Increased Enrollment Among Previously Eligible Individuals
Medicaid enrollment has grown regardless of expansion status in most states following implementation of the ACA. This is likely due to the so-called welcome-mat effect in which enrollment increases among individuals who were previously eligible for coverage but not enrolled. One of the underlying reasons for the welcome-mat effect may be that previously eligible individuals may not have known they were eligible for coverage and applied as a result of increased outreach efforts surrounding ACA implementation.
In non-expansion states, growth in Medicaid enrollment was lower than in Medicaid expansion states. Between July and September 2013 and March 2020:
- enrollment increased by 939,321 or 5.2 percent
- these increases ranged from 0.1 percent in Texas to 20.8 percent in Georgia
- enrollment declined in five non-expansion states .
In addition, while childrens eligibility was not affected by state decisions to expand to the new adult group, enrollment in Medicaid and CHIP has also grown among children in both expansion states and non-expansion states. As of March 2020, 35.4 million children were enrolled in Medicaid or CHIP in 49 reporting states and the District of Columbia, with child enrollment comprising nearly half of enrollment in these states .
What Month Does Medicare Part B Start
The dates and scenarios above apply to Medicare Part A. The other half of Original Medicare is Part B, which covers outpatient health care services, durable medical equipment and doctors office services. Part B can start at the same time as Medicare Part A if you sign up for it prior to the month you turn 65.
If youre automatically enrolled in Medicare at 65, you will typically be automatically enrolled in Part A and Part B. Since Part B is optional, you can choose to disenroll from Medicare Part B after age 65 if you desire, though it isnt typically recommended.
If you do not enroll in Part B before the month you turn 65 and you arent automatically enrolled, you typically must sign up during the Medicare General Enrollment Period at the start of the new year, and your Part B coverage will not begin until July 1.
You may potentially qualify for a Medicare Special Enrollment Period to sign up for Part B if you arent automatically enrolled at age 65.
If you plan on keeping your employer-provided health insurance coverage when you turn 65, you should make sure you carefully review your Medicare enrollment options so that you dont potentially face a Part B late enrollment penalty or any lapse in coverage.
The Initial Enrollment Period
The Initial Enrollment Period is the first opportunity to enroll in Medicare. This is a seven-month window during which you can sign up for Medicare Parts A, B, C and D. The seven months are aligned with your date of birth:
If you sign up for Medicare during the first three months of your IEP, your Medicare coverage will start on the first day of the month you turn 65. However, if your birthday is on the first day of the month, your coverage will start the first day of the previous month.
If you sign up during your birthday month, your Medicare coverage will begin the first day of the following month.
If you enroll in Medicare one month after your 65th birthday, your Medicare coverage will start two months later.
If you enrolled for Medicare two or three months after your 65th birthday, your Medicare coverage in both cases will begin three months later.
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Medicare Coverage When Automatically Enrolled
If you are already receiving Social Security or Railroad Retirement Board benefits before your 65th birthday, you will be automatically enrolled in Medicare Parts A and B when you turn 65. In such a case, your Medicare coverage will begin on the first day of the month you turn 65.
If your birthday is on the first day of the month, the coverage will begin on the first day of the previous month. For instance, if your 65th birthday is on August 1, your Medicare coverage will start on July 1.
Additionally, people who are below age 65 and receive Social Security Disability Insurance payments will attain Medicare eligibility after a two-year waiting period. For those diagnosed with Amyotrophic Lateral Sclerosis or with End-Stage Renal Disease , they are automatically enrolled in Medicare with no waiting period.
When Does Medicare Start
For most people, Medicare coverage starts the first day of the month you turn 65. Some people delay enrollment and remain on an employer plan. Others may take premium-free Part A and delay Part B.
If someone is on Social Security Disability for 24 months, they qualify for Medicare. Those with End-Stage Renal Disease will be immediately eligible for Medicare with a diagnosis. When Medicare starts is different for each beneficiary.
People with disabilities, ALS, or End-Stage Renal Disease may be eligible for Medicare before theyre 65. If you qualify for Medicare because of a disability, there is no minimum age for receiving benefits. However, most beneficiaries get Medicare at age 65.
Some people wait until they retire to start collecting benefits. For some, that could be 66 years old for others, waiting until 70 to get delayed retirement credits may be the most beneficial retirement plan.
If you choose to enroll at age 65, benefits start on the first day of the month you turn 65. For example, if you turn 65 on June 30th, your coverage begins on June 1st. However, if your birthday is on the 1st, your Medicare will begin the first day of the month before you turn 65. You can get Medicare at age 65 even if youre not collecting Social Security. So, you can keep working and take your Medicare if thats the path you want to choose.
