Prior to celebrating your 65th birthday, retirement is perhaps not the only significant consideration many incur, but there is also healthcare. Many older individuals elect to enroll in a Medicare healthcare program, which acts as a lifeline and puts healthcare in the reach of millions of individuals in the United States. Medicare also helps millions of individuals maintain adequate health and independence while easing an inherent culpability for younger families and individuals.
Prior to Medicare, nearly one in two Americans did not have any healthcare. The majority of uninsured individuals either wiped out their saving accounts to cover unexpected medical expenses or go without any health insurance altogether. As for individuals with a Medicare insurance plan, they may benefit from the coverage that Medicare provides for them, which they may otherwise be unable to afford. Furthermore, an enrolled Medicare beneficiary may be secured from rising healthcare costs. There are numerous aspects to the Medicare healthcare program, with many eligibility restrictions, costs and much more. Essentially, Medicare is comprised of four major parts, A, B, C, and D. These are all distinctive in the coverage provided by each while aiding in covering the costs for various medical services.
Where Does Medicare Come From And Who Can Benefit From It
Medicare is a federal health insurance program that funds various health care expenses. It’s managed by the Centers for Medicare and Medicaid Services, CMS, which is a division of the U.S. Department of Health & Human Services, HHS. Medicare beneficiaries are generally senior citizens aged 65 and older. Adults with particular approved medical conditions, such as Lou Gehrig’s disease, or eligible permanent disabilities may qualify for Medicare benefits as well. Similar to Social Security, Medicare is an prerogative program. The majority of U.S. citizens earn the right to enroll in Medicare through labor and paying their taxes for a minimum requirement duration. Even if an individual does not work for the required amount of time to be entitled to Medicare benefits, they may still be authorized to enroll, but they also may be required to pay more capital.
Medicare Part A
The four parts of Medicare all cover unique services and costs. However, many individuals claim that Part A is perhaps the most beneficial and useful part, especially for older individuals. When an individual applies to Medicare, they are automatically enrolled in the Part A plan. Part A of Medicare is associated with hospital insurance. Part A covers inpatient hospital care, limited stays in a skilled nursing care facility, sparse home health care services, and hospice care. Most Medicare Part A beneficiaries are not required to pay a monthly premium in order to receive coverage through this part of Original Medicare, which is referred to as “premium-free Part A.”
The Cost For Medicare Part A?
Typically, if an individual worked for at least 10 years or 40 quarters, and paid Medicare taxes while working, they are eligible for premium-free Part A. Otherwise, they must pay a monthly premium. Medicare Part A generally does not cover the entire amount of a beneficiary’s hospital bill. Consequently, they will probably be accountable for a portion of the cost of their bill. Additionally, those beneficiaries will also be required to pay a deductible prior to the initiation of their Medicare benefits. Medicare will actually find the full amount of their costs for up to 60 days in a hospital and up to 20 days in a skilled nursing facility or home. Subsequently, the beneficiary will be required to pay a fixed amount up to the maximum number of eligible covered days. Those beneficiaries’ Part A benefits cover a portion of the costs for an aggregate of 90 days in a hospital and 100 days in a skilled nursing facility. Medicare also covers an amount of up to 60 “lifetime reserve days.” These are days a beneficiary lodges in a hospital for more than 90 days consecutively. Beneficiaries earn a lifetime sum of 60 reserve days.
Qualify for Medicare Part A
In order to qualify for Medicare Part A and Part B, an individual must be a U.S. citizen or a permanent legal resident for a minimum of five consecutive years. Additionally, they must also meet a minimum of one of the following specifications in order to be eligible for Medicare:
- They may be automatically enrolled into Part A, hospital insurance when they ultimately turn age 65 as well as becoming eligible for Social Security. Furthermore, if an individual is already receiving benefits from Social Security or the Railroad Retirement Board, RRB, they will automatically earn Part A and Part B. This enrollment commences the first day of the month after turning 65. However, if an individual is not getting retirement benefits from Social Security or the Railroad Retirement Board resulting from current employment, they are required to sign up for Medicare Part B when they reach the age requirement, as the enrollment is no longer an automatic process.
- Beneficiaries automatically receive Part A and Part B after they receive disability benefits from Social Security for a minimum of 24 months or particular disability benefits from the Railroad Retirement Board, RRB, for at least 24 months.
- They are required to sign up and enroll for Medicare, as the enrollment is also no longer automatic. This is a result of those beneficiaries incurring penalties for failure to enroll.
- They automatically receive Part A and Part B during the month their disability benefits initiates.
Costs associated with Medicare Part A
Beneficiaries may receive Part A at age 65 without being required to pay premiums if:
- They are already receiving retirement benefits through Social Security or the Railroad Retirement Board.
- They are entitled to get Social Security or Railroad benefits but they have not yet applied and filed for them.
- They or their spouse previously possessed Medicare-covered government employment.
