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.
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, andhad 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.


General Enrollment Period
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.

    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
    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. Medicare beneficiaries enrolled in these plans will have the same basic services that Medicare covers but 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 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.

    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

    Step 4: Making Your Decision

    Helpful materials from SHIINE to guide you through Step 4:

    Understanding Your Medicare Options in South Dakota
    Medicare Options Comparison Worksheet

    Other insurance and how it works with Medicare


     
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