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Switching To A Medicare Advantage Prescription Drug Plan
Whether youre switching from Original Medicare or from a standalone drug plan to an MAPD, making the switch not only allows you to get drug benefits but access to other health benefits such as dental, vision, hearing, and wellness coverage. Plus, Medicare Advantage plans include Original Medicare Parts A and B, so you get to bundle your hospital, medical, prescription drug, and supplemental health coverage all into one plan.
Can You Get Private Insurance Instead Of Medicare
If you have Medicare Part A or Part B, insurers generally arent allowed to sell you a traditional individual health insurance plan .
You can purchase individual health insurance if youve never enrolled in Medicare because you think the overall costs are too high. If youre in the unusual situation of paying for Part A premiums, you can also switch to individual health insurance.
If you develop a medical condition before turning 65 that would qualify you for Medicare, such as ESRD, you can decline to purchase Medicare.
If you decide to purchase private insurance once youre eligible for Medicare unless youre continuing the employer-sponsored insurance that qualifies you for a Special Enrollment Period then youll have to pay the costly late enrollment penalty once you do apply.
If youre nearing the age of 65, then its important you start considering your Medicare coverage.
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Important Open Enrollment Dates
Complete your enrollment to make sure your coverage is active January 1, 2022.
Complete your enrollment to make sure your coverage is active starting January 2022. Your health insurance ID cards may be delayed.
This is the last day of Open Enrollment, and the last day to complete enrollment for 2022 coverage. PLEASE NOTE: your coverage will be active February 2022.
When To Apply For Medicare
While there are exceptions, in general, adults become eligible for Medicare on their 65th birthday. In fact, more than 11,000 people turn age 65 daily and get their eligibility for coverage. This is often a source of confusion because originally you got your Medicare and Social Security retirement benefits at the same time .
Social Security retirement and Medicare benefits are no longer linked. If you retire at the earliest age possible, which is age 62, you wont receive your Medicare benefits until age 65. However, if you delay taking Social Security until age 70, your Medicare benefits will start at age 65 anyway. In all cases, you can apply for Medicare up to three months prior to your 65th birthday to make sure your benefits start on time.
Medicare is also available to adults with Social Security disability benefits. If you qualify for Social Security Disability Insurance , your Medicare benefits start on the 25th month of your Social Security benefits.
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Medicare Initial Enrollment Period
The earliest time you can enroll in Original Medicare, a Medicare Advantage plan or a Medicare Part D prescription drug plan is during your Medicare Initial Enrollment Period .
Your Initial Enrollment period lasts for seven months:
- It begins three months before you turn 65
- It includes your birth month
- It extends for another three months after your birth month
If you are under 65 and qualify for Medicare due to disability, the 7-month period is based around your 25th month of disability benefits.
Your First Chance To Sign Up
Generally, when you turn 65. This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65.
Avoid the penaltyIf you miss your 7-month Initial Enrollment Period, you may have to wait to sign up and pay a monthly late enrollment penalty for as long as you have Part B coverage. The penalty goes up the longer you wait. You may also have to pay a penalty if you have to pay a Part A premium, also called Premium-Part A.
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When Does Medicare Part D Open Enrollment End
The 2022 AEP for Medicare Part D ended December 7. From the AEP start date , you have about eight weeks to enroll in Medicare Part D coverage before the AEP deadline. The coverage you choose during the Medicare Part D Enrollment will be effective the first day of the following year. For example, if you enrolled in a Part D drug plan by December 7, 2021, your coverage would start January 1, 2022.
Why Is There An Open Enrollment Period
The open enrollment period gives people a reason to buy health insurance before they get sick. Without a set time frame, some people might not buy insurance. The way health insurance works is that it combines the costs of taking care of sick people and people who arent sick. So having healthy people with insurance helps the system.
For a health insurance company to stay in business, it has to get more money from people than it pays out for services. By only giving people a few weeks at the end of the year to sign up for insurance during the enrollment period, it makes them more likely to buy a plan fast. This is good for insurance companies. Its good for people if they have problems in the future, too.
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What Are The Medicare Enrollment Periods
Enrollment periods are designated time periods to enroll or disenroll from the various parts of Medicare. There are six Medicare enrollment periods.Medicare.gov, When does Medicare coverage start?, Accessed September 25, 2021Medicare.gov, Joining a health or drug plan, Accessed September 25, 2021
Make Sure You Are Eligible To Make Coverage Changes
If youre newly eligible for Medicare, or delayed coverage for one reason or another, and are not yet signed up for Part A and Part B, this is NOT the enrollment period for you. You wont be eligible to make changes at this time unless youre within your Initial Enrollment Period or are eligible for a Special Enrollment Period. Youll need to wait until the General Enrollment Period to enroll in Original Medicare.
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Medicare Part D Prescription Drug Plan Enrollment
When youre eligible to enroll in Original Medicare, you also become eligible to enroll in a Medicare Part D prescription drug plan.
If you want Medicare prescription drug coverage, you typically have two options:
- Enroll in a Medicare Advantage plan that includes prescription drug coverage
- Enroll in a Medicare Part D standalone prescription drug plan
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent.
You can also enroll in a prescription drug plan online in as little as 10 minutes when you visit MyRxPlans.com.1
When Is Open Enrollment If I Get Health Insurance Through My Work
If you get health insurance through work, your employer sets the open enrollment period. Its typically in the fall so that your benefits can start at the beginning of the calendar year. Choosing a health care plan for the year ahead is an important decision during open enrollment. Take some time to explore your options to help you decide what coverage is best for you before you enroll.
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Late Enrollment Penalty For Medicare Part D
The late enrollment penalty is an amount that is added to your Medicare drug coverage monthly premium when you:
- Enroll in Medicare Part D after the Initial Enrollment Period.
- You dont have Medicare drug coverage for 63 days or more.
- You do not have creditable prescription drug coverage for 63 or more days.
The late enrollment penalty is permanent and will have to be paid for as long as you receive Medicare drug coverage.
Get Help With Enrollment
Nevada Health Link provides a number of options for help with the enrollment process. For a complete list of resources please visit our Get Help page.
For free in-person assistance please use the broker directory to locate a licensed agent/broker or enrollment professional near you.
- Get answers to the most commonly asked questions by visiting Nevada Health Links FAQ page on the platform
- You can also locate an agent/broker by calling our customer service line and inputting your zip code 1-800-547-2927
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Does It Cover 100% Of All Healthcare Costs
Since its inception, Medicare health insurance covers about 80 percent of all major medical costs. Medicare beneficiaries are responsible for the remaining 20 percent. Both Original Medicare and Medicare Advantage are designed to be this way.
A simple doctor visit might only require a $20 to $40 coinsurance or copay, but more complicated healthcare services can cost beneficiaries hundreds or even thousands of dollars out of pocket. The big difference between Original Medicare and Medicare Advantage is that Medicare Advantage plans have an annual cap called the maximum out-of-pocket limit, whereas Original Medicare has no limits.
Imagine needing cancer treatment, which can cost upwards of $2 million. With Original Medicare and no additional coverage, you would be responsible to cover upwards of $400,000 out of pocket. To insure against these costs, people often buy supplemental insurance called Medigap .
If youre thinking that a Medicare Advantage plan will help you avoid this issue, youre partially right. However, most low-cost Medicare Advantage plans have a high MOOP. Some as high as $7,550 per year. Thats a lot of money to pull out of your pocket, and it does not include the monthly premiums or the cost of your medications. Read Why Medicare Advantage Plans are Bad.
When Does Coverage Start Under A Medigap Plan
During the Medigap OEP, you have guaranteed issue rights. This means that private insurers cannot deny coverage or charge you more based on your health condition.
It may be challenging to get a Medigap plan after this one-time guaranteed issue period. In order to get Medigap coverage, you will need to pass medical underwriting or pay more to cover pre-existing health problems.
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Medicaid Enrollment Increases In Expansion States
States that expanded Medicaid to cover the new adult group showed the largest growth in enrollment. Between July and September 2013 and March 2020:
- enrollment in Medicaid expansion states increased by 13.0 million or 33.9 percent
- 22 of these states saw increases in enrollment of at least 25 percent
- increases ranged from 2.9 percent in Delaware to 113.5 percent in Kentucky and
- one expansion state experienced a decline in enrollment Kentucky .
Growth in Medicaid enrollment has been driven primarily by adults qualifying under the adult group . As of March 2020:
- Enrollment in the new adult group made up 20.7 percent of Medicaid enrollment across all reporting states .
- At that time, the 35 expansion states and the District of Columbia reported a total of 12.3 million enrollees in the new group. Of these, 81.2 percent were newly eligible individuals and entitled to the newly eligible enhanced federal matching rate .
Get Help With Medicare Part D Open Enrollment
Its important to review your Part D options annually during Medicare Open Enrollment. The cost, pharmacy network, and drug formulary for Medicare Part D plans can vary from plan to plan year to year.
HealthMarkets FitScore can compare your current medications against different standalone Medicare Part D and Medicare Advantage drug plans to find an option that meets your needsall at no cost to you and with no obligation to enroll. Dont get confused by the Medicare Part D Open Enrollment. HealthMarkets makes reviewing and comparing plans easy. See if your current plan is still your best choice by reviewing your options now.
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After The Open Enrollment Period Ends
However, after the Open Enrollment Period ends, that is no longer the case. Instead, you will pay higher premiums and could even be rejected from enrolling in some plans.
Medicare coverage does not start at the same time for everyone. While the Initial Enrollment Period is the best time to sign up for Original Medicare, a Medicare Advantage plan, Medicare Part D, or a Medicare Supplement plan, its not the only time to do so.
The key to meeting your enrollment deadlines is knowing well in advance the exact coverage you want to sign up for.