Questions to Ask When Applying for Medicare
Written for the months around a 65th birthday in the United States, whether you are enrolling yourself or making the calls for a parent or spouse. The questions follow the order the decisions come in: your enrollment dates, the coverage you already have, what Parts A, B and D each do, what you will pay, Original Medicare or an Advantage plan, and the application itself. Premiums and deductibles are reset every January and some rules turn on your state or your employer's plan, so treat any figure you are given as one to confirm for this year.
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The questions
Each question, and why to ask it
When to enroll
What are the first and last dates of my Initial Enrollment Period?
Why ask it
It generally runs seven months: the three before the month you turn 65, that month, and the three after. A birthday on the first of a month moves the whole window one month earlier. Write both dates down, because nearly every other answer on this list is counted from them.
Will I be enrolled automatically, or do I have to apply?
Why ask it
People who have been drawing Social Security or Railroad Retirement benefits for at least four months before 65 are generally signed up for Parts A and B without asking, and the card comes in the mail. Anyone else has to apply and should not count on a reminder. The representative can tell which group you are in from your record.
If I sign up this month, on what date does my coverage begin?
Why ask it
Enrolling in the three months before your birthday month generally starts coverage on the first of that month, and enrolling in that month or later starts it the month after you apply. Set the date you are given against the last day of your current insurance. If there is a gap between the two, ask what would close it.
What is the penalty for signing up for Part B late, and how long would I pay it?
Why ask it
Under the current rule the premium rises by 10 percent for each full twelve months you could have had Part B and did not, and the increase generally lasts as long as you have Part B. Have it worked out in dollars for your own dates before deciding to go without Part B to save the premium.
Can I sign up for Medicare now and wait to claim my Social Security retirement benefit?
Why ask it
Yes: the two are separate decisions that happen to go through the same agency, and Medicare at 65 arrives before full retirement age for people enrolling now. Say at the start that you are applying for Medicare only, so nobody opens a retirement claim by mistake. The follow-up is how you will be billed for premiums with no monthly benefit to take them from.
I have missed my window, or am about to. When is my next chance?
Why ask it
First check whether you count as late at all: with insurance from your own or a spouse's current job the whole time, you may come in under a special period and owe no penalty. Without that, the usual answer is the General Enrollment Period, January through March, with coverage starting the month after you sign up, unless an exceptional circumstance such as a disaster or wrong information from an employer fits. The penalty is counted in full twelve-month blocks, so ask whether another is about to complete.
My spouse and I are different ages. Does each of us enroll separately, at our own 65?
Why ask it
Each person has a separate window counted from their own birthday, so a younger spouse cannot come in early on the older one's enrollment. The work record is the part that can be shared, which matters if one of you spent years out of paid work. With birthdays a year or two apart, get both sets of dates in one call.
Current coverage
Does my employer's plan let me delay Part B without a penalty, and does the size of the company matter?
Why ask it
Group coverage from your own or a spouse's current job generally lets you wait, but at an employer with fewer than 20 employees Medicare usually becomes the first payer at 65, and a plan in that position can refuse to pay what Medicare would have. Have the benefits office put in writing which one pays first for you. A coworker's experience at a different company is no guide.
Is there a reason to take Part A at 65 and leave Part B for later?
Why ask it
Many people still on a job's plan do just that, because Part A usually has no premium and can pay hospital costs behind the employer plan. The exception is anyone paying into a health savings account, who usually holds off on both. Before enrolling, confirm with the benefits office that Part A changes nothing about your place in their plan.
I pay into a health savings account. What does enrolling in Medicare do to it?
Why ask it
Contributions generally have to stop once you are enrolled in any part of Medicare, Part A included, though money already in the account stays yours to spend. Part A can also be backdated by up to six months when you sign up after 65, so ask which month should be your last contribution. A tax preparer is the right person for what happens if you overshoot.
I was enrolled automatically but still have coverage from work. How do I turn down Part B?
Why ask it
The packet that comes with the card explains how to decline Part B, and that generally has to be done before the start date printed on the card. Check with the benefits office first that your plan really allows you to delay. Then get the refusal confirmed in writing, because a premium deduction that starts anyway takes time to undo.
