When Do You Enroll For Medicare?

 While most people start Medicare when they turn 65 years old, you can also gain access to Medicare before age 65 by virtue of a qualifying disability or by developing certain conditions such as ALS (Lou Gehrig’s  Disease) or ESRD (End Stage Renal Disease). You could also be considered “new” if you delayed Medicare, continued working past age 65, and remained on your employer group health plan. Regardless of how you are approaching Medicare, as you are getting ready to take the “plunge” you may be wondering “now what”? You may have even heard that you could be fined or penalized by not signing up when you are eligible! 

 When it is time for Medicare, it can seem overwhelming and that is unfortunate because it shouldn’t be. Medicare is, by most accounts, a very popular  government program. For many, it is the first time in a long time that they have affordable health coverage. The process of choosing your Medicare health plan should be exciting, not scary or confusing. 

You must be a citizen or legal resident. A legal resident must have lived in the United States for at least 5 years in a row including the 5 years  immediately preceding applying for Medicare. You must also be: 

• Age 65 or older or…
• Younger than 65 with a qualifying disability for at least 24 months or…
• Any age and diagnosed with ALS or ESRD

There are 4 parts to Medicare: A, B, C, D

Part A 

Helps pay for hospital stays, inpatient care, hospice, and skilled nursing.
For most people Medicare Part A is premium free by virtue of a life full of working and paying taxes. In fact, most beneficiaries do not have to pay premium for Part A. The work requirement is working 40 quarters (10 years) and pay payroll taxes. For those that did not work 40 quarters, there will be a premium. The premium charged will depend on how many quarters were worked.

Hospital Stay:
• You pay a $1,676 deductible per benefit period (up to 60 days)
• Then $400 per day for days 61-90 of each benefit period
• Additionally, $800 per lifetime reserve day (maximum of 60 days)

Skilled Nursing Confinement:
•Medicare pays all eligible expenses for the first 20 days. You pay a copay of $200 per day days 21 – 100 of each benefit period. You are responsible for all costs each day after day 100 of the benefit period.

**There is NO out-of-pocket maximum limit.

Part B 

Helps pay for Doctors and other outpatient care and services.
Part B cost is based on your income. Most people pay the standard rate which is $185.00/mo (2025). This premium is deducted from your social  security payment if you are receiving benefits. If you haven’t started taking your social security, you will be billed quarterly. For people who earn more, you might be charged an IRMAA (Income Related Monthly  Adjusted Amount). Medicare calculates your IRMAA by looking at your Modified Adjusted Gross Income (MAGI) to determine your additional premium. Your MAGI is determined from your IRS tax return from two years prior. Currently about 5% of beneficiaries must pay more than the standard rate.

Deductible: You pay a one-time deductible of $257 per year for 2025. This is subject to change annually.

Other Costs: You must pay 20% of the Medicare-approved amounts for qualifying medical services, plus Excess Charges (if applicable).

**There is NO out-of-pocket maximum limit.

Parts A& B are commonly known as “Original Medicare”

Part C 

Combines Part A and B of Medicare into one plan and is offered by private companies. These plans usually include prescription drug coverage.
Part C consists of Medicare Advantage plans. You must be enrolled in both Parts A and B to be eligible for Medicare Part C. You still must pay any premium associated with Parts A&B (including any IRMAA assessed). There could be an additional premium for a Medicare Advantage plan. Premiums for these plans will depend on the type of plan you choose and can range from $0 up to $200/mo or more.

Part D 

Helps pay for prescription drugs.
Part D prescription drug plans are offered by private companies contracted by Medicare for this purpose. Part D can be acquired within a Medicare Advantage Prescription Drug Plan (MAPD) or as a stand-alone plan. Within a MAPD plan, the Part D plan may or may not have a monthly  premium. As a stand alone plan, premiums can run as low as $7/mo for a basic plan and as high as $100/mo (or more) for plans with enhanced  coverage (2025). Which type of plan you enroll in should be determined  by a thorough analysis of your prescription drug needs and which type of  coverage you desire. Like Part B, people who earn more could have an IRMAA added to the Part D plan premium.

If you are receiving Social Security or Railroad Retirement Board  benefits, enrollment in Medicare is automatic when you become eligible.  You will get your card in the mail.

If, however, you are not receiving benefits, you will have to enroll yourself when you become  eligible. You can enroll online or call the local Social Security office for a phone appointment.