Understanding Medicare’s “3-Midnight Rule” for Skilled Nursing Facility Coverage

by | Oct 21, 2025 | General, Rules & Enrollment

If you ever need short-term rehabilitation or skilled nursing care after a hospital stay, one Medicare rule could make all the difference in whether your care is covered — the 3-midnight rule. This often-overlooked guideline determines when Medicare Part A will pay for a Skilled Nursing Facility (SNF) stay, and misunderstanding it can lead to costly surprises.

As a trusted, independent Medicare brokerage, Emerald Medicare helps clients across the country navigate these details with confidence. Here’s what you need to know about how the 3-midnight rule works — and how to protect yourself from unexpected expenses.

What is the 3-Midnight rule?

To qualify for Medicare coverage of a skilled nursing facility stay, you must first have a 3-day inpatient hospital stay. This means:

  • You must be formally admitted as an inpatient, not under observation or emergency status.
  • The stay must include three consecutive midnights in the hospital.
  • The day of admission counts, but the day of discharge does not.

For example, if you’re admitted on a Monday, stay through midnight on Wednesday, and are discharged on Thursday, your stay meets the 3-midnight requirement.

This rule exists because Medicare only covers skilled nursing facility care when it follows a qualifying inpatient hospital stay. Without it, you may be responsible for the full cost of care — which can add up quickly.

Why Observation Status Matters

A common point of confusion is the difference between being “admitted” and being “under observation.”
Even if you stay overnight or longer, observation status is considered outpatient care. Unfortunately, that time does not count toward the 3-day inpatient requirement.

Before you leave the hospital, ask a simple but crucial question:

“Was I officially admitted as an inpatient?”

Hospital staff can verify your status so you know whether your SNF stay will qualify for Medicare coverage.

    Are There Exceptions to the Rule?

    Yes — and they’re becoming more common. Some programs waive the 3-day requirement altogether:

    • Medicare Advantage Plans: Many Medicare Advantage (Part C) plans waive the 3-midnight rule, allowing coverage for SNF care without a prior hospital stay. Check with your specific plan to confirm.
    • Other programs: Medicaid or Veterans’ benefits may help cover costs if you don’t meet the Medicare rule.

    What You Should Do Before Leaving the Hospital:

    1. Confirm your admission status. Make sure your stay was inpatient, not observation.
    2. Talk to your care team. Ask if your hospital participates in any ACO or waiver program.
    3. Contact your Medicare plan. Whether you have Original Medicare or a Medicare Advantage plan, confirm coverage and potential exceptions before discharge.

    Plan Ahead with Emerald Medicare
    Understanding Medicare’s 3-midnight rule can protect you from major out-of-pocket expenses and ensure your care transitions are covered. At Emerald Medicare, our licensed Medicare specialists are here to explain these rules in plain language — and help you plan ahead for the unexpected.

    If you have questions about skilled nursing coverage or your Medicare plan, we’re here to help.

    Reach out to Emerald Medicare Today!

    Contact Us
    📞 (888) 683-6372 or (845) 358-1220
    📧 office@emeraldmedicare.com

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    How Do I Apply for Medicare?

    by | Oct 9, 2025 | Medicare Advantage, Medicare Supplement, Original Medicare, Prescription Drug Coverage, Rules & Enrollment

    Understanding the Medicare Application Process

    Enrolling in Medicare is a major milestone in your healthcare journey, but it doesn’t have to be confusing. Whether you’re approaching age 65 or qualifying earlier due to disability, knowing when and how to apply ensures you avoid gaps in coverage or penalties. Here’s a step-by-step guide to applying for Medicare with confidence.

    Eligibility: Who Can Apply for Medicare

    You are generally eligible for Medicare if:

    • You’re 65 or older, and either a U.S. citizen or a permanent resident who’s lived in the U.S. for at least five years.

    • You’re under 65, but have received Social Security Disability Insurance (SSDI) for 24 months.

    • You have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s Disease).