When I stop working, how long do I have to sign up, and when does that clock start?
Why ask it
The special enrollment period for Part B generally lasts eight months, counted from the month after the job or the group coverage ends, whichever comes first. The window to join a drug plan after losing drug coverage is much shorter, about two months. Get both end dates, and aim to enroll before your last day so one coverage hands straight over to the other.
Does COBRA or retiree coverage count the same way as insurance from a current job?
Why ask it
Generally neither does: both come from past employment, so the months allowed for signing up for Part B keep running while you are on them, and a penalty can build up unnoticed. The trap is that the coverage looks the same from the inside. Raise it before electing COBRA, and find out from the plan what it would pay once you are eligible for Medicare.
I am covered through my spouse's job, not my own. Do the same rules apply to me?
Why ask it
Coverage through a spouse's current employment is generally treated like your own for delaying Part B, with the same question about the size of the employer. A domestic partner's plan may be treated differently, so ask directly if that is your case. Find out too what happens to you if your spouse retires or leaves that job first.
What happens to my spouse and children on my plan when I move to Medicare?
Why ask it
Medicare covers one person at a time and has no family plan, so a younger spouse or a dependent child needs coverage from somewhere else once you leave the employer plan. The benefits office can say whether they may stay on, for how long and at what price. If the answer is poor, that alone can be a reason to keep the job's coverage a while longer.
My employer offers retiree health benefits. Do they require Parts A and B, and how do the two work together?
Why ask it
Retiree plans commonly assume you have both parts and pay only after Medicare, so going without Part B can leave most of a bill with you. Ask whether the retiree plan is a supplement, a group Advantage plan or something else, and get the booklet. One more thing to raise: what happens to the retiree coverage if you join an outside drug or Advantage plan, because some employers end it and do not let you back.
I buy my own insurance through the Marketplace. When should it end?
Why ask it
An individual plan does not count as job coverage for delaying Part B, and the premium tax credit generally stops once you are eligible for premium-free Part A. Nobody cancels the Marketplace plan for you. Find out how to end only your own enrollment on the day Medicare starts, so that family members staying on the plan keep theirs.
I have VA, TRICARE, federal employee or union coverage. How does Medicare fit with it?
Why ask it
Each program has its own rule, and they do not point the same way: some require Part B to keep the benefit, and others treat Medicare as optional. Put the question to the program's own benefits office as well as to Social Security, and ask whether its drug coverage counts as creditable.
Parts A, B and D
Which of the care I use now falls under Part A, and which under Part B?
Why ask it
In outline, Part A is hospital stays, skilled nursing care after a hospital stay, hospice and some home health, and Part B is doctor visits, outpatient care, tests, preventive services and medical equipment. Bring a list of your regular appointments and treatments and go through it line by line, so the brochure answer becomes your own.
Do I qualify for Part A without a premium, and on whose work record?
Why ask it
Premium-free Part A generally takes about ten years of work on which Medicare taxes were paid, by you or by a current, former or late spouse. The representative can check the record on the spot. If you fall short, or have not lived in the country long, ask whether you can buy in, what Part A would cost each month and whether a few more quarters of work would change it.
What does Medicare not pay for that people tend to assume it does?
Why ask it
The usual list is routine dental care, eyeglasses, hearing aids, most care outside the country and long-term help with daily living at home or in a facility. Hearing it at the start changes what you look for in the coverage you add on top. Name anything specific you are counting on and get a yes or no on it.
Do I need a Part D drug plan if I take few or no prescriptions?
Why ask it
Going without creditable drug coverage for more than about two months after you first could have had it generally adds a penalty for each month missed, and it stays on the premium for as long as you have Part D. That is why some people who take nothing choose a low-premium plan anyway. Ask what the penalty would come to after one year and after five, and decide with the numbers in front of you.
Is the drug coverage I have now creditable, and where do I get that in writing?
Why ask it
Creditable means the coverage is expected to pay at least as much as standard Part D, and employer and union plans generally send a notice saying so each year. Keep every one, because you may be asked to show them years later when you finally join a drug plan.
