Get Your Medicare Questions Answered

We give CPS Advisors and their clients all the answers to that and more, with guidance through Medicare enrollment.

As many individuals begin to approach retirement age they often wonder, ”When can I apply for Medicare?”  Generally speaking, the answer is when turning 65. 

While the answer may seem simple, the process can sometimes be a bit overwhelming and confusing. 

Lucky for you and your clients, we have answers.  Keep reading to find out how and when your clients can apply for Medicare benefits.

When is your client eligible to sign up for Medicare?

Most individuals are eligible for Medicare when they turn 65; however, there are a few instances in which they may be eligible before their 65th birthday.  Let’s take a look at each scenario in which your client would be eligible to apply for Medicare:

• Age:  You are eligible to sign up for Medicare during a seven-month time frame around your 65th birthday.  The window of eligibility begins three months before your birthday,  continues through your birth month, and ends three months after your birthday.
• Disability:  If you have a disability and have been receiving Social Security benefits for 24 consecutive months you are eligible to apply for Medicare regardless of age.
• Lou Gehrig’s Disease:  If you suffer from Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS), you automatically qualify for Medicare even if you aren’t 65.

What are the plans available to your Medicare-eligible client?

Generally speaking, your client has four main plan choices in Medicare:

1. Medicare Part A, also known as Hospital Insurance, covers most inpatient hospital services, home healthcare, and hospice care.
2. Medicare Part B, also known as Medical Insurance, covers most outpatient medical services such as preventive care, lab tests, x rays, ambulance services, and more.
3. Medicare Part C, known as Medicare Advantage, is offered through private insurance companies and provides all the same benefits as Original Medicare plus more. Most Part C plans offer vision, dental, and prescription drug coverage.
4. Medicare Part D provides prescription drug coverage and is offered through private insurance companies approved by Medicare.  A Part D drug plan usually is combined with a MediGap private insurance plan.

In addition to these plans, there are ten supplement insurance plans the client can purchase, known as MediGap Plans, that will help cover the gaps in coverage with Original Medicare (Parts A and B).

When are the deadlines to apply?

• Initial Enrollment Period (IEP):  The Initial Enrollment Period is the first opportunity that occurs over a seven-month period of time.  The seven-month window begins three months before your client’s 65th birthday, the client’s birth month, and three months after the birthday month.  Your client may be subject to a lifetime late enrollment penalty If that enrollment doesn’t occur during these seven months.

• Special Enrollment Period (SEP):  A Special Enrollment Period is available for those who continue working past 65 and have health coverage through their employer or spouse.  The time frame for a SEP is eight months, which begins one month after your employment or health coverage ends.  Failure to enroll within those eight months can result in a lifetime late enrollment penalty.

• General Enrollment Period (GEP):  A General Enrollment Period begins on January 1st and ends on March 31st.  When your client misses the Initial Enrollment Period a new Medicare enrollment can occur during these three month.  Coverage will take effect the month following enrollment.  A lifetime late enrollment penalty is likely to result when a client misses the Initial Enrollment Period.

• Annual Enrollment Period (AEP):  The Annual Enrollment Period runs from October 15th through December 7th.  During this time frame, the client can add Medicare plans, drop Medicare plans, and make changes to existing Medicare plans.  Any changes made during this enrollment period will take effect in January the following year.

How to Apply for Medicare

After asking, “When can I apply for Medicare?” The next most common question is, “How do I apply for Medicare?”  There are various ways your client can apply for Medicare including:

• Online at ssa.gov
• By phone at 1-800-772-1213
• In-person at your local social security office
• Through a licensed and certified Medicare Insurance Agent

Documents Needed to Enroll in Medicare

• Birth certificate or other proof of birth
• Proof of United States citizenship or legal residency
• Driver’s license

CPS Advising for Your Medicare-Eligible Clients

Trying to figure out which coverage is best while juggling enrollment periods, costs, insurance gaps, and more can leave anyone feeling frustrated and helpless.  Enlisting the help of an experienced Medicare Insurance Agent can help ease the stress of enrolling in Medicare.  With over 40 years of insurance experience, the in-house Medicare Advisor at CPS, Dan Griset, can guide your clients through the Medicare planning and enrollment process.  If you aren’t certified for Medicare and want to retain your clients, introduce Dan as your Medicare specialist.  He’ll go to work on your behalf while you earn a referral fee.

Interested?  Contact Daniel E. Griset, CLU, Medicare Advisor, at dgriset@cpsinsurance.com, (949) 225-7144, or schedule a quick call with Dan HERE.