    If you’re already receiving Social Security benefits, you’ll be enrolled automatically in Medicare Parts A and B. Otherwise, you’ll need to apply manually through the Social Security Administration.

    How to Apply for Medicare Parts A & B (Original Medicare)

    You can apply for Original Medicare in one of three ways:

    Online: Visit SSA.gov/Medicare

    By Phone: Call Social Security at 1-800-772-1213.

    In Person: Visit your local Social Security office.

    • Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing, and hospice care.

    • Part B (Medical Insurance) covers doctor visits, preventive care, outpatient services, and durable medical equipment.

    If you’re still working and covered under employer insurance, you may choose to delay Part B to avoid paying unnecessary premiums—but it’s important to confirm this with your HR department or a licensed Medicare advisor before making that decision.

    Applying for Medicare Advantage (MAPD) Plans

    After enrolling in Parts A and B, you may decide to choose a Medicare Advantage Plan (Part C) instead of using Original Medicare as your primary insurance. These plans are offered by private insurance companies and often include additional benefits such as:

    • Bundled Prescription drug coverage

    • Additional dental, vision, and/or hearing benefits

    • Wellness programs and gym memberships

    Enrollment in a Medicare Advantage Plan is handled through the private insurer offering the plan, not through Medicare directly. The benefit of using a brokerage (like Emerald Medicare) to enroll in a MAPD plan is they will usually handle the enrollment & application process on your behalf, acting as the middleman between you and your insurance provider.

    Medigap (Medicare Supplement) Plans

    If you prefer to stay with Original Medicare, you can add a Medigap policy to help pay for costs that Parts A and B don’t cover—such as deductibles, coinsurance, and copayments.

    • You must have both Parts A and B to buy a Medigap plan.

    • Depending on your home state, you may or may not have to go through medical underwriting and wait for approval.

    Just like with a Medicare Advantage (MAPD) Plan, the best & easiest way to enroll in a Medigap plan is to reach out to your Medicare broker, who will advise you on the coverage options available in your zip code. Otherwise, you can reach out to the carriers directly to get prices and/or compare options, and even enroll directly with the carrier by reaching out to their customer service and/or new enrollment department. 

    Prescription Drug Plans (PDP – Part D)

    If you choose Original Medicare (if you do NOT choose an MAPD plan) you’ll likely also need a standalone Part D prescription drug plan.

    • These plans are also available through private insurance companies.

    • Enrollment is typically completed via Medicare.gov or directly through the plan’s website.

    • Make sure to review each plan’s formulary (drug list) to ensure your prescriptions are covered affordably.

    With Emerald Medicare, once you enroll in Original Medicare (Parts A/B), we walk you through all your coverage options and thoroughly explain how these options differ. We also handle your enrollment application(s) along with reviewing your list of Medications & Doctors to make sure there are no gaps in your coverage. 

    Get Guidance from the Medicare Experts

    Applying for Medicare doesn’t have to be stressful. At Emerald Medicare, our licensed experts can walk you through every step—from choosing Parts A and B to comparing Supplement, Advantage, and Part D options personalized to your needs.

    Start your Medicare journey confidently—contact Emerald Medicare today!

    (888) 683-6372 or (845) 358-1220

    info@emeraldmedicare.com

    Do I Need Medicare Part A and/or Part B If I Am Still Working?

    by | Sep 18, 2025 | Original Medicare, Rules & Enrollment

    Of course, turning 65 doesn’t mean you have to retire—but it does mean Medicare eligibility begins, and many people still wonder:

    “If I’m still working and have health insurance through my employer, do I need to enroll in Medicare when I turn 65?”

    The answer depends on several factors—including your employer size, your current health coverage, and whether you’ve already started Social Security. At Emerald Medicare, we help clients evaluate these decisions every day to avoid penalties, gaps, or unnecessary costs.

    Let’s break it down…

    âś… Start with Medicare Part A: Most People Enroll

    Medicare Part A (hospital insurance) is premium-free for most people and generally covers inpatient hospital stays, skilled nursing, and hospice care.

