New to Medicare

Who can get Medicare?

U.S. citizens and legal residents living in the U.S. for at least five years in a row are eligible for Medicare. One of the following also must be true:

• You are age 65 or older.
• You are younger than 65 with a qualifying disability (a medical or physical condition that has lasted, or is expected to last, more than 12 calendar months and that prevents you from working).

You may be automatically enrolled in Original Medicare Parts A and B when you turn 65 if you are already getting benefits from Social Security or the Railroad Retirement Board (RRB).

If you are automatically enrolled, you will receive your Medicare card and materials three months before your 65th birthday. The materials will explain your choices and what you need to do next.

If you are not receiving Social Security or RRB benefits when you turn 65, then you will need to contact a Social Security office to enroll in Medicare. You can do this up to three months before your 65th birthday.

• Enroll in Part A, Part B or both.
• Choose how to get your coverage: Original Medicare or a Medicare Advantage (Part C) plan. Or enroll in a standalone prescription drug plan if you have Original Medicare

Step 1: Enroll in Original Medicare when you become eligible

Step 2: If you want additional coverage, you have choices…

• Keep Original Medicare and add Medicare Supplement Insurance* and/or Medicare Part D
• Enroll in a Medicare Advantage plan (Part C)

A Medicare Advantage plan (Part C) combines Parts A & B and may cover prescription drugs. In addition, Medicare Advantage plans typically provide additional benefits that Original Medicare does not cover.

*If you enroll in a Medicare Advantage plan, you can’t enroll in Medicare Supplement Insurance.

Original Medicare includes Part A and Part B:

• Part A helps pay for inpatient care in the hospital or a skilled nursing facility.
• Part B helps pay for outpatient care, such as doctor visits, preventive care and more.

Medicare Part C is also called Medicare Advantage. Medicare Advantage plans are offered by private insurance companies contracted by Medicare. You must be enrolled in both Part A and Part B to join a Medicare plan.

Below is a list of product types offered through the Medicare Advantage program.

• Coordinated Care Plans
  • Health Maintenance Organization (HMO) plans: usually you only pay for care you receive from providers in the plan network.
  • Preferred Provider Organization (PPO) plans: you will pay a portion for care that you receive outside of the plan network.
  • Point of Service (POS): a benefit option with some HMO plans covering care received from both network and out-of-network providers.
  • Special Needs Plan (SNP): for individuals who meet certain criteria; SNPs may be an HMO, POS or PPO plan and must include prescription drug coverage
    • People who are entitled to both Medicare and state Medicaid
    • People with severe or disabling chronic conditions
    • People who live in an institution
    • People who require the same level of care as those who live in an institution
• Other types of Medicare Advantage plans are:
  • Private Fee-for-Service (PFFS) plans
  • Medical Savings Account (MSA) plans

Go to Our Plans page to learn more about the plan types offered by Eon Health. Simply select your State and County to begin exploring your Eon Health options.

• By law, Medicare Advantage plans must provide at least the same coverage that’s offered by Original Medicare Parts A and B. Plans may also include a variety of additional benefits – all combined in a single plan.
• Medicare Advantage plans do not help with the cost of hospice care. Original Medicare Part A pays for hospice care even when you get your benefits through a private Medicare Advantage plan.

Go to Our Plans page to learn more about the plan types offered by Eon Health. Simply select your State and County to begin exploring your Eon Health options.

When can you change your Medicare coverage?

You have the chance to change your Medicare coverage during one of the following three time periods:

• Annual Election Period: This is when you can make new Medicare choices to better meet your needs in the coming year. It occurs every year from October 15 through December 7.
• Special Election Periods (SEPs): This is when you can change your coverage outside of the Annual Election Period. You must meet certain requirements to qualify for an SEP.
• Medicare Advantage Disenrollment Period (MADP): This allows you to drop a Medicare Advantage plan purchased during the previous Open Enrollment and return to Original Medicare. It occurs every year from January 1 through February 14. If the Medicare Advantage plan included drug coverage, then you can enroll in a standalone prescription drug plan at this time.

This is your first chance to enroll in Medicare.

The Initial Enrollment Period (IEP) if when most people first enroll in Medicare. You need to pay attention to the dates of your IEP. If you miss out, you may have to pay more for your coverage.

Turning 65: Medicare Initial Enrollment Period

Your IEP begins three months before the month of your 65th birthday. It runs through your birthday month and for three more months after your birthday month for a total of seven months.

Qualifying Disability: Medicare Initial Enrollment Period

If you are under age 65 with a qualifying disability, then you are eligible for Medicare on the first day of the 25th month of receiving disability benefits. Your IEP begins three months before this month and lasts for a full seven months.

All Medicare beneficiaries can change their Medicare coverage once a year.

The Annual Enrollment Period is October 15 – December 7. It’s a chance to make changes to your coverage.

If you like your current coverage, you can do nothing and your coverage will continue. If your health status or current coverage is changing for the coming year, you may want to change your Medicare coverage.

What can you do during the Annual Election Period?

• Change from Original Medicare to a Medicare Advantage plan.
• Change from a Medicare Advantage plan back to Original Medicare.
• Switch from one Medicare Advantage plan to a different Medicare Advantage plan.
• Join a Medicare prescription drug plan.
• Switch from one Medicare prescription drug plan to a different Medicare prescription drug plan.

A Special Election Period (SEP) allows you to enroll in Medicare or change your Medicare coverage outside of your Initial Enrollment Period and the Annual Election Period. There are different SEPs to cover different circumstances. Below is a list of some common SEPs:

• Employer Health Coverage Ending
• You change where you live.
• You lose your current coverage.
• Your plan changes its contract with Medicare.
• You are receiving help from Medicaid.

You can call us at 1-877-364-4566 (TTY: 711) to see if you qualify for a special election. Or explore Our Plans to learn more about the benefits offered by Eon Health.

Medicare Part A, Part B and Part D all may charge premium penalties if you miss your initial enrollment dates unless you qualify for a Special Election Period. The most common penalty is the Part D premium penalty.

The penalty for late enrollment in a Part D plan is about 1% of the average Part D premium for each month you delay enrollment. You pay the penalty for as long as you’re enrolled in a Medicare Part D plan.

You may delay enrolling in Medicare Part D without penalty if you qualify for Extra Help or have creditable coverage.