Important aspects of Medicare
The federal health insurance program provided to the adults 65 years of age or above is known as Medicare. This program also qualifies for young people with specific disabilities but signing up for one is quite complicated. That’s because this program involves remembering deadlines and enrolment periods. Medicare covers various expenses, including the prescribed drugs, doctor’s appointments, hospital bills, and many more. Adults with the age of 65 years or more get all the facilities from Medicare. Waiting till the age of 65 is not exactly required. But if it is waited for too long, then you may have to pay the late enrollment penalties.
Let’s first see how the enrollment works to make the right choices based on your insurance requirements for detailed information.
It is advised to know the parts that Medicare cover:
Medicare Part A: Medicare Part A covers the hospital bills involving hospital stays, home health (limited extent), hospice care, and good nursing facilities care.
Medicare Advantage: Medicare Advantage is also known as Medicare Part C and thus, it covers the facilities of both Medicare Part A and Part B. A private company is involved in this part and provides some extra benefits.
Medicare Part B: Medicare Part B covers the medical insurance required for the doctor’s appointment, cares for outpatients, and expenses like durable medical equipment.
Medigap: Another name Medicare supplement insurance. This part helps cover the expenses considered to the out-of-pocket and the “gaps” in the coverage of Original Medicare.
Medicare Part D: Medicare Part D covers prescribed drug coverage with the help of a private insurance company.
The Centers for Medicare and Medicaid Services (CMS) manages and organizes the Medicare program. To apply for this program, you need to go through SSA (Social Security Administration).
How to Apply for Medicare?
People receiving benefits from either the SSA or RRB (Railroad Retirement Board) are not required to apply for Medicare, as you are automatically signed up for this program. The Medicare card and the enrollment information are mailed to you within three to four months before your 65th birthday. But if you want to enroll or switch to the Medicare Part C or Part D plan, you have to do that in your initial enrollment period.
Therefore, for the people who are not automatically enrolled in any Medicare plans, They need to apply for Medicare Part A or Part B. The Medicare Part A and Medicare Part B of Medicare is considered the original Medicare and the plan that can bear the other additional expenses. Medicare enrollment period depends on various factors, including the employment status and the coverage types that the person wants.
Original Medicare enrollment procedure
Medicare Part A
To begin with the process of applying for the Medicare plans like Medicare Part A, you need to keep in mind the type of Medicare coverage that is ultimately required for you and the following steps will help you to do that:
- Firstly, check if you are automatically enrolled in the original Medicare plan.
- Then, decide if you want those to continue with those parts or if you want to add or switch any part of the existing plan.
- You can also check the Medicare Advantage facilities in your area to see if that plan is better than the existing one.
- And lastly, if you are staying with the existing plan, then do consider checking the Medicare Part D or Medigap options as it is beneficial for you.
The SSA provides a helpful application named a checklist for Medicare application,and this application lists the type of forms you will need during the process. These forms involve proof of military service, tax forms, and W-2s. When all the information for applying is obtained, you can begin applying for Medicare.
The original Medicare enrollment is done in the following ways:
- Through online: To begin with the enrolling process online, you can visit gov
- By phone: For applying by phone you can either call SSA on 800-772-1213 or you can call TTY at 800-325-0718 during the weekdays (i.e. Monday to Friday) in between 7 a.m. to 7 p.m.
- In-person: The in-person process of applying needs you to go to the local SSA office and you can get further details there.
- Through the mail: In this process of applying, you need to send an application to your local SSA office with your details like your name and Security number and the date when you want to enroll. They will send you the guidelines for enrolling.
If you already enrolled for Medicare and are receiving benefits from SSA or RRB, then you can call RRB (877-772-5772) or TTY (312-751-4701) during the weekdays (i.e. Monday to Friday) in between 9 a.m. to 3:30 p.m. for any query.
