Healthcare is crucial for everyone, but more imperative for seniors because of the required amount of medical services necessary for healthy living. Medicare is the most important component of getting American seniors the healthcare they need. However, it comes with rules that can be hard to understand. Below, we’ve disclosed five pivotal Medicare rules that are paramount for seniors to grasp.

1. When to apply for Medicare

The majority of Medicare beneficiaries become eligible to receive it once they turn 65 years old. But you can file an application within three months of your 65th birthday. Meanwhile, if you already applied for Social Security benefits earlier than that applying for Medicare, then your Medicare Part A coverage will likely kick in automatically on the day of your 65th birthday. Take note, however, if you and/or your spouse worked at least 10 years to get Medicare coverage. In this case, you want to apply for the free hospital coverage under Medicare Part A as soon as you are able.

Like with Medicare Part A, applying three months prior to turning 65 is the best time to get Medicare Part B, as you can get automatic coverage if you so choose when applying for early Social Security benefits. Unlike for Medicare Part A, there is a monthly premium required to pay for Medicare Part B. Hence, you may want to avoid automatically enrolling in Medicare Part B if you already have other sources of coverage such as group health coverage under an employer’s plan. You save money if you choose to sign up later when your other coverage ends. You can sign up during a Special Enrollment Period after coverage in your other plan ends.

Read more about enrolling in Medicare.

2. Don’t be late!

Sometimes, the old adage “better late than never” should not apply. Mark you calendar, and set a reminder, for those first three months before you turn 65 years old. If you don’t apply for Medicare within the correct timeframe, then expect a healthy dosage of late fees.

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With Medicare Part A, you don’t need to worry about late fees. But you do for Medicare Part B. For every 12 months that in which you are not enrolling, the monthly premiums you pay for Medicare Part B will increase by by 10%. And those increased rates aren’t temporary, but instead remain with you for the rest of your life! There are also late penalties to pay if you sign up for Medicare Part D prescription drug coverage later than your first opportunity to enroll.

3. Medicare Advantage plans can fill coverage gaps

Unfortunately, Medicare doesn’t cover everything. But there are supplemental insurance plans available to fill the gaps where the coverage otherwise remains lacking. Plans under Medicare Part C, more familiarly known as Medicare Advantage, can cover services that Original Medicare does not.

Extra coverage means different processes, which means there will be different co-payments and situations that can change the amount you pay for your medical services. Although Medicare Advantage plans can leverage managed care options to trim prices for policyholders to save money while providing better benefits or lower premiums, plans may also be limited depending on which medical professionals accept the coverage and provide available options. Make sure you examine your options carefully so that you can pick the one that best fits your needs.

Watch this video to learn more about Medicare Advantage.

4. When you can change your coverage

You can make various changes to your Medicare plan during the Open Enrollment Period, which takes place from October 15 to December 7. Such changes include switching Medicare Advantage plans or changing between Original Medicare and a Medicare Advantage Plan. The same opportunities for change are available for prescription drug coverage under Medicare Part D as well, whether you choose to to enroll in an integrated Medicare Advantage plan that offers such prescription drugs coverage or if you seek a separate Medicare Part D policy. If you wish to switch from a Medicare Advantage plan back to Original Medicare, you can do so from January 1 to February 14. Note, however, that you are not allowed to make any other changes during this period.

Read more about how to change Medicare plans.

5. You can file an appeal to disputes coverage

If you disagree with a decision about one of your Medicare claims, including Medicare Advantage and Medicare Part D, you have the right to challenge that decision and file an appeal. Contact your doctor or supplier first to see if they can file a claim. If they don’t, you must file the claim within 12 months of the incident. Call 1-800-MEDICARE to start the process, which may involve several steps.

The appeals process for all types of Medicare plans has five levels. At each level, a decision about your appeal is made and communicated to you in a letter. If you disagree with the decision made at any level of the process, you can generally go to the next level. At each level, you’ll be given instructions in the decision letter on how to move to the next level of appeal.

How you file an appeal depends on the type of Medicare coverage you have. But no matter what type of Medicare plan you have, at any step of the appeals process, you can—and may want to—ask your doctor, health care provider or supplier for any information that may help your case, or other help.

Read more about the Medicare claims and appeals process.

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Medicare World Editorial Team

The Medicare World editorial team works diligently to make sure our stories are informative, unbiased, and of utmost relevance to our readers. Our team of researchers and writers presents the best and latest information on all things Medicare, including legislation, enrollment rules, changes in coverage and costs, and health information. We enjoy keeping our readers up-to-date and helping them navigate the often-complicated Medicare maze.