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According to the 2016 Annual Report of the Medicare Trustees, more than 55 million Americans rely on Medicare for their health care coverage. This includes $9 million under the age of 65. Every day, another 10,000 people turn 65, making them eligible for the government-provided health insurance program. But the rules are complicated.

Medicare is mandatory

Once you turn 65 and are collecting Social Security benefits, you must enroll in Medicare Part A, which covers hospital costs. If you don’t want to enroll in Medicare, then you must repay your Social Security benefits. Medicare A is free for most people who have worked at least 10 years to earn the minimum 40 credits required for coverage or who are married to someone who is eligible for Medicare. If you are not yet collecting Social Security, you can delay enrolling in Medicare penalty-free under certain conditions.

Don’t forget about or ignore signing up

Your initial enrollment period (IEP) to sign up for Medicare Part B, which covers outpatient services and doctors’ fees, begins three months before your 65th birthday, includes your birthday month and extends three months beyond that. Miss that seven-month window and you will pay a delayed enrollment penalty of 1% per year for each year you were eligible but failed to enroll. Wait until 70 to enroll, for example, and that five-year delay will cost you an extra 50% of the standard Part B premium every month you are enrolled in Medicare. There is also a 10% per month delayed enrollment penalty for Medicare Part D prescription drug plans.

You may work longer to avoid penalties

Working longer is a valid reason to skip enrolling in Medicare at 65. If you or your spouse is covered by a group health insurance through a current employer or Union, you can delay enrolling in Medicare penalty-free. You have eight months after that insurance coverage ends to sign up for Medicare during a special enrollment period (SEP). Retiree health coverage does not count as creditable coverage, but can be used as a supplemental coverage plan to fill the gaps in Medicare coverage.

Medicare has a lot of gaps

Medicare doesn’t cover everything. If you need certain services Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance that covers them. Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance and copayments. That’s where Medigap or Medicare Supplemental coverage comes in.
NOTE: Some of the items and services that Medicare doesn’t cover include; long-term care, most dental care, eye exams and eyeglasses, dentures, hearing aids and routine foot care.

Income determines Medicare premiums

Although most people who enroll in Medicare Part B in 2017 pay the standard monthly premium of $134 per month, high-income retirees pay more. Individuals with modified adjusted gross incomes (MAGI) of $85,000 or more and married couples with MAGI topping $170,000, pay monthly premiums, including surcharges, ranging from $187.50 to $428.60 per month per person. Premiums are based on the latest available tax return, so 2017 Medicare premiums reflect income reported on 2015 federal income taxes.

Income brackets change next year