    • If your employer has coverage and you’re still working, you can usually enroll in Part A at 65 without any downside.
    • HOWEVER—if you’re contributing to a Health Savings Account (HSA), you may want to delay Part A to avoid tax issues.

    🧾 What About Part B? It Depends on Employer Size

    Medicare Part B covers outpatient care, doctor visits, and preventive services. Unlike Part A, you do pay a monthly premium for Part B—so enrolling unnecessarily could cost you.

    IF YOUR EMPLOYER HAS 20 OR MORE EMPLOYEES:

    • You can delay enrolling in Part B without penalty.
    • Your employer coverage remains primary, and Medicare is secondary.
    • You’ll qualify for a Special Enrollment Period (SEP) when you retire or lose coverage—no late penalty.

    IF YOUR EMPLOYER HAS FEWER THAN 20 EMPLOYEES:

    • You must enroll in Medicare Part A and B when first eligible.
    • In this case, Medicare becomes your primary insurance, and your employer plan pays second—or not at all.
    • Failing to enroll could leave you uninsured and/or penalized.

    Always check with your HR department—don’t assume your employer coverage counts as “creditable” for Medicare.

    đź’Ľ Still Working with an HSA? Be Careful

    If you’re contributing to a Health Savings Account (HSA) and you enroll in any part of Medicare, including Part A, you must stop HSA contributions.

    • Enrollment in Medicare (even Part A) disqualifies you from contributing.
    • Retroactive Part A enrollment (up to 6 months) can create IRS penalties if you’re not careful.
    • We typically recommend stopping HSA contributions at least 6 months before you apply for Medicare.

    đź“Ť Why It Matters

    Making the wrong choice about when to enroll can lead to:

    • Late enrollment penalties
    • Gaps in coverage
    • Unexpected bills if Medicare should have paid primary
    • Tax consequences for HSA users

    âś… When to Enroll (or Delay) Original Medicare: A Quick Recap

    Situation Part A Part B
    Employer has 20+ employees, no HSA Usually enroll Delay OK
    Employer has fewer than 20 employees Enroll Enroll
    Still working and using an HSA Delay Delay
    Retiring soon or leaving coverage Enroll Enroll (within 8 months of losing coverage)

    Click below to schedule an appointment with one of our Medicare Experts.

    Or, Contact Us
    📞 (888) 683-6372 or (845) 358-1220
    📧 office@emeraldmedicare.com

    Mark Brownstein, CSA® | Calendly

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    An Essential Guide for Medicare Advantage Plans

    by | Feb 5, 2025 | Medicare Advantage, Rules & Enrollment

    As your trusted Medicare experts, Emerald Medicare is committed to helping you navigate your healthcare options with ease. Medicare Advantage (Part C) plans are a popular choice among beneficiaries, offering comprehensive coverage with additional benefits not included in Original Medicare. If you’re considering Medicare Advantage, this guide will walk you through how these plans work, their benefits, and how to choose the best plan for your needs.

    What is Medicare Advantage?

    Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A & B) offered by private insurance companies approved by Medicare. These plans bundle hospital (Part A), medical (Part B), and prescription drug coverage (Part D) into one all-inclusive plan. Many also offer extra benefits like dental, vision, hearing, and even wellness programs—making them an attractive option for those seeking added value beyond traditional Medicare.

    With Medicare Advantage, all healthcare services are managed through your plan’s network of doctors, hospitals, and pharmacies. While this structure helps control costs, it’s important to understand how provider networks function before enrolling, and how this may limit your options for medical care.

    —————

    What Do Medicare Advantage Plans Cover?

