How to Transition to Medicare? (2021 Updated Edition!)

Susie Valentine
 • 
Sep 9, 2021
 • 
5
 min

First, congratulations on the multiple new milestones you’ve reached. If you’re reading this article, chances are that one of the exciting transitions below applies to you:

  1. You turned 65 - happy birthday to you! 
  2. You’re over 65 and retired from your job - hurray!  
  3. You’re part of the 15% of the American population who is eligible for Medicare. 

Signing up for Medicare is a very important next step for your health and wellness. It can seem daunting at first to understand and manage all the information and details. We’ve made it easier for you in this helpful guide for how to transition to Medicare.

Confirm Your Eligibility:

Before we jump into the details, let’s make sure you meet the requirements of this checklist. Ready?

  • You’re an American.
  • You are 65 years of age or will be in the next 2 months
  • You’re under the age of 65 and have been on social security disability for at least two years
  • You have End Stage Renal Disease or ALS


Meet Medicare, An Important Benefit:

Let’s start out with the basics of Medicare. Medicare is  a program managed by the federal government to provide eligible individuals with coverage for and access to doctors, hospitals, or other health care providers who accept Medicare. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any Medicare-covered service it covers. You’ll be responsible to pay the rest, unless you have additional insurance that covers those costs. 


Easy Sign Up:

There are 3 easy ways to sign up, so no excuses! Here are your convenient options:

  1. Online at www.SocialSecurity.gov
  2. Over the phone by calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7 a.m. to 7 p.m.
  3. In-person at your local Social Security office.


Mark these Dates in Your Calendar for 2020/2021:

  • October 15 to December 7, 2020 – Open enrollment period for Medicare Advantage, Medicare Part D, and supplemental plans called Medigap plans 
  • January 1 to March 31, 2021: General enrollment for Medicare Part B, for people who didn’t sign up when they were first eligible (this is also the general enrollment period for people who have to pay premiums for Medicare Part A and didn’t sign up when first eligible).  
  • January 1 to March 31, 2021: People who already have Medicare Advantage can switch to Original Medicare (plus a Part D prescription drug plan) or to a different Medicare Advantage plan.
  • Your 65th birthday!: If you are turning 65 this year or next, mark the 3 months prior to your birth month and the 3 months after.  This is your initial enrollment period.  For example, if your birthday is in May, you’ll be eligible to first enroll in Medicare from February 1st to August 31st.   
  • Special enrollment periods: These are enrollment periods for which the above rules usually don’t apply.  See more details here!


Pick a Plan that’s Right for You: 

It’s important to sign up for the parts of Medicare that best match your healthcare needs. These needs may be different in the future, so you may want to reevaluate this every year. If you and your spouse are signing up for Medicare together, keep in mind that you may need different plans depending on your individual, unique healthcare needs. 


Medicare Part A

Medicare Part A is hospital insurance. Most Medicare Part A beneficiaries don’t have to pay a monthly premium to receive coverage. If you’ve worked at least 10 years (40 quarters) and paid Medicare taxes while you worked, you’re eligible for premium-free Part A. If you don’t meet those requirements, you will pay a monthly premium for your coverage. It covers a variety of hospital-related scenarios such as inpatient hospital care, skilled nursing facility care, hospice care, inpatient lab tests and surgery, and home health care. 

Medicare Part B

Medicare Part B is medical insurance and for most Americans over 65, one of the most important parts of Medicare to sign up for during the transition to retirement. You’ll be responsible to pay a deductible each year before your Medicare Part B benefits kick in. As a Medicare Part B beneficiary, you are also usually responsible for a portion of your health care (usually 20% or Medicare-approved services) called a coinsurance.

Here are some benefits that Medicare Part B cover: 

  • Certain non-hospital medical expenses to keep you feeling well. This includes doctors’ office visits, blood tests, X-rays, diabetic screenings and supplies, and outpatient hospital care. You pay a monthly premium for this part of Original Medicare. The fee can be higher for people with high incomes. 
  • Medicare usually pays 80% of the full cost of many lab tests and services requested by your doctor.  You will typically have to pay the remaining 20%.  .

Medicare Part C

Medicare Part C, or Medicare Advantage, plans are an alternative to Original Medicare. They're offered by private insurance companies contracted with Medicare to provide Medicare Part A and Part B benefits. Some Medicare Advantage plans include coverage for prescription drugs and services not covered by Original Medicare, like eye exams, hearing aids, or dental care. For many Americans, Medicare Advantage plans are an alternative to Original Medicare. Enrolling in a Medicare Advantage plan is optional. If you’re interested in it, it’s easy to get started but you must have enrolled in Original Medicare, Part A and Part B, first. 

Medicare Part D

Medicare Part D is an optional prescription drug coverage plan for anyone who has Medicare. Medicare Part D is available as a standalone prescription drug plan through private insurance companies, and the monthly fee varies among insurers.  Remember that Rx coverage can also be offered with many Medicare Advantage plans (called an MA-PD plans).  

There are multiple Medicare Part D plans depending on your prescription drug needs. Take the time to understand the different plans and choose the one that is right for you.  All of these plans must provide a minimum level of coverage as defined by Medicare, though each plan has its own formulary, or list of covered drugs and how they’re tiered.  Tiers are a way of controlling how much you pay for your prescriptions.  They are structured like this:

  • Tier 1: generics (lowest copay)
  • Tier 2: brand name, preferred (higher copay)
  • Tier 3: more expensive brand name, non-preferred (highest copay).  Once you’ve picked your plan, you will share in the costs of your prescription drugs according to the terms of the specific plan.  Remember that Part D plans also have a separate monthly premium as well as a deductible and copay or coinsurance.   

Make Sure You’re Managing Your Medical Bills Right!

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