If you’re at least 64 and nine months old, it’s time to apply for Medicare!
Get Your Documents Ready
You’ll need at the very least your Social Security number and an original birth certificate.
If you’re not the Average Bear, then also:
- Original marriage certificate, if applicable
- Legal residency and immigration documents, if applicable
- Proof of employer- or union-based insurance from your own or your spouse’s active employment since turning 65, if applicable (here’s the form if you need it)
Apply in Person: Call Social Security at (800) 772-1213 and schedule an interview at your local office if you don’t want to wait in line. Bring your paperwork. To find your office, look here.
Apply by Phone: Call Social Security at (800) 772-1213 and schedule a phone interview. You may be on hold up to 45 minutes, so consider leaving your phone number and waiting for a return call. Pro Tip from the Actual Social Security Guy on the Phone: Thursday afternoon is a great time to call, because you will wait longer if you call first thing Monday Morning! (Note: Apply by phone if you are applying based on your spouse’s work credits or if you have an uncommon situation; the online version may tell you that you don’t qualify on your own. The person on the phone can help you to enroll.)
Apply Online: Apply online if you’re at least 64 years and nine months old.
- First, create an online Social Security account by clicking here. If you already have an online Social Security account, proceed to step 2.
- Apply for Medicare by clicking here. (I do recommend having something to write with, because they will give you a special re-entry number. Write this number down and save it until you have completed your application. This lets you leave and come back to the application if you need to.)
Here is a handy government checklist to make sure you have all the documents you need mentioned above, lol! You can create your Social Security account and literally minutes after that, apply for Medicare. It’s that easy!
Do I have to Choose My Plan When I Sign Up for Medicare?
Actually, you can’t. You need to have your Medicare card first, and that takes a few weeks to generate after you sign up. There will be time to sign up for your plan as long as you do it before your Part B effective date.
Where’s My Card?
If you’ve applied for Medicare some time ago and your card still hasn’t shown up yet and you’re getting nervous, call me! I have a way to find out your number so you can apply for a plan on time and not get stuck with a Part D late enrollment penalty. (Yes, this is an actual thing – I’ve helped several people this year who never received their cards and are stuck paying that penalty! Grrrr!)
I only have Part A and now I need Part B
Ah, in that case, you need to prove to the Feds that you’ve had creditable coverage when you didn’t have Part B. Here’s the CMS-L564 form you need to prove your coverage, and here’s the application for Part B, CMS-40B you’ll need to submit at the same time!
(Talk to me before you fill out the CMS-40B so we can determine the best date for you to put in the Remarks section.)
How do I submit these forms I just downloaded?
You have four options:
- Apply Online for Medicare Part B During a Special Enrollment Period and upload your evidence of Group Health Plan or Large Group Health Plan
- Fax your forms to (833) 914-2016 (if your fax system gives a proof of transmittal, keep that proof)
- Mail your CMS-40B, CMS-L564, and evidence to your local Social Security field office. You can find it here.
- Hand-carry your forms to your local Social Security office if time is getting short!
But what if I didn’t have creditable coverage?
YIKES, then sign up for Medicare Part B ASAP, quick like a bunny, because they’re gonna fine you based on how long you could have had the Part B but didn’t! (If you can get your Part B less than a year of not having creditable coverage, you may be spared the penalty, so get crackin’!)
What is this “Creditable Coverage” of Which You Speak?
If your current drug plan pays the same or better than what the standard Medicare prescription drug coverage would pay, then your coverage is creditable. If your plan pays less in drug coverage, then your drug plan is not creditable.
This may become a concern if you are still working past your Medicare Birthday or other Medicare eligibility and stay on your employer’s group plan. If your group plan has “creditable coverage,” then when you decide to fully go onto Medicare complete with Part B, you will avoid a fine for not having had prescription drug coverage when it was first available. But if your company’s drug plan has been determined not to be creditable, then get yourself a prescription drug plan or risk paying a steadily growing fine! (Yes, if you only have Part A, you are eligible for Part D.😊)
FYI, some of those older “grandfathered” Medicare Supplement plans that include drug coverage (Plan J, anyone?) may not be creditable! You may have to stay put to avoid a fine.
How will I know if I have creditable coverage? The Centers for Medicare and Medicaid Services (CMS) require that people eligible for Medicare Part D must be notified if their current coverage is “creditable prescription drug coverage” every year. So pay attention to any letters from the Feds; legitimate letters from Medicare would have these logos:
I’m 65 and have great insurance through my employer. Do I even need to sign up for Medicare?
