Nuts and bolts info about your Medicare benefits

By David Sayen
Regional Administrator
U.S. Centers for Medicare & Medicaid Services

So you’re turning 65. Congratulations! It’s time to start taking advantage of your Medicare benefits. And just how do you do that?

First, a quick overview of the benefits. Medicare Part A pays for hospitalization, and many eligible people don’t have to pay premiums for it. Part B covers doctor’s fees, outpatient care, home health care, screenings for cancer, glaucoma, diabetes and other diseases, and other medical services. Part B has a monthly premium, which for most beneficiaries is $115.40 in 2011.

Part C is Medicare managed care and Part D is prescription drug coverage.

In most cases, if you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically get Part A and Part B starting the first day of the month you turn 65. (If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.)

You’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday. If you don’t want Part B, follow the instructions that come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.

If you aren’t getting Social Security or RRB benefits (because, for instance, you’re still working), you’ll need to sign up for Part A and Part B.

It’s easy to do. You can sign up by calling Social Security at 1-800-772-1213. If you’re 65 or older, you can also apply online for Part A (if you don’t have to pay premiums) and Part B at www.socialsecurity.gov/retirement. The whole process can take less than 10 minutes.

You can sign up when you’re first eligible for Part B. If you’re eligible for Part B when you turn 65, you have a 7-month window that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

But make sure you sign up early! That way you’ll avoid any delay in getting your benefits. The best time is the 3 months before you turn 65. Then you’ll get coverage the month you actually hit your 65th birthday.

If you wait until the last four months of your Initial Enrollment Period, your start date for coverage may be delayed for as long as 3 months. You may also face a penalty in the form of a higher Part B premium.

If you didn’t enroll in Part A and/or Part B when you were first eligible because you were employed and covered under a group health plan based on that employment, you have a Special Enrollment Period. That means you can sign up any time while you or your spouse are working and you have employer or union group coverage. Or you can enroll during the 8-month period that begins after your employment ends or your group health coverage ends, whichever happens first.

Usually, you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period.

But here’s an important caveat: If you have COBRA coverage or a retiree health plan, you don’t have coverage based on current employment. You’re not eligible for a special enrollment period when that coverage ends.

For more information about enrolling in Medicare, visit www.medicare.gov/MedicareEligibility. You can also get free, personalized counseling from your State Health Insurance Assistance Program (SHIP). Call 1-800-MEDICARE to get a number for your state’s SHIP, or to ask other questions about Medicare.

David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories. You can get answers to your Medicare questions 24/7 by calling 1-800-MEDICARE.