    Unlike Original Medicare, which requires separate coverage for prescriptions (Part D) and supplemental benefits (Medigap), Medicare Advantage plans integrate multiple types of coverage into a single, bundled plan. Here’s what’s typically included:

    Hospital Coverage (Part A) – Inpatient stays, skilled nursing facility care, and some home healthcare services.
    Medical Coverage (Part B) – Doctor visits, outpatient services, diagnostic tests, preventive care, and durable medical equipment.
    Prescription Drug Coverage (Part D) – Most Medicare Advantage plans include built-in drug coverage, covering a range of prescription medications.

     

    Additional Benefits – Many Medicare Advantage plans also offer:

    • Dental Coverage (routine cleanings, fillings, dentures, etc.)
    • Vision Coverage (eye exams, glasses, and contacts)
    • Hearing Coverage (hearing exams and hearing aids)
    • Fitness Benefits (gym memberships, virtual exercise programs)
    • Transportation (rides to medical appointments)
    • Over-the-Counter (OTC) Allowances (stipends for medical supplies and everyday wellness products)

    Because benefits vary by plan, it’s essential to compare options carefully or consult a Medicare expert to find the best fit for your healthcare needs.

    —————

    Why Should I Choose a Medicare Advantage Plan?

    Medicare Advantage plans combine coverage, convenience, and cost savings into a single plan, making them a great option for many beneficiaries. Here’s why they appeal to millions of Medicare enrollees:

    1. Comprehensive Coverage

    Unlike Original Medicare, which requires additional plans for prescriptions and supplemental coverage, Medicare Advantage offers all-in-one protection with extra benefits.

    2. Lower Out-of-Pocket Costs

    Many Medicare Advantage plans have low or $0 monthly premiums, and they cap out-of-pocket expenses, protecting beneficiaries from excessive costs. In contrast, Original Medicare has no limit on annual medical expenses unless paired with a Medigap policy.

    3. Extra Benefits Beyond Original Medicare

    With dental, vision, hearing, and wellness perks, Medicare Advantage covers services not included in traditional Medicare, making healthcare more affordable and accessible.

    4. Preventive Care & Care Coordination

    Many Medicare Advantage plans focus on preventive care and managed healthcare, offering case management services, wellness incentives, and telehealth options for added convenience.

    —————

    Medicare Advantage vs. Medigap: Key Differences

    Understanding the distinction between Medicare Advantage and Medigap (Medicare Supplement Insurance) is crucial when choosing a plan.

    Feature Medicare Advantage (Part C) Medigap (Supplement)
    Coverage Type Combines hospital, medical, and drug coverage Supplements Original Medicare, filling cost gaps
    Network Limited to plan’s provider network (HMO/PPO) No network restrictions—see any provider nationwide who accepts Medicare
    Premium Costs Often lower premiums, but may have higher copays/coinsurance Higher premiums but lower out-of-pocket costs
    Out-of-Pocket Maximum Yes (protects against high medical bills) No limit on costs under Original Medicare
    Extra Benefits Includes dental, vision, hearing, fitness, etc. No additional benefits beyond medical cost coverage
    Prescription Drug Coverage Usually included (Part D) Requires separate Part D enrollment
    Travel Coverage Limited outside your service area Nationwide and some foreign travel coverage

    Medicare Advantage is best for those who prefer bundled coverage and lower upfront costs, while Medigap is ideal for those who want broad provider access and more predictable expenses.

    —————

    How to Choose the Right Medicare Advantage Plan

    When selecting a Medicare Advantage plan, consider the following:

    🔹 Provider Network: Does your preferred doctor, hospital, or pharmacy accept the plan? HMOs require referrals and network providers, while PPOs offer more flexibility.
    🔹 Prescription Drug Coverage: Check the plan’s formulary (covered drug list) to ensure your medications are included.
    🔹 Extra Benefits: Need dental or vision care? Want access to telehealth or home fitness programs? Compare added perks to find a plan that suits your lifestyle.
    🔹 Out-of-Pocket Costs: Compare premiums, deductibles, copays, and maximum out-of-pocket (MOOP) limits to determine your total expected expenses for the year.
    🔹 Star Ratings: Medicare.gov rates plans on a 5-star scale based on customer satisfaction and quality of care. A higher-rated plan often means better coverage and service review from real beneficiaries.

    —————

    How to Enroll in a Medicare Advantage Plan

    You can enroll in a Medicare Advantage plan during specific enrollment periods:

    📌 Initial Enrollment Period (IEP) 
    Starts 3 months before you turn 65 and continues 3 months after your birthday month.
    📌 Annual Enrollment Period (AEP) 
    October 15th – December 7th each year. You can switch, join, or drop a Medicare Advantage plan.
    đź“Ś Medicare Advantage Open Enrollment Period
    January 1st – March 31st each year. If you’re already enrolled in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare during this time.

    —————

    Explore Medicare Advantage with Emerald Medicare

    Choosing a Medicare Advantage plan is an important decision that requires careful consideration of your healthcare needs, provider preferences, and financial situation. At Emerald Medicare, we’re dedicated to helping you find the best-fit plan with zero-cost expert guidance.

    If you’re considering a Medicare Advantage plan or need help comparing options, we’re here for you! Click below to schedule an appointment with one of our expert brokers through Calendly or contact us directly:

    Contact Us:
    Phone: (888) 683-6372 or (845) 358-1220
    Email: office@emeraldmedicare.com

     

    Click below to schedule an appointment with one of our Medicare Experts.

    Mark Brownstein, CSA® | Calendly

    An Essential Guide for Medicare Supplement Plans

    by | Jan 30, 2025 | Medicare Supplement, Rules & Enrollment

    As your dedicated team at Emerald Medicare, we understand that navigating the Medicare enrollment process can be overwhelming. That’s why we’re here to provide clarity on one of the most valuable options available to Medicare beneficiaries: Medicare Supplement Insurance, also known as Medigap. This comprehensive guide will walk you through what Medigap plans are, how they work, and how they can benefit you by filling the gaps left by Original Medicare.

    —————

    What are Medicare Supplement (Medigap) Plans?
    A Comprehensive Guide

    A Medigap plan (Plan G, Plan N, etc.) is private health insurance designed to work alongside Original Medicare (Parts A & B).

    While Original Medicare provides broad coverage, it doesn’t cover everything. For example, beneficiaries are still responsible for certain deductibles, co-pays, coinsurance, and out-of-pocket costs. Medigap plans help cover these “gaps” in Medicare, providing financial protection and peace of mind.

    Here’s how it works:

    • Original Medicare pays for its share of covered healthcare services (typically 80% of approved costs).
    • Medigap plans help pay for the remaining out-of-pocket costs, like the 20% co-insurance on doctor visits or hospital stays.

    What Do Medigap Plans Cover?

    Medigap plans can help pay for various out-of-pocket expenses that Original Medicare doesn’t cover. Depending on the Medigap plan you choose, it may cover:

    • Medicare Part A coinsurance and hospital costs
    • Medicare Part B coinsurance or copayments
    • The first three pints of blood used in a medical procedure
    • Part A hospice care coinsurance or copayments
    • Skilled nursing facility care coinsurance
    • Part A deductible
    • Part B deductible (for some older plans)
    • Part B excess charges
    • Foreign travel emergency coverage (up to plan limits)

    Each Medigap plan is standardized, meaning that the benefits for each plan type are the same no matter which insurance company offers the plan. For example, Medigap Plan G from one insurance company will offer the same benefits as Medigap Plan G from another. However, premiums can vary based on things like your home state, income, and more, so it’s essential to compare offerings or work with a Medicare broker, like our team at Emerald Medicare, to find the best plan for your needs and budget.

    —————

    Why Should I Choose a Medigap Plan?

    Medigap plans, as opposed to Medicare Advantage (Part C) plans, are particularly beneficial for individuals who:

    • Want predictable healthcare costs: If you want to avoid unexpected out-of-pocket expenses, a Medigap plan can provide peace of mind by covering those costs.
    • Travel frequently: Some Medigap plans offer coverage for medical care when traveling outside the U.S. (a benefit not offered by Original Medicare).
    • Need frequent medical care: If you visit doctors or specialists regularly or require frequent hospital stays, Medigap plans can help reduce the financial burden of these services.
    • Prefer flexibility in healthcare providers: Unlike Medicare Advantage plans, Medigap plans don’t have network restrictions. You can see any doctor or specialist nationwide who accepts Medicare.

    —————

    Medigap vs. Medicare Advantage: What’s the Difference?

    It’s essential to understand that Medigap and Medicare Advantage plans are different, and you cannot have both – only one or the other.

    • Medigap works with Original Medicare (Parts A and B) to cover out-of-pocket medical costs, like co-insurance and/or certain deductibles. However, as prescription medications are not covered by Medigap plans, you are also required to enroll in a Part D plan (Prescription Drug Plan) when enrolling in a Supplemental plan. In tandem, A Medigap plan + a Prescription Drug Plan is a highly comprehensive option for a higher monthly premium – with less restrictions than Medicare Advantage. Any doctor’s office in America will accept your Medigap insurance as long as their office accepts Medicare.
    • Medicare Advantage (Part C) is an alternative to Medicare Supplement + Part D coverage that combines hospital, medical, and drug coverage into one all-encompassing plan, often including additional benefits like dental or vision. However, Medicare Advantage plans all have their own unique network of ‘preferred’ medical providers that beneficiaries are limited to, meaning the patient will be 100% financially responsible for services received from Out-Of-Network doctors. Furthermore, some Medicare Advantage plans provide less comprehensive drug coverage when compared to dedicated Prescription Drug Plans (Part D) and their formularies.

    —————

    How to Enroll in a Medigap Plan

    You can enroll in a Medigap plan during your Initial Enrollment Period [IEP] – which begins as you approach age 65 – after enrolling in Original Medicare (Parts A & B). This six-month IEP window is critical because during this time, you have guaranteed issue rights, meaning insurance companies can’t deny you coverage or charge higher premiums based on your health status. After this period, you may still be able to apply for a Medigap plan, but insurers can use medical underwriting to determine your eligibility and rates.

    How to Choose the Right Medigap Plan

    Choosing the right Medigap plan depends on your specific healthcare needs, budget, and lifestyle. Here are a few tips to help you decide:

    1. Assess your current health needs: If you frequently visit doctors or specialists, a Medigap plan that covers Part B copayments and coinsurance can be very beneficial.
    2. Consider your travel habits: If you travel frequently, especially outside the U.S., look for a Medigap plan that includes foreign travel emergency coverage.
    3. Plan for the long term: While some Medigap plans may have higher premiums, they can save you money in the long run by limiting out-of-pocket expenses.
    4. Consult with a Medicare broker: A licensed Medicare broker, like the experts at Emerald Medicare, can help you compare different Medigap options, review costs, and find the plan that best suits your needs.

    For advice on choosing a Prescription Drug Plan, read our Blog Post to learn more:  

    Blog: How to Choose a Part D Plan

    —————

    Explore Medigap Options with Emerald Medicare

    At Emerald Medicare, we’re here to help you make informed decisions about your healthcare. Medigap plans can be a great way to secure financial peace of mind while ensuring that you get the care you need. Our team of licensed Medicare experts will guide you through the process, helping you understand your options and choosing a plan that fits your unique needs.

    If you’re interested in learning more about Medigap plans or need help finding the right one for you, we’re here to help. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us directly:

    Contact Us:
    Phone: (888) 683-6372 or (845) 358-1220
    Email: office@emeraldmedicare.com

    Click below to schedule an appointment with one of our Medicare Experts.

    Mark Brownstein, CSA® | Calendly

    Medicare Eligibility & Enrollment

    by | Sep 13, 2024 | Original Medicare, Rules & Enrollment

    As your trusted Medicare resource with Licensed Medicare experts, we know that understanding Medicare eligibility and the enrollment process can often overwhelming or confusing. Whether you’re approaching age of 65 or considering retirement, or navigating Medicare eligibility for yourself or a loved one, this guide will help clarify who qualifies for Medicare and how to navigate the enrollment process.

