Get started with Medicare

Original Medicare is a fee-for-service plan managed by the federal government. When you sign up, you receive a Medicare card, which entitles you to Medicare-approved services. Original Medicare allows you to choose any doctor, hospital or other facility that accepts Medicare. All Sharp-affiliated doctors, hospitals and medical groups accept Original Medicare. Original Medicare includes:

• Medicare Part A (inpatient/hospital insurance)

• Medicare Part B (outpatient/medical insurance)

Medicare Part A provides hospital coverage, skilled nursing facility care, hospice care and home health care.

Most people do not pay a monthly premium for Medicare Part A; you or your spouse paid for this through payroll taxes while working. With Medicare Part A you are responsible for costs when receiving inpatient care.

Medicare Part B provides outpatient services like visits to your primary care doctor or specialists, outpatient surgery, ambulance, outpatient medical health, durable medical equipment, outpatient physical therapy and outpatient lab work. Medicare Part B also has a deductible and coinsurance including 20% of the Medicare approved amount for services after you meet the deductible.

There is a monthly premium for Medicare Part B, which is determined by your modified adjusted gross income reported on your tax return from two years prior. Depending on your income, you may pay more or less per month for your Medicare Part B coverage.

If you are receiving Social Security benefits, you should automatically be enrolled in Medicare Part A and receive your Medicare card in the mail around your 65th birthday.

If you are not receiving Social Security benefits, you may apply for Part A as soon as three months before your 65th birthday. You can apply online at http://www.ssa.gov/medicare or in person at your local Social Security office. Call 1-800-772-1213 to confirm Social Security office hours and holiday closures.

San Diego Social Security office locations:

• 1333 Front St.
  San Diego, CA 92101

• 8505 Aero Drive
  San Diego, CA 92123

• 626 L St.
  Chula Vista, CA 91911

• 700 East 24th St., Ste. A
  National City, CA 91950

• 367 Via Vera Cruz
  San Marcos, CA 92078

I am turning 65

If you are receiving Social Security benefits, automatic enrollment in Part B should occur. If you were automatically enrolled in Medicare Part B and do not wish to keep your Part B coverage, follow the instructions included with your Medicare card and send it back to Social Security. If you keep the card, you keep Part B and pay monthly premiums.

If you are not receiving Social Security benefits, you must apply for Part B no sooner than three months before your 65th birthday.

You have a total of seven months to enroll in Medicare Part B — three months before the month you turn 65, the month of your birthday and three months after your birth month has ended. You can apply online at http://www.ssa.gov/medicare or in person at your local Social Security office. Call 1-800-772-1213 to confirm Social Security office hours and holiday closures.

Once a full three months have passed since the month you turned 65, you are locked in to the decision you made. If you did not enroll in Medicare Part B when you were first eligible, you can sign up during the general enrollment period that begins Jan. 1 and ends March 31 each year and you may have to pay a higher monthly premium for late enrollment. Your coverage will begin on July 1 of that year.

Exceptions to the late enrollment penalty do apply (i.e., if you will continue to work and receive health insurance through your employer).

If you are planning to continue working past the age of 65, you will want to review the cost and benefits of your employer-based insurance and compare it to the cost and benefits of enrolling in Medicare Part B.

To learn more about comparing your options and delaying enrollment in Medicare Part B, attend a free educational Medicare webinar.

If you have Original Medicare, you can choose to go to any doctor or hospital that accepts Medicare. All Sharp-affiliated doctors, hospitals and medical group accept Original Medicare.

If you are considering Original Medicare (Parts A and B), you may also want to consider enrolling in a Part D prescription drug plan or a Medicare Supplement insurance plan. These are both optional add-ons to Original Medicare.

I am over 65 and retiring

If you are retiring from work and will no longer have insurance through your employer and you are enrolling in Medicare Part B after age 65, there are important steps you need to take to avoid a late-enrollment penalty.

Before you retire, Social Security requires your employer to complete the Request for Employment Information form, which states the date through which you had creditable coverage. This form will exempt you from the late-enrollment penalty.

To learn more about how to avoid late-enrollment penalties, attend a free educational Medicare webinar.

If you have Original Medicare, you can choose to go to any doctor or hospital that accepts Medicare. All Sharp-affiliated doctors, hospitals and medical groups accept Original Medicare.

If you are considering Original Medicare (Parts A and B), you may also want to consider enrolling in a Part D prescription drug plan or a Medicare Supplement insurance plan. These are both optional add-ons to Original Medicare.

Parts A and B of Original Medicare do not include drug coverage. If you want to add drug coverage, you will need to choose a Part D plan and pay a monthly premium.

These plans are offered through Medicare-approved private insurance companies, not the federal government. The cost for a Part D plan, and the drugs included in the plan, varies based on the plan you choose. You may qualify for extra help paying for your prescription drug costs, monthly Part D premiums and/or annual deductible.

If you go 63 days or more without a Part D plan (or other credible drug coverage) after your initial enrollment period is over, you may owe a late-enrollment penalty. The late-enrollment penalty is calculated by multiplying 1 percent of the national base premium for a Part D plan by the number of full uncovered months you were eligible but didn't join a Medicare prescription drug plan.

Medicare Supplement Insurance Plans, also known as Medigap plans, cover "gaps" in Parts A and B of Original Medicare. Gaps are costs that you are responsible for, such as deductibles and copays. The policy cost and coverage depend on the plan you select. These plans are offered through private insurance companies, not the federal government.When you choose a Medicare Supplement plan, you can continue to go to any hospital or physician that accepts Medicare. Sharp accepts all Medicare Supplement plans.

Medicare Advantage plans, also known as Part C plans, provide coverage beyond Original Medicare Parts A (hospital coverage) and B (outpatient coverage). These plans are offered through Medicare-approved private insurance companies, not the federal government.

A Medicare Advantage plan is an alternative to having a Part D and Medicare Supplement plan. You cannot have both a Medicare Advantage plan and a Medicare Supplement plan.

Medicare Advantage plans offer the same coverage as Medicare Parts A and B. They also include prescription drug coverage and may include extra benefits like vision, hearing and dental, as well as access to care management services. For people managing specific chronic conditions including diabetes, cardiovascular disease and/or chronic heart failure, Medicare Advantage plans may offer additional benefits.

These plans also provide financial protection through annual limits on out-of-pocket expenses. Medicare Advantage plans offer a low or no-cost monthly health plan premium beyond what you pay for Part B and give you access to care from doctors and hospitals that are within the plan's network.

To find out which doctors are included in the network, contact Sharp Health Plan or UnitedHealthcare, which offer Medicare Advantage plans accepted by Sharp.

When you select one of the plans accepted by Sharp, you'll have access to our skilled and compassionate caregivers. No matter which plan you choose, as a Sharp patient, you will receive:

• Convenient access to Sharp medical offices and urgent care centers, plus Sharp hospitals and emergency departments

• Coordinated care provided by a primary care doctor working in partnership with you and specialists to maintain your optimal health

• Clinical excellence delivered with understanding and compassion — the level of care we call The Sharp Experience