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Medicare Enrollment Criteria

Are You New to Medicare?

 

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

Medicare Part A

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

Eligibility

  • 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.

Active Employment

  • 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 cannot 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.

Eligibility

  • 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 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.

Active Employment

  • The only time you may delay Part B enrollment without a penalty is if you or your spouse is actively employed and the employer has 20 or more employees (100 employees are younger than 65) and 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 or download forms CMS-40B and CMS-L564. Once the forms have been completed, they may be sent to SSA via certified mail or faxed to 1-833-914-2016. The CMS-L564 form will enable 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. Due to COVID-19, if your are unable to obtain your employer's signature for the form CMS-L564, you may apply online. You will need to upload documentation as evidence that you have had group health insurance.

  • 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.

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, copays and pharmacies accepting the plan.

Eligibility

  • You (the beneficiary) should sign up during the seven-month Initial Enrollment Period that begins three months before the month in which you turn 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 $0.33 for each month you should have had the coverage and you will have to pay the penalty for the rest of your life.

Annual Plan Changes

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 period from 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 (copayment) 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, copayments 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).

Medicare Savings Programs

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

Prescription Drug Plan Savings Programs

If a person is income-eligible, they can apply for prescription drug plan savings through the Maryland Senior Prescription Drug Assistance Program (MD SPDAP) or Social Security Administration Extra Help and Low Income Subsidy (LIS), which provide financial assistance to people with low income and limited assets.

Explore Medicare Help

 

Contact Us

State Health Insurance Program (SHIP)

Bykota Senior Center
611 Central Avenue
Towson, Maryland 21204

Hours

Monday through Friday
9 a.m. to 4 p.m.

Phone

 
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