Medicare For Dummies Cheat Sheet - dummies
Cheat Sheet

Medicare For Dummies Cheat Sheet

From Medicare For Dummies, 3rd Edition

By Patricia Barry

If you’re new to Medicare (or soon will be), here’s some information at a glance on three crucial Medicare topics: a useful list of do’s and don’ts to keep in mind before you embark on the program; a quick run-through of the best times to enroll, depending on your specific circumstances; and a mini-directory of organizations that can help you with Medicare issues.

Copyright © 2018 AARP. All rights reserved.

A Few Key Medicare Do’s and Don’ts

Copyright © 2018 AARP. All rights reserved.

Medicare is a key program for millions of older and disabled Americans, but many don’t really understand how Medicare works because they lack accurate information. Medicare is a complex program, but the following key elements are things you need to know right from the start:

  • Do give yourself time to bone up about Medicare. It’s a system with many choices and deadlines. Being informed is the best way to side-step pitfalls and avoid mistakes that cost money.

  • Don’t expect to be notified when it’s time to sign up. Unless you’re already receiving Social Security retirement or disability benefits, you must apply for Medicare. But you won’t get any official notice on when or how to enroll.

  • Do enroll when you’re supposed to. To avoid permanent late penalties, and maybe a delay in coverage, you need to know your personal deadline for enrolling in Medicare. It’s either during your initial enrollment period around age 65 or during a special enrollment period if you continue to have health insurance after age 65 from an employer for whom you or your spouse is still working.

  • Don’t despair if you haven’t “worked long enough” to qualify. You may qualify for Medicare Part A (hospital insurance), without paying premiums for it, on your current or former spouse’s work record. Or you may be able to buy into Part A by paying premiums. But you can get Part B benefits (coverage for doctors’ services, outpatient care, and medical equipment) and Part D (prescription drug coverage) regardless of how long you worked (or even if you never have), just by paying the required premiums — provided that you’re a U.S. citizen or a legal permanent resident (green-card holder) who’s lived in the United States for at least five years before applying for Medicare.

  • Do find out how other health insurance works with Medicare. Being eligible for Medicare can affect other insurance you have (such as benefits from a current or former employer or union) in significant ways.

  • Don’t worry that poor health will affect your coverage. If you qualify for Medicare, you receive full benefits. You can’t be denied coverage or asked to pay higher costs because of current or past health problems.

  • Do remember that Medicare isn’t free. You pay premiums for coverage and co-payments for most services unless you qualify for a low-income program or have extra insurance from another source.

  • Don’t assume that Medicare covers everything. It covers a wide range of medical services (including expensive ones like organ transplants), prescription drugs, and medical equipment. But there are gaps, such as coverage for routine vision, hearing, and dental care. And Medicare doesn’t cover the non-medical costs of long-term care in nursing homes and assisted-living facilities.

  • Don’t expect Medicare to cover your dependents. Nobody can get Medicare under age 65, except those who qualify through disability. Medicare has no family coverage.

  • Do get help if you need it. You may qualify for low-income programs that cover your premiums or provide low-cost prescription drug coverage. Whatever your income, you can also get free personal help — in English or another language — to sort through your options in Medicare and choose the one that best suits your needs.

Enrolling in Medicare at the Right Time for You

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The right time for Medicare enrollment depends on your circumstances. But if you don’t enroll in Medicare at the right time for you and then you try to enroll later, you risk permanent Medicare late penalties and a delay in coverage. Here are your options for enrolling in Medicare (without risking penalties) for the first time at age 65 or later:

  • Initial enrollment period (IEP): Your IEP lasts seven months — from three months before the month in which you turn 65 to three months after that month. (For example, if your birthday is in September, your IEP begins June 1 and ends December 31.) Sign up for Medicare during this time frame if you don’t qualify for the special enrollment period.

  • Special enrollment period (SEP): You qualify for this SEP if you’re beyond 65, you have group health insurance from an employer for whom you or your spouse actively works, and the employer has 20 or more employees. If you meet these conditions, you can delay Medicare enrollment after turning 65. The SEP lasts throughout the time you have this coverage and extends for eight months after it ends or the employment ends — whichever comes first. For example, if you stop work at the end of February, you can enroll in Medicare without risking late penalties until your SEP ends on October 31 — but to avoid a gap in coverage, you’d probably want to enroll in February so that your Medicare benefits begin March 1. (But if you work for a small employer — fewer than 20 employees — it may require you to sign up for Medicare at 65 as a condition for continuing to receive its health insurance. Contact the employer to find out.)

  • Automatic enrollment: If you start receiving retirement benefits from Social Security or the Railroad Retirement Board, you’ll be enrolled automatically in Medicare Parts A and B at age 65 or later instead of having to apply. You can decline Part B enrollment if you want to delay it because you qualify for an SEP, as described in the preceding bullet.

  • General enrollment period (GEP): This GEP allows you to sign up for Medicare if you failed to do so during your IEP or SEP. It lasts for three months each year, from January 1 to March 31. If you sign up during a GEP, your Medicare coverage doesn’t begin until the following July 1. You may also be hit with late penalties that are added to your Part B premiums for all future years.

Note: Medicare offers other enrollment periods that allow you to change your coverage in certain circumstances. Also, some people — for example, those who are younger than 65 or who aren’t American citizens — usually have to meet different rules and/or time frames.

Key Sources of Help for Medicare

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Understanding the key ins and outs of Medicare can be tough, but don’t worry; sources of Medicare help are only a call or click away. For helpful information on Medicare issues, these key resources are good bets: