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We are here to help you navigate Medicare

As a health insurance company, our goal isn't just to fit you with a plan that's right for you but to help you better understand insurance in general. Below, you'll find commonly asked questions related to Medicare. But, after reviewing, if you still have questions, give us a call, 1-800-336-0505 click to call, or drop us a line. We are here to help in any way we can.

You are eligible for Medicare if you meet one of these requirements:

  • You are age 65 or older and a U.S. citizen or a permanent U.S. resident who has lived in the U.S. for five years prior to applying.
  • You are under age 65 but have a qualifying disability.
    • You have received disability benefits from Social Security for 24 months.
    • You have received certain disability benefits from the Railroad Retirement Board for 24 months.
  • You have a diagnosed end-stage renal disease or amyotrophic lateral sclerosis (ALS), regardless of age.

Find out if you are eligible by using the Medicare.gov eligibility tool.

To apply for Original Medicare (Parts A and B)

  • ONLINE — Visit Social Security online External Site and follow the instructions. The application takes less than 10 minutes. After you submit the application, you will get a receipt and an application number you can use to check the status of your application later. Once you are enrolled, Social Security will send you a "Welcome to Medicare" packet that includes your Medicare card.
  • BY PHONE — Call the Social Security national customer hotline at 800-772-1213.
  • IN PERSON — Visit your local Social Security office.

You have four opportunities to enroll in Medicare.

Initial Enrollment Period (IEP)

Your IEP begins three months before the month you turn 65 and ends three months after you turn 65. During this seven-month period, you can enroll in any part of Medicare. Note: Part B and Part D may have a late enrollment penalty should you wait.

Annual Enrollment Period (AEP)

Every year from Oct. 15—Dec. 7, you have the option to add, switch, or drop a Part C (Medicare Advantage), Part D (Prescription Drug) or Medicare supplement plan. During AEP, you can also enroll in Original Medicare for coverage starting Jan. 1.

Open Enrollment Period (OEP)

If you are enrolled in a Part C (Medicare Advantage) plan, during Jan. 1—March 31, you are allowed to make a one-time change to another Medicare Advantage plan or switch back to Original Medicare. If you enroll in Original Medicare, you may add a Medicare supplement or a prescription drug plan during this time.

Special Enrollment Period (SEP)

Certain events may qualify you to enroll or change your plan outside of IEP, AEP, or OEP. You may qualify for an SEP if:

  • You move outside your plan's service area.
  • You lose your employer or union coverage.
  • Your insurance company cancels your health plan.
  • You are eligible for both Medicare and Medicaid.
  • You qualify for extra help in paying for Medicare prescription drug coverage.
  • You are able to get other coverage such as an employer or union plan, TRICARE or PACE.
  • See other special situations

You are eligible for premium-free Original Medicare Part A (hospital insurance) if you qualify for one of these situations:

  • You are age 65 or older, and you or your spouse worked and paid Medicare taxes for at least 10 years.
  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits, but you have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

If you fail to enroll for Part A during your initial enrollment period, you will have to wait until the open enrollment period that takes place Jan. 1—March 31 each year with coverage starting July 1. Additionally, a premium will be included for Part A, even if you qualified for premium-free coverage, if you didn't sign up when you were first eligible (and have no special enrollment period opportunities). 

Find your expected premium by using the Medicare.gov eligibility tool.

If you are receiving Social Security, the Social Security Administration will automatically sign you up at age 65 for Part A and Part B. And, if you are not receiving Social Security, you will need to enroll.

Most people who are eligible for premium-free Part A coverage choose to enroll in Part A even if they have other qualifying health coverage because it can help cover costs not included by their existing health coverage. Note that enrolling in Part A will end the ability to contribute to a health savings account (HSA).

If you aren’t eligible for premium-free Part A, and don’t have other qualifying health coverage, you should enroll when you’re first eligible in order to avoid a penalty. Contact Social Security to enroll yourself.

It depends. You may want to delay enrolling in Part B if you still have qualifying health coverage through an employer or a spouse's employer. If this is the case, you may qualify for a Special Enrollment Period. What is a Special Enrollment Period for Part B?

If you don't enroll in Part B during your Initial Enrollment Period, and you are not eligible for a Special Enrollment Period, you will be able to enroll again each year during the Open Enrollment Period between Jan. 1 and March 31, but you may have to pay a penalty for as long as you have Part B coverage. If you wait and use your OEP to enroll in Part B, your coverage won't begin until July 1, creating a gap in coverage.

Yes, Medicare rates and deductibles change each fall for the coming year. Medicare members are notified of these changes by mail Oct. 15—Dec. 7 each year of the upcoming changes starting Jan. 1.

You do not need a physical to qualify for Medicare, but you do need to complete a one-time preventive physical exam — the "Welcome to Medicare" exam — within one year of beginning Part B coverage. This physical is covered by Part B.

Yes, you can enroll in Original Medicare and receive benefits no matter your past or current health status. 

You have a choice to enroll or delay Medicare. Get the details of enrolling in Medicare past age 65.

Depending on your situation, you may qualify for other coverage, or you may want to purchase an individual policy. For more details about Medicare plans in Iowa or South Dakota, talk to an agent or visit Healthcare.gov External Site.