How does Original Medicare work?

Original Medicare is the foundation of your Medicare coverage. It has two parts: Part A (health insurance) and Part B (medical insurance). Part B has a monthly premium.  In general, prescriptions are not covered by Original Medicare.

You must enroll in Medicare to begin coverage. If you are 65 or older, you are eligible to enroll in Original Medicare. Some people younger than 65 with certain disabilities are also eligible.  

The Initial Enrollment Period (IEP) lasts 7 months. It begins three months before the month you turn 65 and ends three months after the month you turn 65. This applies whether you retire at age 65 or you’ve enrolled in Covered California. 

During the IEP, you can make additional choices about your Medicare coverage.

• Bundle your plans with a Medicare Advantage (Part C) plan
• Pick a Prescription Drug Coverage (Part D) plan  
• Add a Medicare Supplement plan

Covered California

If you get a subsidy from California you may no longer qualify for it when you become eligible for Medicare.* And if you continue to get a subsidy after that time, you may have to pay back some or all of the money. 

It’s important to discuss your options. Call a Blue Shield Medicare Adviser at (855) 203-3874 to learn more about your options. 

How to enroll in Original Medicare 

Call Social Security at 1 (800) 772-1213, 8 a.m. to 7 p.m., Monday through Friday. TTY users should call (800) 325-0778. You can also visit your local Social Security office.

If you have health insurance through your employer or your spouse’s employer, check your options before signing up for Part B. Depending on your coverage, you may not need Part B and can avoid paying the monthly premium. Ask your benefits administrator or HR representative for help in choosing the right option for you. Or call Blue Shield of California toll free at (855) 203-3874. We’re here to help.

 

How to enroll in Medicare beyond the Initial Enrollment Period (IEP)

There are times outside of the IEP when you can still sign up. But you might have to pay a late-enrollment penalty.

General Enrollment Period (GEP)

The GEP allows you to enroll if you didn’t enroll during your IEP.

• The GEP occurs each year from January 1 – March 31
• You might be charged a penalty fee for failing to enroll during your IEP

Annual Enrollment Period (AEP)

The AEP is a time to make changes to your existing coverage.

• The AEP is open each year from October 15 – December 7
• You can change your Medicare coverage. For example, switching to a Medicare Advantage plan or adding a Medicare Supplement plan
• You can enroll in Medicare during an AEP, but you might be charged a penalty fee for missing your IEP

Special Enrollment Period (SEP)

The SEP is an eight-month period for enrolling in Medicare Part B if you are leaving group, employer, or union coverage.  It’s for people who didn’t get Medicare Part B when they signed up for Original Medicare.

• The SEP begins the month after your group, employer, union coverage, or the employment ends. 
• If you enroll in Medicare during an SEP, you do not have to pay a late enrollment penalty

Other Medicare enrollment options:

There are other situations that affect your enrollment eligibility.

• You are collecting Railroad Retirement Board or Social Security retirement benefits. Signing up in special cases. 
• You are receiving disability benefits. What to do if you receive disability benefits.
• You have amyotrophic lateral sclerosis (ALS). How to sign up if you have ALS.
• You have end-stage renal disease (ESRD). Enrolling when you have ESRD.

Get more information