Where do I sign up for Part D, since it is not on this application?
Why ask it
Social Security handles Parts A and B, while drug plans and Advantage plans are run by private companies and joined through Medicare's plan finder, by phone with Medicare, or with the plan itself. It is easy to leave the office believing you are finished. Go home with the deadline for joining a drug plan written down.
How do the preventive visits work in the first year, and what should I book?
Why ask it
Part B includes a one-time 'Welcome to Medicare' visit in the first twelve months and a yearly wellness visit after that. Neither is a full physical, and tests ordered during one may be billed separately. When booking, use the visit's name so the office codes it correctly, and ask what you might owe.
Costs
What will I pay each month for Part B this year, and how is it collected?
Why ask it
The standard premium is reset every year, so get the current figure. It is generally taken out of a Social Security payment if you receive one; otherwise a bill comes, usually for three months at a time, and an automatic bank payment can be set up. Coverage can end for nonpayment, which makes the grace period worth knowing.
Does the income-related surcharge apply to me, on Part B and on Part D?
Why ask it
Higher earners pay an added amount on both, usually worked out from the tax return of two years earlier. A single unusual year can set it off: a house sale, a large retirement account withdrawal, a final year of salary. Ask to see this year's income brackets and where your return puts you.
My income has dropped since the tax return you are using, because I stopped working. Can the surcharge be reduced?
Why ask it
Social Security has a form for life-changing events such as retirement, a cut in work hours, divorce or the death of a spouse, and it asks for evidence of the new income. A one-time gain in the earlier year generally does not qualify. File it as soon as the notice arrives, and ask how any amount already paid is handled.
We file taxes jointly. Does each of us pay our own premium and our own surcharge?
Why ask it
Each person on Medicare pays a separate Part B premium, and with a joint return an income surcharge generally lands on both spouses who are enrolled. A couple budgeting from one person's figure will be short by half. If one of you is still working, ask whether that salary counts against the retired one's premium.
Beyond premiums, what are the deductibles and coinsurance under Parts A and B this year?
Why ask it
Get this year's figures for the Part A hospital deductible, the Part B deductible and your share of each bill after it, which is generally a fifth. Two details deserve a follow-up: the hospital deductible is charged per benefit period, not per year, and Original Medicare sets no yearly ceiling on what you can owe. That missing ceiling is the reason to look hard at what goes on top.
Is there help with premiums or drug costs at my income?
Why ask it
Two programs to ask about by name: Medicare Savings Programs, run through state Medicaid offices, and Extra Help with drug costs, handled by Social Security. Income and savings limits change yearly and differ by state, so do not rule yourself out by guesswork. A SHIP counselor can screen you for both in one sitting.
What should I budget each month in total, with a drug plan and whatever I add on top?
Why ask it
Have the counselor add up Part B, any surcharge, a drug plan and either a supplement or an Advantage premium, and then add what Medicare leaves out, such as dental work and glasses. Do the sum once for each route, since one monthly number per route is easier to compare than six separate ones.
Original or Advantage
Once I have Parts A and B, what are my choices for how I get the coverage?
Why ask it
There are two routes. With Original Medicare you can see any provider that accepts Medicare, and most people add a separate drug plan and often a supplement. A Medicare Advantage plan is a private plan that delivers Parts A and B itself, usually with a network, approval rules, a yearly out-of-pocket limit and often drug coverage built in.
Do I have to choose during my enrollment window, or can I change later?
Why ask it
You can generally change each fall, from mid-October to early December, and people in Advantage plans get another chance from January through March. The catch is the supplement: insurers usually have to sell you one only in the six months after Part B starts, and after that in most states they may ask health questions first. How your state handles it decides how reversible the first choice really is.
Which Advantage plans are sold in my county, and are my doctors and hospital in their networks?
Why ask it
Plans are sold by county, so one a relative likes in another state may not exist where you live. Check each doctor twice, in the plan's directory and with the doctor's billing office, because directories fall out of date. Name the hospital you would want in an emergency and ask about that one too.
Do my current doctors accept Original Medicare, and are they taking new Medicare patients?