- If an individual or their spouse did not pay Medicare taxes while in the workforce, as well as they are age 65 years old or older, and is a citizen or permanent inhabitant of the United States, they may be eligible to purchase Part A. If they are under the age of 65, they may receive Part A without vexing required to pay premiums if:
- They have been permitted to Social Security or Railroad Retirement Board disability benefits for at least 24 months.
They are a kidney transplant or kidney dialysis patient.
While the majority of individuals are not required to pay a premium for Part A, everyone must pay for Part B if they elect to obtain it. This monthly premium is subtracted from their Social Security, Civil Service Retirement or Railroad Retirement check. If they do not receive any of these benefit payments, Medicare mails them an invoice for their Part B premium every three months.
Enrollment for Medicare Part A
Eligible individuals have various options when the time is appropriate for enrollment in Medicare. There are three times annually which individuals can sign up for Medicare.
- Initial Enrollment Period: This is a seven months period which begins three months prior to an eligible individual’s 65th birthday, including the birthday month, and concludes three months after their birthday. It is advised to sign up as early as eligibility begins in order to avoid late penalties. Additionally, Initial coverage may be delayed if an individual waits until the fourth month after turning 65. Generally, the earlier an individual signs up for Medicare, the sooner the coverage will start.
- Special Enrollment Period: After the Initial enrollment period, select individuals who meet specific criteria may still have an opportunity to sign up for Medicare. If an individual is covered under group health plans, or current employment, they may sign up at any time as long as they or their spouse is working and covered by a group health plan through the employer. If an individual enrolls in Medicare during this special enrollment period, their coverage will begin the month after Social Security gets the completed enrollment request.
- General Enrollment Period: If an individual delays their enrollment and misses the special enrollment period, they would be required to wait until the Medicare general enrollment period. This duration runs from January 1 until March 31. Additionally, the coverage will begin on July 1 of that year. In most cases, those who enroll during this period will be required to pay a late enrollment penalty.
Where To Enroll
In most cases, if an individual is already receiving benefits from Social Security or the Railroad Retirement Board RRB, the will be automatically be enrolled in Part A and Part B starting the first day of the month they turn 65.
Individuals may enroll in Part A or Medicare Part B in one of these following ways:
- Online at www.SocialSecurity.gov
- By calling Social Security at 1-800-772-1213
Monday-Friday, from 7 AM to 7 PM
- In person at the local Social Security office.
The Annual Enrollment Period, AEP, runs from October 15 to December 7 each year. If an individual is enrolled in Original Medicare at the time of the AEP, they may either enroll in a Medicare Advantage plan or enroll, disenroll from, or switch to a different Medicare Part D, which is a prescription drug plan.
When You Turn 65 Automatically Enrolled For Medicare
There are various instances where Medicare enrollment may transpire on an automatic basis including:
- If the beneficiaries are already receiving Social Security retirement or Railroad Retirement Board benefits when they turn 65, they will automatically be enrolled in Part A
- If they live outside of the United States or D.C, residing in Puerto Rico for an example, they will automatically be enrolled in Part A but will be required to physically enroll in Medicare Part B.
- If they are under 65 as well as getting certain disability benefits from the Railroad Retirement Board or Social Security. Those individuals will be automatically enrolled in Original Medicare, Part A, and Part B, following a minimum of 24 months of receiving disability benefits. The exclusion to this is if an individual is diagnosed with End-Stage renal disease, ESRD. If they are diagnosed with ESRD and have had a kidney transplant or are in the need of ordinary kidney dialysis, they may apply for Medicare. If they have amyotrophic lateral sclerosis, often referred to as ALS or Lou Gehrig’s disease, they will be automatically enrolled in Original Medicare during the same month that their disability benefits commence.
- If they are automatically enrolled in Medicare Part B but do not desire to retain it, they incur various options to cancel the coverage. If their Medicare coverage has not yet begun and they received a red, Blue or white Medicare card, they may pursue the stipulations that arise with their card, as ultimately mail the card back. If they keep the Medicare card, they also retain Part B and will be required to pay the Part B premiums. Furthermore, If they applied for Medicare through Social Security, they will need to notify them in order to cancel their Part B coverage. If their Medicare coverage has begun and they want to drop Part B, they are required to notify Social Security for instructions on the process to submit a signed request form. Their coverage will conclude the first day of the month after Social Security receives the request.
If an individual has health coverage through current employment through employment or a spouse’s employer, the beneficiaries may elect to delay their Medicare Part B enrollment. They should contact their employer’s health benefits administrator in order for them to comprehend the features of their current coverage with Medicare, as well as knowing the consequences for dropping Medicare Part B. Prior to any enrollment, cancellations or alterations to a health care program, beneficiaries must perform extensive research in order to ensure they are purchasing adequate healthcare coverage to suit their needs. When contemplating Medicare enrollment, beneficiaries must know how to qualify for Medicare Part A, the enrollment for Medicare Part A and know whether when you turn 65 automatically enrolled for Medicare.