Your complete Medicare 101 introduction

Your Initial Enrollment Period is your opportunity to enroll in Original Medicare (Parts A and B) or a private Medicare plan.

Your IEP is a seven-month window around your 65th birthday:

• The three months before the month you turn 65
• The month of your birthday
• The three months after the month you turn 65

For example, if your birthday falls on June 10, your IEP would start on March 1 and end on September 30. For coverage to start the month you turn 65, you must sign up in the three months before the month of your birthday.

If you don’t enroll in Original Medicare Part B during your IEP, you may pay a penalty for late enrollment. The late-enrollment penalty takes the form of higher premiums and lasts for as long as you have Part B.

If you don’t sign up for Medicare Part A or Part B when you’re eligible, you can apply for Medicare for the first time using the General Enrollment Period from January 1 through March 31 every year. You can also sign up for a private Medicare plan at this time.

This enrollment period is usually only available to people who didn’t sign up during their Initial Enrollment Period and who aren’t eligible for a Special Enrollment Period (see below). Coverage would begin the month after you sign up. You may have to pay a higher premium for Part A or Part B due to late enrollment.

A Special Enrollment Period lets you enroll in Original Medicare or a private Medicare plan outside of your IEP and the GEP due to certain circumstances, such as losing your employer coverage after the age of 65.

If you qualify for an SEP, you have a certain amount of time to enroll. The length of time is determined by the type of SEP you are qualified for, but it’s generally between two and three months.

If you or your spouse work past the age of 65, you may not need Medicare until your employer health coverage ends. Every situation is unique, and it’s important to weigh your options to ensure you’re getting the coverage you need.

For example, you might consider:

• Combining an employer health plan and Medicare – It’s possible to have both Medicare and an employer health plan after age 65. One type of plan does not replace the other. Instead, they can work together to ensure your health care needs and expenses are covered.
• Delaying Medicare Parts A and B – Depending on the size of your employer(s), you may be able to delay both Medicare Parts A and B without penalty as long as you or your spouse have employer health coverage. When you do enroll in Medicare, it must be within eight months of losing your health coverage or your last day of work, whichever comes first (see SEPs above).
• Enrolling only in Part A – Most people don’t pay a monthly premium for Medicare Part A, so you could enroll while you or your spouse is still working. However, if you have a health savings account (HSA), be aware that once you enroll in any part of Medicare, you can no longer make contributions to it.

If yes: If you have a strong relationship with your current care team, you’ll want to make sure you choose a plan that includes them in its network. Also, make sure needed specialty care is covered by your plan and confirm whether you need a referral to see a specialist.

In addition, the more times you visit your doctor(s), the more coverage you may need. If you see your care team multiple times a year, it’s worth looking for plans with lower deductibles and lower out-of-pocket maximums.

If no: You can be more flexible in the plans you choose.

If yes: Consider a Medicare plan that includes prescription drug coverage (Medicare Part D), like a Medicare Advantage plan. When you find a plan you like, look through the plan’s drug list (formulary) to see how your medicines are covered and look through the plan’s pharmacy network to see if your favorite pharmacies are available.

If no: Even if you don’t use prescription drugs right now, you may still want to consider Medicare Part D to avoid a late-enrollment penalty later.

If yes: A plan with low out-of-pocket maximums might be better for you.

People who exceed their out-of-pocket maximums or deductibles tend to get care regularly. Though your monthly premiums may be higher in a plan with low out-of-pocket maximums, your copays and coinsurance amounts may be lower when you visit the doctor.

If no: If you stay well under your deductible or out-of-pocket maximum each year, a plan with higher out-of-pocket maximums could be a good fit.

People who stay under their deductible and out-of-pocket maximums usually do so because they don’t get care very often. A plan with low out-of-pocket maximums often means your copays and coinsurance amounts may be higher when you visit the doctor, but your monthly premiums will typically be lower.

If yes: You might be okay having separate plans for medical and prescription drug coverage. These plans usually come with separate member ID cards, additional paperwork and different service teams.

If no: You could find having all your Medicare benefits in one plan, like a HealthPartners UnityPoint Health Medicare Advantage plan in Iowa or Illinois, to be more convenient and less stressful.