Why ask it
This one goes to each doctor's front desk, not to Social Security. Acceptance is wide, but a practice can close its list to new Medicare patients or opt out altogether. Ask whether they 'accept assignment', which means taking Medicare's approved amount as full payment.
What should I bring so my prescriptions can be checked against the plans here?
Why ask it
Bring each drug's exact name, dose and how often you fill it, plus the pharmacy you prefer. The plan with the lowest premium is frequently not the one with the lowest cost for the year once your own drugs are entered. Take the comparison away printed or emailed, with the date on it.
I split the year between two addresses. Which route covers routine care at both?
Why ask it
Original Medicare works anywhere in the country that takes Medicare. An Advantage plan built on a local network may cover only emergencies away from home, though some have travel or visitor arrangements. The test for any plan is what a routine appointment at your second address would cost, not an emergency.
If I try an Advantage plan at 65 and it does not suit me, what are my rights to go back?
Why ask it
People who join an Advantage plan when first eligible at 65 generally have a trial right: within the first twelve months they can return to Original Medicare and buy a supplement without health questions. Ask for the last date on which you could use that right and note it. After it passes, the answer depends heavily on your state.
How much do the dental, vision and hearing extras in an Advantage plan pay in a year?
Why ask it
Ask for the yearly dollar limit, the list of dentists or providers who take it, and what a crown or a pair of hearing aids would cost you after the plan pays. Extras can change every January, and they are worth counting only once the medical side of the plan fits.
Are you paid by any of the plans you are describing to me?
Why ask it
SHIP counselors are free and take no payment from insurers, agents and brokers are paid commissions by the plans they enroll people in, and Social Security staff do not recommend plans at all. None of that makes anyone's advice wrong. It tells you whose list of options might be incomplete, and when a second opinion is worth an hour.
Applying
Can I do the whole Medicare application online, or does my situation need a call or an office visit?
Why ask it
The online application on Social Security's website needs no appointment and can be done for Medicare alone. Phone and office visits may mean a wait for an appointment, which matters if your window is nearly over. If it is close, ask which date counts as your filing date and how to protect it.
What will the Medicare application ask for that I should have in front of me?
Why ask it
Expect to give your Social Security number, your date and place of birth, and details of any current health coverage with its start and end dates. Some people are also asked for proof of age, citizenship or lawful residence, or for employer forms. Check before a visit so that one trip is enough, and before mailing any original document.
I delayed Part B because of job coverage. What proof will you need, and who fills in the form?
Why ask it
Enrolling under the special period generally means a Part B application plus a second form on which the employer certifies the dates you were covered. A previous employer may have to complete one as well if you changed jobs after 65. Hand it to the benefits office weeks ahead, since a signature from a busy office can be the slowest step.
How will I know the application went through, and when should the card arrive?
Why ask it
Ask for a confirmation number and how to follow the status in your online Social Security account. The card is mailed to the address on file, so check that address while you are there. Get a date by which to call if nothing has come, and ask how to show a pharmacy you are covered in the meantime.
Can my spouse or adult child deal with you on my behalf?
Why ask it
Social Security and Medicare each have their own way of letting another person speak for you, and a power of attorney may not be enough on its own. Ask what each one needs: usually the person being present or on the line, or a signed authorization on file. Sort it out while the person enrolling can still make the call themselves.
On what date should I cancel my current insurance?
Why ask it
Not until the Medicare start date is confirmed in writing and any drug or other plan you added has confirmed its own. Ending the old plan on the last day of the month before Medicare begins is the usual aim, and a few days of overlap costs less than a gap. The old plan will have its own notice period, so call it before you pick the day.
If I disagree with a penalty or a start date, how do I ask for a review?
Why ask it
A decision letter generally explains how to request reconsideration and gives a deadline, so read the last page first. If you delayed because a government employee, an employer or a plan gave you wrong information, say so and ask whether relief is available for that. Notes with names, dates and what was said are the evidence, so start keeping them at the first call.
Will Medicare or Social Security ever phone me to ask for my number or a payment?