Technically, no! BUT, it is a good idea to apply for your Part A if you’ve already qualified for the $0 premium, because later on when you need the Part B, you’ll have a Special Enrollment Period. If you’ve passed your time to apply for Part A, then pick it up during the General Enrollment Period to spare yourself some grief.
If you didn’t apply for Part A when you had a chance and you are leaving employer coverage, you have an eight-month period to sign up for Part A and/or B that starts either of these times (whichever comes first):
- The month after your employment ends,
- The month after your group health plan insurance ends.
But Pay Attention! You only have TWO MONTHS to apply for Part D (prescription drug plan) or Part C (Medicare Advantage plan). Make sure to talk to me so we can plan your coverage to avoid any late enrollment penalties.
How to Apply: Apply online, in person, or on the phone. Have your employer fill in the CMS-L564 form you need to prove your coverage to avoid a late-enrollment penalty.
On the other hand, if you missed your Initial Enrollment Period (Medicare Birthday) and are on COBRA or a retiree health plan, but never applied for any Medicare you can only do this from January 1st through March 31st of the year; your Medicare will start the month after you apply. So to avoid this problem, I recommend at least applying for Part A when you have your Medicare birthday.
I Wasn’t Able to Sign Up for Medicare at All and I Missed My Medicare Birthday, What About Me?
If you missed your Medicare Birthday (those 7 months around turning 65), missed the General Enrollment Period, and don’t qualify for a Special Enrollment Period, perhaps you have an Exceptional Condition? Here are the usual suspects:
- Emergency or Natural Disaster (the weather!)
- Group Health Plan or Employer Misrepresentation
- Termination of Medicaid Eligibility
- Formerly Incarcerated Individual
- Other Exceptional Conditions
There is a new form for this, you can download it here. You submit the form directly to your local Social Security field office.
I have Part B only, what about Part A?
It’s possible that by your Medicare Birthday you were missing some Part A credits – you didn’t have 40 quarters or had not paid into Medicare Part A for 10 years, so Our Friends at Medicare only gave you Part B. This is something to consider – check out your Social Security account (you can make an online account to access it immediately – see above). If you have your full 40 quarters now, then you’re completely paid up and it makes sense to get your Part A. If you’re married to someone who has enough work credits, then you also qualify for premium-free Part A.
If you have between 30 and 39 credits, you are entitled to a reduced Part A premium.
What if I don’t have 40 quarters – what’s the Marriage Rule?
Marriage has benefits! If you’ve been married to your current spouse for at least one year, you are 65 or older, and your spouse is at least 62 and has 40 work credits (quarters), then you qualify for $0 Part A. There are other twists regarding divorce, deceased spouses, and divorced late spouses, so my list here isn’t exhaustive. But if your spouse has less than 40 credits, you will pay either a partial or total Part A premium, depending on your spouse’s work credits.
What if I Only Have a Green Card? Same as above – if your spouse has the full credits, so do you! Like I said, marriage has benefits.
When to Apply for Part A
If you’ve passed your Medicare Birthday, you can apply during the General Enrollment Period for your Part A. The General Enrollment Period is January 1st through March 31st of every year. Your new Part A will be effective the month after you apply.
You might take a chance with the Exceptional Condition situation, above; download the form, send it to your local Social Security office, and see what they say!
I’m Not Taking Social Security Yet, How Do I Pay for Part B?
Did you get a rather shocking letter from Medicare asking for hundreds of dollars right away? They like to charge three months at a time, but you don’t have to pay three months at a time! You can pay them month by month, by check, credit card, online bill pay, or by signing up for Medicare Easy Pay. Take a look below:
Pay by check or money order. Mail your Medicare premium payments to:
Medicare Premium Collection Center
P.O. Box 790355
St. Louis, MO 63179-0355
Pay by credit card or debit card. Complete the bottom portion of the payment coupon on your Medicare bill. You’ll need to provide the account information and expiration date as it appears on your card. Mail your payment to:
Medicare Premium Collection Center
P.O. Box 790355
St. Louis, MO 63179-0355
Pay through your bank’s online bill payment service. Contact your bank or go to their website to set up this service. You’ll need to give the bank the following information:
Account number: Your Medicare claim number without dashes
Biller name: CMS Medicare Insurance
Remittance address:
Medicare Premium Collection Center
P.O. Box 790355
St. Louis, MO 63179-0355
Sign up for Medicare Easy Pay, a free service that automatically deducts your premium payments from your savings or checking account each month.
Mail a completed Authorization Agreement for Pre-authorized Payments form (SF-5510) to:
Medicare Premium Collection Center
P.O. Box 979098
St. Louis, MO 63197-9000
Are you overwhelmed? Feel free to contact me with any questions.
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