If you’re turning 65, you’ll begin to qualify for Medicare, federal government-sponsored healthcare. Here's how to sign up for Medicare , which can be confusing.
Medicare, the federal program created in 1965, offers insurance to Americans ages 65 and up, the disabled, and people with end-stage renal disease requiring dialysis or a kidney transplant.
You’ll need to know how to sign up to get started.
Medicare has several parts
- Part A covers in-patient hospital care, skilled nursing home care, hospice care, and some home healthcare. Most people don’t pay a monthly premium for Part A.
- Part B, which amounts to medical insurance, covers certain services from doctors and other healthcare providers, outpatient care, medical supplies, and some preventive services. Everyone pays a monthly premium for Part B.
- Part C, also called Medicare Advantage, is an option run by Medicare-approved private insurance companies. If you choose to join a Medicare Advantage plan, it will provide coverage for everything included in Parts A and B. Most also cover prescription drugs, and there may be other benefits, typically with extra costs. About half of all people in Medicare choose a Medicare Advantage plan, usually a plan that is open to everyone in Medicare. Employers and unions also sponsor plans that are restricted to certain people, as well as plans for people with special needs.
- Part D is also optional. It helps cover the cost of prescription drugs, including recommended vaccines.
When should I sign up for Medicare?
You can sign up three months before you turn 65 or after you become disabled. Coverage always begins on the first of the month. Your initial enrollment period lasts for seven months. If you miss that window, you may run into penalties. This link may help you check your specific situation to find out when to sign up.
You'll also want to enroll in Medicare Part D before your 65th birthday, unless you're getting coverage from another source.
Once you’re eligible for Medicare, coverage can’t be denied.
If you continue working beyond age 65 and are covered by your employer's medical plan, or a union, as an active employee make sure you understand how that plan coordinates with Medicare.
Should I choose Medicare Advantage?
Medicare Advantage plans usually have lower premiums and a cap on how much you may have to pay for out-of-pocket expenses. That is helpful if you run into a serious illness.
The plans, however, limit which hospitals and doctors you can use. You will usually need a referral from your primary care physician and approval from the plan to have services from covered specialists.
If you want to stick with your current doctors, you will have to ask them whether they take Medicare or are part of a Medicare Advantage plan.
You can switch between different Medicare Advantage plans during specific time windows, called enrollment periods. You can also switch back to original Medicare.
If you’re still working, check with your employer or union before you join a Medicare Advantage plan. In some cases, you can lose the coverage your employer offers (including coverage for your family), and you may not be able to get it back. Your employer or union may offer its own Medicare Advantage plan.
To join a Medicare Advantage plan, you’ll need your Medicare number and the date your Part A or Part B coverage started. You’ll need to visit a plan’s website and either fill out a paper form, join online, or call.
This interactive website from Medicare will help you shop for Medicare Advantage plans and prescription drug plans.
Be very careful not to give your personal information to people who call representing a private plan.
Should I buy a Medigap policy?
Medicare does not have a maximum for out-of-pocket costs. With a Medigap policy, most of those costs are covered. As the name suggests, it should fill in gaps to pay the costs of services Medicare covers.
In most states, you will have a choice among Medigap policies offered by private insurers or groups like AARP. Premiums vary considerably, based on your gender, age, health, whether you smoke, your location, and the company. You can see a printable guide here.
Medicare doesn’t cover all medical needs. Even if you have a Medigap policy, you may have additional uncovered medical costs — for example for hearing aids, dental care, or health costs when you travel abroad.
Don’t confuse Medicare with Medicaid
Medicaid is a state-run program that provides hospital and medical coverage for nearly 93 million Americans with low incomes, including children enrolled in the separate Children’s Health Insurance Program. Each state has rules about who is eligible and what Medicaid covers.
Some people qualify for both Medicare and Medicaid.
November 08, 2023
Christopher Nystuen, MD, MBA and Janet O'Dell, RN