Applying for coverage
When can I apply for Medicare coverage? How do I go about applying for it?
If you are turning 65 and plan to begin Medicare, you can apply for coverage up to three months before and three months after your 65th birthday through Social Security. Unless you are still working and have comparable coverage through your employer, you could incur late enrollment penalties if you don’t sign up during your Initial Enrollment Period.
You can sign up for Medicare by:
Visiting Social Security services online
- Going to your local Social Security office
- Calling Social Security at 1-800-772-1213 (toll free) or 1-800-325-0778 (toll-free TTY for the hearing/speech impaired), Monday through Friday, 7 a.m. to 7 p.m. ET
Am I able to apply for Medicare if I do not plan on retiring at 65?
If you or your spouse plan to continue working past the age of 65 and you want to keep your employer-based health coverage, you do not need to enroll in Medicare until you retire. If you prefer to enroll in a Medicare plan even through you or your spouse is still working you may do so. You can then choose to keep your employer health plan, or if you choose to disenroll, ask your employer about their rules for disenrolling.
Should I apply for Medicare if I am already receiving Social Security benefits?
You do not need to apply for Medicare if you are already receiving Social Security benefits, as you will be automatically enrolled in the Medicare program through those benefits. You should receive your Medicare card and coverage documents from your Social Security office approximately 90 days before your 65th birthday. Once you have your red, white and blue Medicare card, you can choose to enroll in a Medicare Advantage plan like Sharp Advantage, or other types of additional Medicare coverage.
How do I get Medicare Part D drug coverage?
You can receive Medicare Part D coverage by enrolling in a qualifying plan, such as a Medicare Advantage with Part D coverage (MAPD) or Sharp Advantage. If you do not enroll in a plan with Part D drug coverage when you are first eligible, you may receive late enrollment penalties from Medicare.
Medicare coverage and costs
What is Original Medicare? How do I use my Original Medicare benefits?
Original Medicare refers to Part A (Hospital Insurance) and Part B (Medical Insurance). When you visit a medical provider that accepts Medicare patients, these visits are covered with a cost share from Medicare. Although Original Medicare may cover a percentage of your care, there is no cap on your out-of-pocket costs and most drugs are not covered. Most people with Medicare enroll in additional coverage, such as a Medicare Advantage plan (like Sharp Advantage), Medicare Supplement (Medigap) plan or stand-alone Medicare prescription drug plan.
Is there a cost for Medicare?
Most people pay no premium for Part A but do pay a monthly premium for Part B, which may vary by your income level and when you enrolled. Depending on income, some people also pay a monthly premium for Part D. These premiums are payable to Medicare and are typically deducted from your Social Security check if you receive one.
How do Medicare Advantage plans work?
Private insurance companies like Sharp Health Plan offer Medicare Advantage plans, or Part C plans. These plans always offer at least the same benefits as Original Medicare and usually more. Depending on the plan, premiums can be as little as $0 per month. These plans combine Part A, Part B and usually Part D into one comprehensive plan, and may add benefits not found in Original Medicare, like hearing and vision. When you enroll in a Medicare Advantage plan, you must only use in-network providers (except in emergency situations).
What is the difference between Medicaid and Medicare? Can I qualify for both?
Medicaid (known as Medi-Cal in California) is a state health care program available to people who qualify based on low income status. Medicare is a federal health care program available to people who are 65 and older, as well as people under 65 with specific qualifying disabilities, or people with end-stage renal disease (ESRD). If you think you may qualify for Medi-Cal, you should speak with a representative of your local Social Security office.
What are the requirements to enroll in the Sharp Advantage Medicare plan?
To enroll in Sharp Advantage, you must meet the following requirements:
- Have Medicare Part A and be eligible for Medicare Part B
- Reside in San Diego County
- Enroll during a valid enrollment period. [link to enrollment period page]
- Not have end-stage renal disease (ESRD), except under specific circumstances
How do I enroll in a Sharp Medicare health plan?
You can choose how you would like to enroll:
How can I check my enrollment status?
Contact Sharp Advantage at 1-855-562-8853 (TTY 711) to check your enrollment status. We are open from October 1 to February 14: 7 days per week 8 a.m. to 8 p.m. From February 15 to September 30: Monday through Friday, 8 a.m. to 8 p.m. and on weekends and holidays, your call will be handled by our voicemail system. A Sharp Advantage Specialist will return your phone call the next business day.