Medicare Basics
What you need to know when turning 65
Medicare is federal health insurance that saves you money on health care. Most people need to sign up for Medicare just before they turn 65 to avoid paying more for the rest of their life and make sure the insurance starts on time.
Who can get Medicare before age 65? These groups will be signed up for Part A and Part B automatically:
People getting Social Security Disability (SSDI) benefits for 2 years
People who have ALS (Lou Gehrig’s)
People who have end-stage renal (kidney) disease
Medicare Options
Do you have low or no income? Call the 2-1-1 helpline to find your local ADRC (Aging and Disability Resource Center) to learn about programs that can help you pay for Medicare.
There is an additional plan you can add to either option #1 or option #2 called Part D. It covers prescription drugs, and is also called Medicare Prescription Drug Plan. Another option in Wisconsin is SeniorCare Prescription Drug Assistance Program.
Option #1: Original Medicare Part A & Part B
With original Medicare you can use any doctor or hospital in the U.S. or it’s territories that take Medicare.
Part A is hospital insurance. It covers stays at a hospital or skilled nursing facility.
Part B is medical insurance. it covers medical care such as doctor and emergency room visits.
Medigap is a Medicare Supplement Plan for Original Medicare. It helps pay for out-of-pocket costs like deductibles, co-pays, and co-insurance.
Option #2: Medicare Advantage Part C
To get Medicare Advantage, you must first sign up for Original Medicare. With Part C, you:
Get Original Medicare benefits from a private Medicare Advantage Plan.
Must use doctors or hospitals in the plan’s network.
Usually get Part D prescription drug benefits.
When do I sign up for Medicare?
Sign up for Medicare during your Initial Enrollment Period. This is your 7-month period around your 65th birthday. After the initial enrollment period, you can still sign up but you will pay more, and you may have a gap in your health insurance coverage.
Warning:If you sign up late, you will usually pay a higher monthly premium for the rest of your life.
Do you get monthly benefits from Social Security or the Railroad Retirement Board?
When you turn 65, you will automatically be signed up for Original Medicare and get your Medicare card in the mail.
Do you have other health insurance?
If you or your spouse have group health insurance from a job when you turn 65, you can sign up for Medicare after the 7-month Initial Enrollment Period.
You won’t pay a penalty to sign up late if you show proof of health insurance from your job.
Ask your job how your health insurance works with Medicare.
Your Medicare start date depends on when you enroll
You may need to enroll in Medicare if it pays before the employer insurance, or else you may have high out-of-pocket costs.
When to sign up if you have insurance from a job:
Anytime you’re still covered by the group health plan.
Up to 8-months after the job or the health insurance from your job ends. Ask your job to fill out the form “Request for Employment Information” from Social Security.
COBRA, Retiree health plans, or private plans from an insurance company or HealthCare.gov don’t count as health insurance from your job
Should you wait to sign up?
Anytime you’re still covered by the group health plan.
Up to 8-months after the job or the health insurance from your job ends. Ask your job to fill out the form “Request for Employment Information” from Social Security.
Are you a veteran?
All veterans should sign up for Medicare during their 7-month enrollment period. The VA only pays for services at the VA (unless you get approval for services outside the VA). You may be able to get a prescription drug plan from the VA.
Veterans who don’t sign up at the right time and need Medicare later, will pay more and may have a gap in their coverage. If you have questions, contact your local Veterans Service Office (VSO).
What if I miss my Enrollment Period?
You can sign up for Medicare during the General Enrollment Period, from January 1 to March 31 each year.
You will pay 10% more for each year you didn’t sign up.
3 ways to sign up:
Call Social Security at 1-800-772-1213
In-person at your local Social Security Office
Online at: www.ssa.gov/medicare
Have questions or need help?
Go to your local ADRC (Aging and Disability Resource Center) to get free in-person help. To find your local ADRC:
Call the 2-1-1 helpline
You can download a printable PDF of this information
Click the image to download a copy in English and Spanish.
