Senior Health Information and Insurance Education

New to Medicare

Step 1: Understand the Basics

Start by watching this video for more information to help you on your "New to Medicare" journey.



Helpful materials from SHIINE to guide you through Step 1:



Step 2: Determine When to Enroll

Are you nearing age 65?

You are approaching your Initial Enrollment Period.

  • This is the seven month window surrounding the month of your 65th birthday.
  • If you are currently drawing benefits from Social Security you will be automatically enrolled in Medicare Parts A & B.
  • If you (or your spouse) plan to continue working and plan to use your (or your spouse's) employer insurance call your current insurance provider to see if you want to delay taking Medicare Part B.
  • If you are not or don't plan on drawing benefits from Social Security before age 65 you will need to initiate your enrollment in Medicare Parts A & B by visiting your local Social Security Administration office or by going to www.socialsecurity.gov. Before enrolling, make sure you understand how Medicare works with any health insurance coverage you currently have.
  • Are you questioning if you should sign up for Medicare at this time?

Example of the Initial Enrollment Period:
Someone with a July 26 birthday can join Medicare Parts A and B from April to October.

Birthday: July 26th - Enrollment Period

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
If you join during:


3 months before birthday month Birthday month 3 months after birthday month

Medicare starts:


July 1 Aug 1 Oct 1 Dec 1 Jan 1

Note:
If you enroll during the first 3 months of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birthday month. However, if your birthday is on the 1st of the month, your coverage will begin the first day of the prior month. The later you enroll, the later your Medicare Parts A and B will start. Medicare Part D starts the month of your birthday, or the month after you enroll.

Are you age 65 and older?

You are outside of your Initial Enrollment Period and you can still join Medicare.

Special Enrollment Period (SEP) for Parts A and B
If you've been covered by insurance through a current job (or spouse's current job), you can enroll up to eight months after the job or the insurance ends.

Special Enrollment Period (SEP) for Part C and Part D
There are several Special Enrollment Periods that would allow you to enroll in a Part C or Part D plan outside of the Initial Enrollment Period and/or the Open Enrollment Period. If you are new to Medicare Part C and/or Part D, and had creditable prescription drug coverage (indicated by your plan), the SEP lasts up to 63 days after the insurance coverage ends. If you do not have creditable coverage you may have to pay a late-enrollment penalty.

Click Here for a listing of all situations that make you eligible for a SEP.
General Enrollment Period for Parts A and B
If you missed your Initial Enrollment Period for Medicare Parts A and B and do not qualify for a Special Enrollment Period you can enroll during the General Enrollment Period. This occurs each year from January 1 to March 31. Your coverage starts July 1, and you may have to pay a late-enrollment penalty.

Open (Annual) Enrollment Period for Part C and Part D
This occurs each year from October 15 - December 7. All Medicare beneficiaries can enroll in a Part C and/or Part D plan, including those who have not had coverage in the past. SHIINE recommends that you review your options every year, even if you are happy with your plan to ensure that the coverage and cost is the best for your situation.

    Are you under age 65 and receiving Social Security Disability Insurance (SSDI)?

    Social Security automatically enrolls you in Medicare Parts A and B after receiving SSDI for 24 months.
    • Generally, your coverage begins on the first day of your 25th month of receiving Social Security disability (SSDI) payments.
    • Some individuals with disabilities don't have to wait as long, like those with End Stage Renal Disease (also called permanent kidney failure) or people with Amyotrophic Lateral Sclerosis (also called ALS or Lou Gehrig's Disease).
    • Medicare will let you know the effective date, and give you the option to defer Part B.
      • If you defer Part B and do not have creditable insurance coverage you may have to pay a late-enrollment penalty. You may also have to wait for the next General Enrollment Period to enroll in Medicare.

    Helpful materials from SHIINE to guide you through Step 2:


      Step 3: Know Your Medicare Options

      As you explore your coverage with your Original Medicare (Parts A & B) benefits you will be faced with a decision whether to add additional coverage or not. The two options you have to do this are with a Medicare Supplement (Medigap) plan (Option 1) or a Part C plan (Option 2).

      Whether you take prescription drugs or not, another decision you will face at this time is adding prescription drug coverage (Part D plan or coverage with a Part C plan). Be mindful that any delays without creditable coverage for prescription drugs will most likely result in a future life-long penalty.

      Option 1:
      Original Medicare
      Part A - Hospital Care Part B - Clinic and Outpatient Care
      You may want to add the following insurance to avoid penalties and fill gaps in coverage from Part A and Part B.
      Medigap - Medicare Part A & B Supplement
      You still retain your Medicare coverage and can see providers that accept Medicare, these plans add coverage for services beyond Medicare's coverage.

      Private insurance companies offer standardized coverage (plans A-N) for ease in comparing cost.
      Part D - Prescription drug coverage
      (Avoid penalties for late enrollment)

      Option 2:
      Part C (Medicare Advantage or Health Plans)
      Alternative to Original Medicare (Part A & B) sold by private insurance companies. Medicare has rules the insurance companies need to follow and pays a fixed amount to the plan each month to provide coverage for your care. If you are enrolled in one of these plans you are no longer covered by Original Medicare. Your plan will provide the sameservices that Medicare covers but you must use the plan's provider network (if applicable) and pay for services at that plan's rates.

      You are still subject to your Part B premium.
      Most Part C plans in South Dakota include drug coverage.

      If the plan you choose doesn't have prescription drug coverage, you should consider adding a Part D Plan to avoid penalties.

