Medicare Eligibility

Most adults become eligible for Medicare on the first day of the month they turn age 65. To be able to get a Medicare policy such as a Medicare Supplement or Medicare Advantage Plan (Part C) you must be enrolled in Medicare Part A and Part B. Part A is basic hospital insurance; Part B helps to pay for medically necessary services such as doctor visits or outpatient care. Premiums for Part B (there is no premium for Part A) will be deducted automatically from your Social Security check or you can pay direct if you choose to wait to start getting your Social Security check. Contact your local Social Security office three months in advance of your 65th birthday to start the process of enrolling in Parts A and B.

If you still receive medical insurance from another provider (such as your employer or your spouse's employer), you can wait to sign up for Medicare. To avoid paying a higher premium, you will be required to enroll during the eight-month period that begins during the month your employment ends or the group health coverage ends, whichever is first. Note also that you may be assessed with higher premiums if your modified gross adjusted income is over $85,000 for single filers and $170,000 for married couples filing jointly.

Medicare Part C and Part D

Both Medicare Part C (Medicare Advantage) and Part D, which is prescription drug coverage, are provided by private insurers whose plans are approved by Medicare. You can get information on these providers on the Medicare Web site www.medicare.gov.

You can sign up for both Part C and Part D shortly before you become eligible for Medicare and the coverage can begin once Part A and Part B are effective. There are also several enrollment periods and special election periods that may allow you to enroll. If you wait and try to sign up after your first initial election period, you may be charged a late enrollment penalty and be forced to pay higher premiums.

Supplementing With Medigap (Medicare Supplement)

Many retirees supplement their Medicare coverage with Medigap plans, which are sold by private insurers. The state where you live may determine the type of plan available to you. It's important to note that these policies do not cover long-term care, vision care, dental care, hearing aids, eyeglasses, prescription drugs, and private-duty nursing. If you anticipate ongoing use of these services, you may need to obtain another form of insurance or pay out of pocket.

When you sign a contract for Medigap insurance, you usually permit the insurer to access your Medicare Part B claim information directly from Medicare and to bill your health care providers directly. In certain instances, Medigap providers will manage claims for Medicare Part A as well.

Your Rights as a Medigap Beneficiary

Medigap policies cover only one individual, which means that for couples, each partner needs to purchase a separate policy. The best time to purchase a Medigap policy is during the Medigap open enrollment period, which lasts for six months after you are both age 65 or older and enrolled in Medicare Part B. During this period, an insurer cannot refuse to sell you a Medigap policy or impose a surcharge because of your health status.