Skip Navigation

New to Medicare Enrollment Criteria

Initial Enrollment Period

The Initial Enrollment Period for Medicare is any of the following:

  • Three months before your 65th birthday
  • The month of your 65th birthday
  • Three months after your 65th birthday

Social Security Information

If you are not receiving a Social Security benefit due to age or disability, you will need to contact Social Security to enroll in Medicare. To enroll, visit www.ssa.gov, call 1-800-722-1213 or go in person to your local Social Security office. If you are a younger person receiving a Social Security Disability (SSDI) check, you will automatically receive your Medicare card about three months before the 25th month of receiving the SSDI check. If you elected to receive your Social Benefit retirement benefit prior to age 65, you will automatically receive your Medicare card about three months before your 65th birthday.

For more information, please watch the ABCs of Medicare video designed for persons new to Medicare.

      
     
 
            

Transitioning to Medicare Workshops

Please plan to attend a Transitioning to Medicare Workshop in your area.

  • Thursday, November 15, Randallstown Library, 6 to 8 p.m.
  • Wednesday, December 12, Cockeysville Library, 6 to 8 p.m.
  • Tuesday, January 15, White Marsh Library, 6 to 8 p.m.

More Information

Please call the State Health Insurance Assistance Program (SHIP) at 410-887-2059 to RSVP or email medicareinformation@baltimorecountymd.gov

Medicare Part A

Medicare Part A helps pay for hospital stays, skilled nursing facilities, home health care, hospice care and other services.

  • You can enroll in Medicare Part A at age 65.
  • If you have worked at least 10 years under Medicare- or Social Security-covered employment, the Part A benefit will be "free" because you paid toward Part A while you worked. If you have never worked but your spouse has worked 40 quarters (10 years), you can apply for Medicare A by using your spouse’s work record.
  • If you elected to receive your Social Security retirement benefit before you turned age 65, you will automatically be enrolled in Medicare A and B. Your card will arrive about three months prior to your 65th birthday. Likewise, you will automatically receive your Medicare card several months before you reach the 25th month of receiving your Social Security disability benefit.
  • If you are not receiving a Social Security benefit, you will need to enroll in Medicare through Social Security.
  • If either you or your spouse is actively working and the employer is providing group health coverage, you may proceed to sign up for just Part A. If you have worked 10 years and paid the FICA tax, Part A will be premium-free and will serve as a secondary insurance to your group health insurance.
    Note: If your employer has fewer than 20 employees, check with the benefits administrator. You may be required to sign up for Medicare A and B, and Medicare will be the primary insurance. Similarly, if you have a Social Security Disability benefit and the employer has fewer than 100 employees, you may be required to sign up for Medicare, in which case the Medicare will be the primary insurance.
  • Do not sign up for Part A if your employer coverage is through a Health Savings Account (HSA). You can not contribute to an HSA and receive Medicare. (If you are entitled to premium-free Part A, there is no penalty for delaying Part A enrollment.)

Medicare Part B

Medicare Part B pays for doctors and other medical services such as physical therapy, occupational therapy, lab service, home health care, outpatient hospital visits and blood.

  • If you are already receiving benefits from Social Security, you will be automatically enrolled in Medicare A and B starting the first day of the month in which you turn 65 or the 25th month you receive your Social Security Disability check. (If you elect not to receive Part B because you or your spouse is actively working and have group health insurance through an employer, you can complete the reverse side of the Medicare card and return it to SSA).
  • If you are not receiving a Social Security check, contact Social Security three months before you reach age 65 to enroll in Medicare A and B. Although you have a seven-month window (three months before, the month of, and three months after your 65th birthday) to sign-up for Medicare A and B, it is best to sign up early to avoid a delay in the start of your benefits.
  • If you did not take Part B when you were first eligible for Medicare at age 65, you may sign up during a General Enrollment Period. This period runs from January 1 through March 31 of each year. Due to the Part B penalty, the cost of your Medicare Part B may go up 10 percent for each 12-month period that you could have had Part B but did not take it. Your Part B coverage would become effective the following July and you will have to pay the extra 10 percent for the rest of your life.
  • The only time you may delay Part B enrollment without a penalty is if you or your spouse is actively employed and the employer is providing group health insurance. You may sign up for Part B at any time while you are working and have the group health coverage. You may also sign up for Part B during a Special Part B Enrollment period, which lasts eight months from the time the employer coverage ended. You will need to contact the Social Security office to enroll in Part B and to obtain the paperwork, which must be signed by your employer to certify that you have had group health coverage since age 65 or the 25th month of receiving your Social Security Disability benefit.

Medicare Part D

Prescription drug coverage, called Medicare Part D, is available to everyone with Medicare. Insurance companies and other private companies approved by Medicare offer the drug plans. Drug plans will vary in monthly premiums, the type of drugs covered, deductibles, co-pays and pharmacies accepting the plan.

  • The beneficiary should sign up during the seven-month Initial Enrollment Period that begins three months before the month in which the person turns age 65 and ends three months after turning age 65.
  • If you do not take Part D when you are first eligible for Medicare at age 65 and you did not have credible coverage during the interim, the cost of Medicare Part D may go up approximately $.35 for each month one should have had the coverage and you will have to pay the penalty for the rest of your life.
  • It is important to annually review the list of drugs you take and review the plans every year because the Part D plans are permitted to change their formulary lists, premiums, deductibles, tier structures and pharmacy contracts every year. Therefore, you may change plans during the open enrollment October 15 through December 7 every year.

