Medicare eligibility, enrollment and coverage options

What are the Medicare eligibility guidelines?

Aging in – For millions of Americans, eligibility for Medicare is somewhat automatic – as straightforward as reaching their 65th birthday.

If you’re aging into Medicare, there’s a lot you can do to ensure that you end up with the right Medicare plan – and that you don’t incur unnecessary costs (including penalties) along the way. Your plan costs, your Medicare benefits, your enrollment windows – and the penalties for missing them – all depend on your plan-buying decisions.

Learn how seniors age in to Medicare.

Eligibility due to a disability  – Although most Medicare beneficiaries are eligible due to their age, about 14% of all Medicare beneficiaries are under 65. That’s because people also become eligible for Medicare due to having a disability for at least two years, or being diagnosed with ALS or end-stage renal disease.

Who’s not eligible? – Some Americans are not eligible to enroll in Medicare because they haven’t lived in the United States for at least five years.

Learn whether you’re eligible for the various Medicare plans.

What are my Medicare coverage options?

Most new Medicare beneficiaries opt to go with one of these coverage scenarios:

• Original Medicare (Part A and Part B)
• Original Medicare plus a prescription drug (Part D) plan and/or a Medicare supplement (Medigap) plan
• Medicare Advantage coverage

The options you choose will define the range of benefits and services covered, your access to providers and your out-of-pocket costs, as well as your flexibility in changing your options down the road if you’re not satisfied with your plan.

• Here’s a list of 10 considerations to help you choose between Medicare Advantage, Medigap and Part D.
• Find out why most beneficiaries don’t elect for Original Medicare coverage alone.

When can I enroll in Medicare or change plans in 2023?

For 2023 coverage, put these enrollment opportunities on your calendar:

• The annual Medicare Advantage open enrollment period for Americans already enrolled in Medicare Advantage will start January 1, 2023 and continue through March 31, 2023. If you’re enrolled in Medicare Advantage at the start of 2023 (even if you just picked a plan in the fall and it started January 1), you can switch to a different Advantage plan or switch to Original Medicare during the first quarter of 2022.
• General enrollment for Medicare Part B starts January 1 and continues through March 31. (This window also applies to Part A, if you have to pay a premium for it and didn’t sign up when you were first eligible). If you sign up for Part B (or Part A, if applicable) during this window, your coverage will start the first of the following month (the start date used to be July 1, but that has changed as of 2023).
• Medicare open enrollment – the annual election period – for 2024 coverage runs from October 15, 2023 to December 7, 2023. This window provides the most plan change flexibility, allowing beneficiaries to make changes to their Medicare Advantage or Part D plans, switch from Original Medicare to Medicare Advantage or vice versa, or sign up for Part D if they didn’t do so when they were first eligible (a late enrollment penalty may apply).

Why would I change my Medicare coverage?

Medicare beneficiaries change their coverage for a variety of reasons, including changes in provider networks, increases in premiums, the availability of new plan benefits, and changes in Part D formularies – as well as changes in beneficiaries’ own situations.

Read more here:

• Four signs you need to change your Medicare Part D coverage
• Four reasons to change your Medicare Advantage coverage
• Four ways to adjust your Medicare coverage

If you choose to go with a Medigap plan, you should definitely take note of the fact that Medigap plans aren’t guaranteed issue in most states after your initial enrollment period ends. That means if you apply for a Medigap policy later on – either for the first time, or because you want to switch plans – the carrier generally has the option of denying the application or charging you a higher premium based on the company’s underwriting requirements.

There are limited guaranteed-issue opportunities for Medigap plans after the initial enrollment window (including the one-time trial right period described above), and a few states have annual opportunities for people to enroll in Medigap on a guaranteed-issue basis (in most cases, this is just an opportunity to switch to a different plan, rather than newly enroll).

What do I need to do to get my Medicare card?

If you’re already receiving Social Security or Railroad Retirement benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare and your Medicare card will be mailed to you about three months before you turn 65, with your coverage taking effect the first of the month you turn 65 (at this point you’ll have a chance to reject Part B if you choose to do so, but make sure you know all the ins and outs of that beforehand).

If you’re not yet receiving Social Security or Railroad Retirement benefits prior to turning 65, you will not be automatically enrolled in Medicare. Instead, you’ll need to apply for Medicare through the Social Security Administration, which will then send your Medicare card to you.

How much does Medicare cost?

A common misconception about Medicare is that it’s a free government safety net that awaits beneficiaries when they reach retirement. The fact is, each type of Medicare coverage does have its own costs, similar to other health insurance you’ve purchased over the years.

So expect premiums, deductibles, copays, and coinsurance (although supplemental coverage may pay some or all of the cost-sharing for you). Also, expect those costs to change each year.

Here’s a look at the plan costs for 2023.

There is assistance available for beneficiaries who may have difficulty paying for Medicare expenses – including premiums and out-of-pocket costs. Many lower-income beneficiaries are eligible for help via the Medicaid system, which includes Medicare Savings Programs as well as full dual-eligibility for both Medicare and Medicaid.