if you proceed to work.

Chamberlin recalled 1 man she counseled who was a lawyer, and his patient had less than 20 employees. At property 70, he came to SHIIP to motion up for Medicare. She had to show him that since he hadn’t signed up astatine property 65, he would person a 10 percent punishment for each twelvemonth he was precocious — successful his case, 5 years.

For a $185 monthly premium, that’s an other $92.50 each period for nan remainder of his life, she said.

“All because cipher told him, and he didn’t know,” she said.

COBRA, short for nan Consolidated Omnibus Budget Reconciliation Act, is simply a national rule that allows nan impermanent hold of wellness sum for workers nether definite circumstances. But policies for group covered nether this proviso besides don’t count arsenic creditable sum to Medicare. Neither does a state-run wellness security marketplace plan, nor do plans sold done nan national government-run Health Insurance Marketplace.

Some typical cases

What if I’m a North Carolina authorities retiree?

State labor are still required to motion up for Medicare Parts A and B erstwhile they move 65. From there, nan state has 3 retiree scheme options: 2 are Medicare Advantage plans and 1 is simply a 70/30 PPO plan, aliases preferred supplier organization. You tin telephone nan State Health Plan Eligibility and Enrollment Support Center for further questions astatine 855-859-0966.

What if I’m eligible for Medicaid?

Some group who gain little than a definite magnitude and who are enrolled successful Medicare are besides eligible for Medicaid. Medicare pays for covered services, past Medicaid can prime up much of nan rest. There are Medicare Advantage plans specifically designed for these “dual” eligibles, Chamberlin said. These beneficiaries don’t usually salary immoderate copays for covered services and may person allowances that tin spell toward expenses for illustration groceries aliases transportation. 

What if I started receiving Social Security benefits earlier property 65?

Most group tin commencement drafting their Social Security benefits at property 62, truthful if you person already done so, you will beryllium automatically enrolled successful Medicare astatine property 65. The aforesaid goes for you if you received Social Security benefits earlier because of a disability.

Choosing betwixt Medicare Advantage and Original Medicare

For astir people, Medicare has 2 avenues: Original Medicare pinch a supplement and supplier plan, aliases a Medicare Advantage plan.

Chamberlin said nan prime depends connected a beneficiary’s finances and really they usage wellness attraction services. Choosing Original Medicare pinch a supplement scheme will apt costs much each period for nan beneficiary, but they will usually salary little for wellness attraction services. 

Medicare Advantage beneficiaries will apt salary overmuch little premiums each month, but will apt beryllium connected nan hook for higher out-of-pocket costs erstwhile utilizing immoderate wellness attraction services. 

Some group would alternatively cognize what their fund is and beryllium assured they won’t person a large aesculapian measure if they get sick, Chamberlin said. Others would alternatively prevention that money pinch nan dream they won’t get very sick.

“It’s astir what lets you slumber astatine night, because it’s astir risk,” she said.

Medicare Advantage plans besides thin to have much constricted networks of providers. If personification pinch a Medicare Advantage HMO (health attraction organization) scheme sees a supplier retired of nan network, they’ll get deed pinch nan afloat cost. If personification pinch a PPO (preferred supplier organization) scheme goes to an out-of-network provider, they conscionable person to salary a higher fee. 

The tradeoff? HMO plans thin to person little premiums than PPOs.

The supplier networks tin besides alteration astatine immoderate time, based connected security companies’ bottommost lines. Beneficiaries of UnitedHealthcare whitethorn person watched past twelvemonth arsenic nan institution and Duke Health battled complete statement negotiations. They reached a last-minute statement connected Nov. 1, WRAL reported, avoiding nonaccomplishment of sum for much than 172,000 Duke patients.

Patients and doctors besides whitethorn person to jump done much hoops to get security companies that tally Medicare Advantage plans to work together to supply coverage, successful a process known as anterior authorization.

In contrast, those pinch Original Medicare tin spell to immoderate expert aliases infirmary successful nan state that takes Medicare, providing you pinch much flexibility. 

Where tin I find other assistance pinch my wellness attraction costs?

Medicare Savings Programs are disposable to eligible individuals to thief salary for premiums, deductibles, coinsurance and copayments. The Extra Help programme besides helps qualified beneficiaries salary for medicine supplier costs. 

Anyone who qualifies for nan Medicaid programme is automatically eligible for Extra Help, Narron said. Many North Carolinians are apt eligible for Extra Help but don’t cognize astir it aliases don’t cognize really to apply, Narron said, truthful much group should inquire into nan program.

Republish our articles for free, online aliases successful print, nether a Creative Commons license.