Medicare Prescription Drug Plans vary by the following:

  • Coverage: Medicare prescription drug plans cover generic and brand name drugs. Each plan can choose which specific drugs they cover in each drug category.
  • Cost: Monthly premiums and your share of the cost (co-payment) of your prescription vary depending on which plan you choose.
  • Restrictions: The plan may limit prescription quantities (how many pills you can get at a time), require prior authorization (before the plan will pay for your prescriptions, your doctor must show the plan that the drug is medically necessary for it to be covered) or require step therapy (the plan may require a lower cost drug to be tried before the plan will pay for the prescribed drug).
  • Convenience: Consider whether you local pharmacy accepts the plan or whether the plan has a mail-order option.

Supplementing Medicare

Medicare is the Federal health insurance program for people over age 65 or people under age 65 who qualify because of a disability. It is not designed to cover all of the cost of medical care. Deductibles, co-payments and medical services not covered by Medicare can be expensive.

Most Medicare beneficiaries select one of three options to assist with the gaps (only Medicare-approved services are covered).

Option 1

Purchase a Medigap insurance policy as a supplement to Medicare.

  • A Medigap policy supplements the Original Medicare Plan to help pay for the “gaps” like co-payments, coinsurance, and deductibles that the Original Medicare Plan does not cover.
  • The policies are standardized (A to N), with each type of policy offering the same basic benefits no matter which insurance company sells it. The only difference between policies is the cost. A policy covers only one person, so a couple must each buy separate policies. Private insurance companies sell these policies.
  • The open enrollment period lasts for six months, beginning on the first day of the month in which you were eligible for Medicare and enrolled in Medicare Part B. During this period, an insurance company:
    • Must sell you a plan
    • Cannot make you wait for coverage to start
    • Cannot charge more for a Medigap policy because of health problems
  • View the names of Medigap Policies approved to be sold in Maryland and their yearly costs. Or call SHIP at 410-887-2059 to request a list.

Option 2

Join a Medicare Advantage plan (substitute for Original Medicare). See a list of current plans in the back of your Medicare and You Book.

There are currently four types of Medicare Advantage Plans offered in Baltimore County. The greatest advantage these plans have over using Original Medicare is their out-of-pocket limits.

  1. Medicare Health Maintenance Organizations (HMOs) cover all Part A and B services and may provide extra services. People who join a Medicare HMO plan may be asked to choose a primary care doctor they see first for most health problems. They usually need a referral to see a specialist (such as a cardiologist) or to get certain services. People who are considering joining a Medicare HMO and want to keep seeing their current doctor should find out if their doctor is in the plan’s network. The plan includes prescription coverage.
  2. Medicare Special Needs Plans (SNPs) membership is limited to certain groups of people, such as those with certain chronic or disabling conditions or in some institution like a nursing home. Medicare Special Needs Plans are Medicare Advantage plans designed to provide focused-care management, special expertise of the plan’s providers and benefits tailored to enrollee conditions. These plans provide case management, care monitoring, health education and monitoring tools, if needed, to provide specialized care. The plans include prescription coverage.
  3. Medicare Preferred Provider Organization (PPOs) cover all Part A and B services and may provide extra services. People who join a Medicare PPO plan can go to network doctors, other health providers and hospitals, but they can also go out-of-network for covered services, usually at a higher cost. Typically, they do not need to choose a primary care doctor and in most cases do not need a referral to see a specialist. The plan includes prescription coverage.
  4. The other type of plan is Programs of All-Inclusive Care for the Elderly (PACE), which combines medical, social and long-term care services for frail elderly people to remain in the community. You must be on Medicare and Medical Assistance, and be geographically confined to the eastern edge of Baltimore City.

Option 3

Continue health insurance coverage through an employer retirement plan such as the Federal Employee Health Benefits Program (FEHBP), State and Local government Retiree Health Plans and private companies Retiree Health Plans.

Medicare Savings

If a person is income-eligible, they can apply for Medicaid, the Qualified Medicare Beneficiary Program (QMB) or the Specified Low Income Medicare Beneficiary (SLMB) Program, which provides assistance to people with low income and limited assets.

  • QMB will pay the Part A ($422 in 2018 if you did not work and pay FICA tax for 10 years in the U.S.) and Part B premiums ($134 in 2018), deductibles and co-insurance payments of the Medicare Program for older and individuals with disabilities who are financially eligible.
  • SLMB is similar to QMB but pays only the Part B premium ($134 in 2018).
  • Low Income Subsidy (LIS) Medicare Beneficiaries who qualify based on low income and limited assets will receive a subsidy to pay for Medicare Part D premiums, co-payments, deductibles and coverage gap (donut hole).
  • The Maryland Senior Prescription Drug Assistance Program (MD SPDAP) will pay up to $40 each month toward the Medicare Prescription Drug plan premium.

Summary

  • Sign up for Medicare A and B at Social Security.
  • Review the eligibility for assistance in paying for Medicare Part A, Part B and Part D LIS.
  • If not eligible for assistance, get a supplement to Medicare to pay the expenses that Medicare does not pay. Choose between a Medigap policy, Medicare Advantage Plan or your company's retired employee plan if it qualifies.
  • Make sure you sign up for prescription drug coverage.
 
Revised November 13, 2018         

 

Did This Page Help?
Fields marked with * are required.
Page Rating*