      Other insurance and how it works with Medicare



      Helpful materials from SHIINE to guide you through Step 3:

      Medicare Basics
      SHIINE's Medicare Supplement Consumer's Guide
      What to Know Before Joining a Medicare Advantage Plan
      Understanding Your Medicare Options in South Dakota
      Medicare Options Comparison Worksheet


      Step 4: Making Your Decision

      Once you know which option in Step 3 is best for your situation you will still need to shop around for the plan that is right for you. The ultimate goal is to find a plan with sufficient coverage that makes you feel comfortable. Instead of shopping around using the pile of plan solicitations and marketing materials that are inundating your mailbox you can use the information below to look for a plan that meets your needs best. For unbiased assistance contact SHIINE.

      Are you looking for a Medigap policy?

      Click here to be directed to SHIINE's information on Medicare Supplement (Medigap) Plans.

      SHIINE's Medicare Supplement Consumer's Guideexplains Medigap plans and lists the companies that were willing to share their pricing information. All prices are based off of a example scenario and are estimates as of the date the guide was printed.

      • Call a few of the companies in that guide, your insurance agent, a company a friend or family member has recommended, and any Medicare Supplement Plans offered by your former employer. SHIINE recommends getting a few quotes and asking how often each company raises their rates before making your decision.
        • The coverage will be the same if you are comparing the same plan (Lettered A-N).
      • The most popular plans sold in South Dakota are Plans F and G. Use the chart in the back of the guide to determine what each plan (A-N) covers to determine your preference.

      The best time to enroll in a Medicare Supplement (Medigap) plan is during your Open Enrollment (Guaranteed Issue Right). This is usually the first six months in which you are enrolled in Part B.

        • If you enroll outside of this time frame the plan can decide if they want to enroll you or not based on your health history or their enrollment capacity.

      Are you looking for a Part C policy?

      Click here to be directed to SHIINE's information on Part C Coverage.

      Each county in South Dakota has a different list of Part C plans available. To find out what plans are available in your area visit Medicare.gov's Plan Finder Tool and enter your zip code or do a Personalized Search. Follow the steps and when you get to Step 4 choose "Medicare Health Plans (with or without drug coverage)" to get a list for your area. Once you discover what is available in your county you will need to determine if any of those options will work well for you.

      SHIINE recommends you look into all the plans you are considering before enrolling to determine what is the best fit for your situation. This will require some research and probably a phone call to the plan and your health care providers. Check out the helpful materials listed below for a list of questions to ask your plan and providers or for help comparing several options side-by-side.

      Are you looking for a prescription drug (Part D) plan?

      Click here to be directed to SHIINE's information on Part D Coverage.

      Determining if a plan is a good fit for your situation is something that you should do right away when enrolling in a Part D plan for the first time. Even if you do not currently take prescription drugs it is important to understand the cost of waiting until a later date to enroll. Sometimes people find it more affordable to enroll in a low premium plan right away than to accrue a penalty without Part D insurance coverage (or other creditable coverage).

      To compare the plans that work best with the prescriptions you take and your pharmacy of choice visit Medicare.gov's Plan Finder Tool and enter your zip code or do a Personalized Search. Follow the steps and the list of results will be listed in order of lowest cost for the details you entered. SHIINE has www.Medicare.gov Plan Finder Instructions available to assist you through the process.

      A comparison shouldbe done each year to ensure that you are always enrolled in a plan that covers all of your medications and works with your pharmacy. SHIINE recommends you do a plan comparison every year during Open Enrollment (October 15 - December 7) and can help you determine the plan that meets these very important needs: cost, coverage and convenience.


      Helpful materials from SHIINE to guide you through Step 4:
      SHIINE's Medicare Supplement Consumer's Guide
      What to Know Before Joining a Medicare Advantage Plan
      www.Medicare.gov Plan Finder Instructions


      Step 5: Going Forward

      You might be wondering how often you need to revisit your plan options to continue to ensure you have coverage that meets your needs and the answer varies depending on which part of Medicare you are talking about. Use this chart to determine how to plan for your next review.

      Part of MedicareWhen to ReviewImportant Considerations
      Original Medicare (Parts A & B)
      Typically once you are enrolled you will stay enrolled in Medicare Parts A & B.
      If you do not enroll in Medicare when you are eligible or do not have creditable coverage you could be assessed a penalty.
      Medicare Supplement (Medigap) Plans
      Most people enroll in a Medigap policy and stay enrolled for a long time. Sometimes the policy will become too costly and people will shop around for new coverage.
      A Medigap plan can deny your application for enrollment. Be cautious when dropping current coverage for new coverage.
      Part C PlansEach year review the Annual Notice of Change that is mailed to you by your plan in September and verify your providers of choice will be covered with your plan. Reflect on your health care situation and make sure that the plan adequately covers your current and prospective needs. Note any changes in coverage, cost increases for services or changes in out-of-pocket limits for the upcoming year.If you are shopping for a new Part C plan make sure you understand the network of facilities and providers that are available and determine if the premium, anticipated co-payments and out-of-pocket maximums are affordable for your situation. SHIINE assists beneficiaries with free, unbiased and confidential counseling on the prescription drug coverage of Part C plans and provides tools and resources to make comparing Part C health plan options easier.
      Part D Plans
      Each year review the Annual Notice of Change that is mailed to you by your plan in September. Compare your plan with the other plans available by using the Plan Finder tool on www.Medicare.gov or by scheduling a counseling session with SHIINE during Open Enrollment (October 15 - December 7).Consider coverage of all your prescriptions and convenience of your favorite pharmacy as you determine if the plan is most affordable for you. SHIINE assists beneficiaries with free, unbiased and confidential counseling of Part D plans.

      SHIINE wants to invite you to volunteer with our program. We have a variety of volunteer roles available that would make you a great resource in your community. The volunteer work is extremely rewarding and SHIINE provides training and mentoring to make sure you are comfortable assisting others in your area. Contact the SHIINE office near you to explore the opportunity and get an application.

       
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