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Americans usually qualify for Medicare when they reach 65 years old. Most are automatically enrolled and have to choose a plan. However, some people who are eligible for Medicare have to sign up, such as those with a qualifying disability which may make them eligible for Medicare before they turn 65

Let’s take a look at the different types of Medicare, who’s eligible and how to sign up for Medicare.

What is Medicare?

Medicare is a federal health insurance program that provides coverage for eligible people who are generally age 65 or older and people on long-term disability or who have specific health problems. The Centers for Medicare and Medicaid Services administers the program, which is divided into two overarching types: Original Medicare and Medicare Advantage.

Let’s take a look at the differences:

TypeWhat it coversWhat it costs
A (Hospitals)Inpatient hospital, skilled nursing facilities, hospice care, home health care in some casesFree for nearly all Americans. People who don’t pay Medicare taxes for at least 40 quarters (or 10 years) have to pay a premium. If you must pay a premium, it costs up to $499 monthly. Part A has a $1,556 deductible. 
B Doctor visits, outpatient care, medical supplies, preventive servicesPart B costs $170.10 monthly in 2022. However, premiums could be more than double depending on income. After you reach the deductible, you’re responsible for 20% of the costs.
C (Medicare Advantage)Medicare plans through private insurers; includes supplemental benefits, including prescription drug coverageMedicare Advantage premiums vary based on coverage and benefits. Average Medicare Advantage premium in 2022 is $19. 
D (Prescription Drugs)Prescription drug coverageAvailable only for people with Parts A and/or B. Average basic Medicare Part D premium is $43 in 2022. 

 

If you choose Original Medicare, you may decide to go only with Part A if you get health insurance through another means, such as an employer or a spouse’s employer. However, if you skip Part B when signing up for Original Medicare, you may have to pay a late enrollment penalty for as long as you have that coverage. Signing up during a Special Enrollment Period may help you avoid this penalty.

The penalty will increase your monthly premium by 10% for each 12-month period that you skipped Part B. You’ll want to keep that in mind when deciding whether to sign up for Part B.

Whether Original Medicare or Medicare Advantage is better for you depends on many factors:

  • Number of plan options.
  • Costs, including premiums, out-of-pocket expenses and deductibles.
  • Prescription drug benefits.
  • Hospital and provider networks.
  • Quality of plans.

You’ll likely have multiple Medicare Advantage plan choices. In total, about 3,830 Medicare Advantage plans are available across the country  for individual enrollment in 2022, according to the Kaiser Family Foundation. When deciding between plans, you can use the  Medicare Plan Finder. The tool lets you compare both Original and Medicare Advantage plans in your area. You answer a series of questions that help narrow the number of plans. 

Who’s eligible for Medicare?

The vast majority of Medicare beneficiaries become eligible when they turn 65.

However, younger people who get Social Security disability benefits are also eligible for Medicare. Medicare usually kicks in 24 months after a person receives Social Security disability benefits. Also, people with end-stage renal disease or amyotrophic lateral sclerosis (ALS) are eligible for Medicare without this waiting period.

Signing up for Medicare

People who are automatically enrolled, such as those turning 65, have a seven-month window to choose a plan. The clock starts ticking three months before the month of your 65th birthday and ends three months after your birth month. 

You’ll likely get a packet that includes your Social Security card three months before your 65th birthday. 

If you’re not signed up automatically, there are three ways to seek coverage:

  • You can apply online at the Social Security site.
  • You can call Social Security at 1-800-772-1213.
  • You can go to a local Social Security office.

You can sign up through an online application if you’re at least 64 years and nine months old.

Making changes to Medicare after you sign up

One thing to not worry about is being locked into a plan for life.

Each year, Medicare has an Annual Enrollment period that allows you to make changes. During that time, which runs from October. 15 to December. 7, you can:

  • Not make any changes.
  • Switch from Medicare Advantage to Original Medicare and vice-versa.
  • Change Medicare Advantage plans.
  • Change Part D prescription drug plans or drop that coverage.

Also, from January 1-March 31 each year, Medicare holds a Medicare Advantage open enrollment. That enrollment is more limited than the one that starts in October. The Medicare Advantage open enrollment allows members only to change Medicare Advantage plans or move to an Original Medicare plan. Only one change can be made during this enrollment period. 

Sources:

Medicare.gov. “Costs.” Accessed August 2022.

Medical News Today. “Medicare Advantage: Monthly costs and more.” Accessed August 2022.

Kaiser Family Foundation (KFF). “Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2022.” Accessed August 2022.

Kaiser Family Foundation (KFF). “Medicare Advantage 2022 Spotlight: First Look.” Accessed August 2022.

Disclaimer:

Insure.com is not affiliated with or endorsed by the government or Federal Medicare program. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day/7 days a week, to get information on all of your options. Not all plans offer all of these benefits. Benefits and availability may vary by carrier and location. Limitations and exclusions may apply. Every year, Medicare evaluates plans based on a 5-star rating system. Part B Premium give-back is not available with all plans. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

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Les Masterson
Contributor

 
  

Les, a former managing editor, insurance, at QuinStreet, has more than 20 years of experience in journalism. In his career, he has covered everything from health insurance to presidential politics.

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