Medicare Part B
Another original Medicare is Medicare Part B and Medicare Part B covers the medical services and supplies medically required to treat the health condition you are facing. This part includes the following health conditions:
- Abdominal Aortic Aneurysm Screening,
- Bone Mass Measurement (Bone Density),
- Cardiac Rehabilitation,
- Diabetes Supplies,
- Doctor Services,
- Durable Medical Equipment (like walkers),
- EKG Screening,
- Emergency Department Services,
- Eyeglasses (limited),
- Federally-Qualified Health Center Services,
- HIV Screening,
- Home Health Services,
- Kidney Dialysis Services and Supplies,
- Kidney Disease Education Services,
- Mammograms (screening),
- Medical Nutrition Therapy Services,
- Mental Health Care (outpatient),
- Non-doctor Services,
- Occupational Therapy,
- Pneumococcal Shot,
- Prescription Drugs (limited),
- Prostate Cancer Screenings,
- Prosthetic/Orthotic Items,
- Pulmonary Rehabilitation,
- Rural Health Clinic Services,
- Second Surgical Opinions,
- Tests (other than lab tests),
- Transplants and Immunosuppressive Drugs, and many more
Other facilities that Medicare Part B covers include ambulance services, outpatient care, preventive care, and durable medical equipment. Sometimes this part involves rehabilitating services like physical therapy and part-time or intermittent home health services if the doctor prescribed. Other one-time preventive services like a visit to the “Welcome to Medicare”, shots for Hepatitis B and flu shots, or screenings for cardiovascular or cancer or diabetes.
Eligibility for Medicare Part B
To get Medicare Part B facilities, you need to be a minimum of 65 years old and a permanent U.S. citizen or must be staying in the U.S. for the last five years continuously. You are eligible for the Medicare Part B services if you are eligible for premium-free Medicare Part A. You are automatically eligible for Medicare Part B if you have a disability. When you are getting disability benefits from SSA or RRB, then the original Medicare enrollment is done automatically. Patients of ESRD (end-stage renal disease) and ALS (amyotrophic lateral sclerosis) are eligible for Medicare Part B even if you are younger.
Receiving retiring benefits before 65 or having Medicare facilities due to your disability, then you are automatically enrolled when you are eligible for the facilities that the Medical Part A and Medicare Part B covers. But if you are getting any benefits, you have to enroll for Medicare Part B during the initial enrollment period, which is during your 65th birthday. If you miss that period, then you can enroll for Medicare with a late enrollment penalty.
Time to enroll for Medicare
There is another period to enroll for Medicare Part B, known as the annual General Enrollment Period. This period is for those who did not enroll during their initial enrollment period and are not eligible for the special enrollment period. This period begins on January 1 till March 31 and the coverage starts from July 1. But you may have to pay the late enrollment fee for not enrolling during your initial enrollment period.
If you are 65 years old or above, keep in mind about your six-month Medigap of Medicare Part B Open Enrollment Period begins. During this time, you purchase the Medicare Supplement Insurance Plan; because during the open enrollment period, you have the government-issue right where you can buy a Medigap plan without medical underwriting or paying any higher premium.
Delaying Medicare Part B
Medicare Part A facility premium is given for free to some people, whereas most of us have to pay the Medicare Part B’s monthly premium. Some people decide not to enroll for Medicare during their initial enrollment period because they are already tied up with a private insurance company. Delaying for Medicare is not good and you must reconsider the decisions you took regarding your Medicare considering your health conditions. When you are looking for the COBRA or retiree coverage, you must know that those are not considered ideal for your health-related coverage. Later, you can’t apply for Medicare Part B as COBRA regardless of it. It would help if you enrolled for Medicare Part B as soon as your employer coverage ends. Waiting for it to end might give you trouble later.
Medicare Part B premium
The Medicare Part B premiums change from year to year. The premium amount varies depending on your condition or situation. the Social Security benefits deduct this amount for some people. When your income extends to a certain amount, your premium can be higher than the standard one because it varies depending on your income. Your premium amount would increase by 10% every 12 months if you did not apply on time. The following chart below will help you with the premium amount based on your income and related information or other guidelines.