    —————-

    Who Qualifies for Medicare?

    1. Age-Based Eligibility

    The most common way to qualify for Medicare is by reaching the age of 65. If you or your spouse have worked and paid Medicare taxes for at least 10 years (40 quarters), you’re eligible for premium-free Medicare Part A (hospital insurance). Medicare Part B (medical insurance) is available for a monthly premium based on your adjusted gross income from your tax return income from 2 years prior.

    2. Disability-Based Eligibility

    If you’re under 65 but have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, you automatically qualify for Medicare. You’ll receive Medicare Parts A and B, just like someone who qualifies based on age. Based on the health insurance you have access to currently you may or may not accept Part B at that time.

    3. End-Stage Renal Disease (ESRD)

    Individuals of any age with End-Stage Renal Disease (ESRD), requiring regular dialysis or a kidney transplant, qualify for Medicare. Coverage usually starts the first month of dialysis if you apply promptly.

    4. Amyotrophic Lateral Sclerosis (ALS)

    If you have ALS, you automatically qualify for Medicare the first month you start receiving SSDI benefits, with no 24-month waiting period.

    —————-

    How to Apply for Medicare

    1. Automatic Enrollment

    Already Receiving Social Security: If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. Your Medicare card will arrive in the mail about three months before your 65th birthday. Based on your specific situation if you are working or covered through your spouse you may keep your company coverage or consider Medicare options at this time. If you choose to keep the company coverage you would need to reject your Part B so that the premium for Part B does NOT come out of your social security check. This decision is an important one and our suggestion is to consult with an experienced Medicare advisor to guide you properly to your best course of action at this stage.

    2. Manual Enrollment

    If you’re not receiving Social Security benefits, you will need to be proactive in signing up for Medicare on your own when the time is right. You can do this through the Social Security Administration (SSA) website, by phone by scheduling an appointment, or in person at your local SSA office. Consult a medicare expert to ensure you avoid timing and/or penalty issues. 

    3. Initial Enrollment Period (IEP)

    The Initial Enrollment Period is a seven-month window that includes the three months before your 65th birthday, the month of your birthday, and the three months after. This is your first opportunity to sign up for Medicare Parts A and B. This ONLY applies to individuals who are self-employed, unemployed or working for a company of less than 20 employees. This is often a very often misunderstood aspect of Medicare.

    4. Special Enrollment Period (SEP)

    If you’re still employed (for a company greater than 20 employees) and covered by an employer’s health plan, you can delay enrolling in Part B without penalty. Once your employment ends, you’ll have an eight-month Special Enrollment Period to sign up for Part B before you would incur a penalty. Each person’s situation is different based on the cost of Cobra for you and your family and the quality and details of coverage your company provides.

    5. General Enrollment Period (GEP)

    Missed Initial Enrollment: If you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you can enroll in Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year. However, a late enrollment penalty may apply.

    —————-

    Understanding Medicare Parts A and B

    Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

    Medicare Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical supplies.

    Understanding these components is crucial for selecting the right coverage and avoiding potential penalties. To learn more, click below to read our blog post on Medicare Parts A and B. 

    An Essential Guide for Medicare Parts A & B

    Take Charge of Your Medicare Journey with Emerald Medicare

    Navigating Medicare eligibility and enrollment can be overwhelming, but you don’t have to do it alone. Our team of Licensed Medicare experts is here to guide you through every step of the process, ensuring you make informed decisions about your healthcare coverage. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us via the provided phone number or email.

    Contact Us:
    Phone: (888) 683-6372 or (845) 358-1220
    Email: office@emeraldmedicare.com

    Click below to schedule an appointment with one of our Medicare Experts.

    Mark Brownstein, CSA® | Calendly

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