Common Questions

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Turning 65? How do I sign up?

People already collecting Social Security benefits will be automatically enrolled into Medicare Parts A&B and should receive their red/white/blue Medicare card in the mail 3 months before birthdate. 

Others will need to contact Social Security Administration in order to enroll. Please call (800) 772-1213, or enroll online at www.ssa.gov 

For additional coverages, such as Medigap Supplements, Advantage, and Part D Prescription Drug plans,  please contact Medicare Plan Shoppe (330) 858-9769. 

I am still covered by an employer group plan

If you are still working and covered by an employer group plan (or spouse's plan), it is recommended to inquire of your group representative to see how your group plan works along with Medicare.

If your company has 20+ employees, you may decide to delay* your Medicare Part B enrollment because your group plan is primary *(without incurring a Late Enrollment Penalty). *Always check with your group representative for details on how your  plan works along with Medicare.   

Some people find that joining a Medicare plan may be more cost effective than staying in their group plan.

Over 65 and ready to retire?

Are you (or spouse) getting ready to retire and will be leaving your group plan within 90 days?  You may qualify for a Special Enrollment Period.  

Contact Social Security (800-772-1213) to enroll into Medicare Parts A & B. Explain you are leaving your group plan and will need to enroll into Medicare Parts A & B.  These will be effective 1st of month after group coverage ends.


2 FORMS ARE REQUIRED TO BE COMPLETED: 

- APPLICATION FOR ENROLLMENT IN MEDICARE PART B (CMS-40B)

- REQUEST FOR EMPLOYMENT INFORMATION (CMS-L564) 

*** MAKE TWO COPIES -Return one copy to Social Security and keep one to show insurance company.  Pick up forms at Social Security office or online www.ssa.gov

How much does Medicare cost?

Monthly premiums for Parts A & B vary and is dependent upon your income for past two years.  Generally speaking, most individuals pay the following: 


Part A - $0 monthly premium (if you/spouse have paid 10+ years in Medicare Tax) .  If you do not qualify for "premium free" Part A, you could pay up to $437/month.

Part B - $135.50 monthly premium (if income less than $85K/ind or $170K couple)

Premiums will be deducted directly from Social Security benefit payment.

If not yet receiving Social Security benefits, Part B will be billed quarterly.



Enrollment Periods

IEP - INITIAL ENROLLMENT PERIOD (turning 65) - 3 months before/during/3 months after 65th birthmonth.

(DISABILITY) IEP - 3 months before/during/3 months after 25th month of receiving SSDI benefits.

AEP - ANNUAL ENROLLMENT PERIOD (Oct 15 - Dec 7) Members with Advantage or PDP plans may choose another plan, to be effective the following January.

OEP - OPEN ENROLLMENT PERIOD (Jan 1 - Mar 31) Members with an Advantage plan or PDP plan can make a "one-time" switch to another Advantage/PDP plan, or return to Original Medicare. 

MADP - MEDICARE ADVANTAGE DISENROLLMENT PERIOD - member with an Advantage plan can drop plan and return to Original Medicare, and choose to enroll into Stand Alone PDP (Prescription Drug Plan).

SEP - SPECIAL ENROLLMENT PERIOD - when certain life situations occur;  such as leaving group coverage, moving out of service area, etc.

GEP - GENERAL ENROLLMENT PERIOD  (Jan 1 - Mar 31) may utilize if you did not sign up for Part A (if you have to purchase) and/or Part B during your IEP. Coverage will not begin until July 1, and you may have to pay higher Part A/B Premium.

 

PENALTIES - (in addition to monthly premium) If you are late in enrollment and have not had creditable coverage, Medicare may impose a Part A, B and/or Part D Penalty.   Call Medicare Plan Shoppe for more detail (330) 858-9769

Why am I enrolling into Medicare thru Social Security?

The Social Security Administration (SSA) and Center for Medicare & Medicaid Services (CMS) are separate Federal government programs.  SSA performs basic administrative functions for both programs, including enrollment.  You may enroll in Medicare by visiting the website www.Medicare.gov or by calling Social Security at 1-800-772-1213 

QUESTIONS???

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I'm turning 65 and will continue to be covered by an Employer Group plan.

Contact your Group Plan to see how it works along with Medicare. You may be able to delay Part A /B/ D enrollment without incurring a "late enrollment" penalty.

I am turning 65, when is my Medicare enrollment period?

Your Initial Enrollment Period begins 3 months prior to birthmonth, includes birthmonth, 3 months after birthmonth (7 months total).



How do I enroll into Medicare Part A or B?

Contact Social Security Administration to enroll into Part A or Part B (1-800-772-1213) or www.ssa.gov.

 

Will I owe a Penalty?

Enrollment periods are crucial!  A penalty may be imposed by CMS (Centers for Medicare & Medicaid Services) who are considered "late" in their Part A/B/D enrollment.  

How can I get help?

MEDICARE PLAN SHOPPE will help you understand Medicare basics and will research your individual healthcare needs in order to focus on plans which will work well for your personal circumstances.  CALL (330) 858-9769.