Why ask it
As a rule, no: neither agency cold-calls to ask for a Medicare number, bank details or a fee to 'activate' a card. Around a 65th birthday the mail and the phone fill with plan marketing, some of it dressed up to look official. Ask what a real contact from them looks like, and treat the Medicare number like a credit card number.
Once I am enrolled, what do I need to look at again each year?
Why ask it
Parts A and B carry on without re-enrolling. Drug plans and Advantage plans change their premiums, drug lists and networks every January, and a notice of the changes arrives in the fall. Put the fall review in a calendar now, and expect any income surcharge to be worked out afresh each year.
How to sign up for Medicare without missing a deadline
Practical guidance for the conversation itself
Getting ready to enroll
Put the seven months on a calendar
Count three months back from the month of the 65th birthday and three months forward, and mark both ends. If the birthday falls on the first of a month, shift everything a month earlier. Enrolling in the first three of those months is what keeps coverage from starting late.
Start with the benefits office if there is a job
Anyone covered through their own or a spouse's work should talk to that employer before Social Security. Three answers are needed in writing: how many employees the company counts for this purpose, which coverage pays first at 65, and what happens to family members on the plan.
Write one page of facts
Birth date, the dates of any current coverage, the name of the employer plan, income from the last two tax returns, and a list of prescriptions with doses. Whoever you speak to will ask for most of it, and having it on paper means a helper can make the call too.
Decide what each call is for
Social Security can enroll a person in Parts A and B in one conversation. It cannot choose a drug plan or weigh Original Medicare against Advantage. Splitting the list by who can answer keeps every call short.
Where each question goes
Social Security
Enrollment in Parts A and B, the dates of your windows, late penalties, the Part B premium and the income surcharge. The When to enroll, Costs and Applying groups mostly belong here. Railroad workers take the same questions to the Railroad Retirement Board.
The employer's benefits office
Everything in the Current coverage group that concerns a job: who pays first, whether COBRA or retiree coverage is offered and on what terms, the creditable coverage notice, and the form that certifies your dates. Ask for the answers by email so there is a record.
A SHIP counselor
SHIP stands for State Health Insurance Assistance Program: free counseling in every state, under different local names, from people no insurer pays. This is the place for Original Medicare against Advantage, drug plan comparisons and screening for help with costs. Appointments can be hard to get in the fall, so book ahead.
Medicare and the plans
Medicare's phone line and its online plan finder show which drug and Advantage plans are sold at your address and what each would cost with your prescriptions. A plan's own staff can confirm a network or an approval rule, but they answer only for their plan.
Mistakes that follow people for years
Waiting for a letter that never comes
Only people already receiving Social Security or Railroad Retirement benefits are enrolled without asking. Someone who is still working or has put off claiming has to apply, and the seven months pass quietly.
Counting COBRA as job coverage
COBRA and retiree plans feel like the old insurance, but they generally do not stop the clock on Part B. Check before relying on either for more than a few months after work ends.
Paying into an HSA after Part A starts
Part A can reach back up to six months when it is claimed after 65, and contributions made in that stretch can cause a tax problem. Stopping early is simpler than correcting it afterward, and a tax preparer can say what applies to you.
Stopping at Parts A and B
The red, white and blue card is not the end of the job. Without a decision on drug coverage and on what sits on top of Original Medicare, a person can be left with a drug penalty later and no ceiling on hospital and doctor bills now.
The first weeks on Medicare
Read the card when it arrives
Check the name, the Medicare number and the two start dates, one for Part A and one for Part B. A date that is not what you were told is easier to fix in the first month than after a claim has been refused.
Hand the old plan over cleanly
End the previous coverage only once the new start dates are confirmed, then give the new card to each doctor's office and the pharmacy at the next visit. A claim sent to the wrong insurer in the changeover month can take weeks to untangle.
Set up the account and the helper
Create the online Medicare account, which shows claims and the plans you hold, and file whatever authorization lets a spouse or child speak for you. Both are quick while everything is fresh and slow in an emergency.
Keep one folder
The award letter, the creditable coverage notices from every employer, the premium bills, and notes of each call with a name and a date. If a penalty is ever charged in error, that folder is where the evidence to challenge it will be.