Medicare Part B monthly premium in 2020
|You pay||When yearly income is|
|filed an individual tax return||filed a joint tax return|
|$144.60||$87,000 or less||$174,000 or less|
|$202.40||$87,001 – $109,000||$174,001 – $218,000|
|$289.20||$109,001 – $136,000||$218,001 – $272,000|
|$376||$136,000 – $163,000||$272,001 – $326,000|
|$462.70||$163,001 to less than $500,000||$326,001 to less than $750,000|
|$491.60||$500,000 or more||$750,000 or more|
|You pay||married but file a separate tax return from your spouse and your yearly income is|
|$144.60||$87,000 or less|
|$462.70||$87,001 to less than $413,000|
|$491.60||$413,000 or more|
There is also an annual deduction for Medicare Part B, which is $198 in 2020, where you have to pay for many covered services with 20% as coinsurance. Your doctor or healthcare center accepts the accept assignment for your covered services. Medicare-approved amount is the money that you have to pay for the rendered services. Accepting assignments is that your doctor has to charge you more than the usual Medicare-approved amount for all the covered services and you will be held responsible for the cost-sharing. Pre-existing health conditions that existed before the policy has limited coverage towards your health expenses.
Enrolling for Medicare Part D
You cannot enroll for Medicare Part D automatically. So if anyone wants to enroll for it, then you have to do it manually. This part is for the coverage of the prescribed drugs.
It is important to remember that Medicare Part D can be added as an add-on to the original Medicare i.e., Medicare Part A and Medicare Part B and if you have Medicare Part C, which is Medicare Advantage. You can’t enroll for the Medicare Part D plan. You are enrolling for Medicare Part D during your initial enrollment period (i.e., within the 7 months after your 65th birthday). Hence, if you didn’t enroll during that period, you have to pay the late enrollment penalty while applying it. You can apply for Medicare Part D during the open enrollment period, starting from 15th October till 7th December.
You can use the following ways for enrolling for Medicare Part D:
- By Phone: Call 800-633-4227 or TTY (877-486-2048) for the detailed information and guidelines for the procedure
- Online: Use tools like Medicare.gov’s plan finder tools for finding better plans in your area
- Contact private company: Contacting private insurance companies who offer Medicare Part D plan through their website; or phone number and you can directly enroll with them.
Applying for Medicare Advantage (Medicare Part C)
The Private insurance company offers Medicare Part C facilities. It provides all the facilities of Medicare Part A and Medicare Part B. Along with these, it also provides the coverage of prescribed drugs sometimes. Some Medicare Advantage plans cover healthcare benefits like vision, dental, and many more. This plan places the yearly cap on your overhead expenses and this is quite helpful when expecting large healthcare expenses.
Nevertheless, Medicare Part C plans can add cost; you pay for other Medicare parts on top of any other premium. Before applying for Medicare it is better to weigh your healthcare needs along with the cost of coverage and then choose accordingly. You can apply for the Medicare Advantage either during your initial enrollment period. Or during the Medicare’s open enrollment period, which begins from October 15 till December 7, or enrolls with the late enrollment penalty. But remember, while paying with the late enrollment penalty, your plan will start from July 1.
Following are the two ways through which you can enroll in this plan:
- Online: You can shop for Medicare Part C after comparing it. Online tools like the Medicare.gov’s plan finder tools can help you with this.
- Private Insurance Company: Contact the company using its official website or phone and directly enroll for this plan.
When to apply for Medicare?
There are some specific deadlines regarding the enrollment for Medicare and those are:
- Initial enrollment period: There is a 7 month window during your 65th birthday, where you can enroll for any Medicare plans. It starts with the 3 months before your 65th birthday and ends with 4 months after your birthday.
- Open enrollment period: The period starts from October 15 to December 7; where you can change your original Medicare plan to Medicare Advantage. In this period, you can add or switch from any part to another.
- General enrollment period: January 1 to March 31 is the period for the general enrollment period. You can enroll for Medicare if you miss the initial enrollment period.
- Special enrollment period: Delaying Medicare due to any private health insurance? You can enroll for Medicare during the special enrollment period. There is a time of 8 months since your private health insurance expires to enroll for Medicare without any late penalties.
You don’t have to go through the procedure alone, resources like Medicare.gov, SSA, SHIP(State Health Insurance Assistance Program). They will help you throughout the enrollment and will also provide guidelines and counseling for it. You can contact them through their official websites and phone.
Medicare is an essential step towards yourself. When entering for your 65th birthday you must enroll for Medicare services. Both the CMS and SSA provide options for it as per your requirements. Then you don’t have to worry about your high treatment expenses.