What is Medicare

Medicare is the federal health insurance program for

  • People who are 65 or older

  • Certain Younger people with disabilities

  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Who can get Medicare

U.S. citizens and legal residents

Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.

You must also meet one of the following requirements

  • Age 65 or older

  • Younger than 65 with a qualifying disability

  • Any age with a diagnosis of end-stage renal disease or ALS

How do you enroll

  • You should be automatically enrolled in Medicare Part A and Part B if you are receiving Social Security or Railroad Retirement Board benefits when you become eligible. You’ll receive your Medicare card in the mail.

  • You need to enroll in Medicare yourself if you aren’t receiving Social Security benefits when you become eligible. Go to SSA.gov/Medicare to enroll online, or call or visit your local Social Security office.

Turning 65

You have choices

You may enroll in Medicare Part A (hospital insurance), Medicare Part B (medical insurance) or both. You may have other coverage choices once you enroll in Medicare, such as a Medicare Advantage plan (Part C), a prescription drug plan (Part D) or a Medicare supplement insurance plan.

Working past 65

You still have an Initial Enrollment Period.

You have Medicare decisions to make at age 65 even if you have coverage through an employer plan (yours or your working spouse’s). Your IEP happens when you turn 65 whether you continue to work or not.

 

Medicare may work with employer coverage

Many people with employer coverage enroll in just Part A during their IEP. Part A is premium-free for most people, and it may provide secondary hospital coverage. Some employers require you to take full Medicare benefits (Parts A and B) at age 65. Check with your employer plan benefits administrator.

When can you enroll in a Medicare Advantage or prescription drug plan

Initial Enrollment Period

Your Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after. It begins and ends 1 month earlier if your birthday is on the first of the month. You may enroll in Part A, Part B or both. You may also choose to join a Medicare Advantage plan (Part C) or a prescription drug plan (Part D). Prescription drug coverage must be creditable or you may be subject to a late-enrollment penalty when you enroll in a plan with Part D benefits.

Annual Enrollment Period, October 15 – December 7

During annual enrollment, you can add, drop or switch your Medicare coverage.

Medicare Advantage Open Enrollment Period, January 1 – March 31

If you are already a Medicare Advantage plan member, you may disenroll from your current plan and switch to a different Medicare Advantage plan one time only during this period.

Special Enrollment Period

Depending on certain circumstances, you may be able to enroll in a Medicare plan outside of the initial enrollment or annual enrollment time frames. Some ways you may qualify for a Special Enrollment Period are if you:

  • Retire and lose your employer coverage

  • Move out of the plan’s service area

  • Receive assistance from the state

  • Have been diagnosed with certain qualifying disabilities or chronic health conditions

  • Qualify for Extra Help

Special Needs Plans have other eligibility requirements.

Cost

Help with Medicare costs

If you have a low income and few assets, you may qualify for help through one or more of the following programs. There may also be other assistance programs in your state. Income includes money you get from retirement benefits or other money that you report for tax purposes. Income eligibility levels vary by state and program.

 

 

Medicaid

Medicaid provides health care coverage for people and families with limited incomes. It may also offer some services not covered by Medicare. Each state creates its own program, so contact your state Medicaid office for more information.

If you qualify for both Medicare and Medicaid, you are “dual eligible.” Sometimes the two programs can work together to cover most of your health care costs.

 

Extra Help

The Extra Help program helps pay some or all Part D premiums, deductibles, and copays.

 

Medicare Savings Programs

Medicare Savings Programs help pay some or all Part A and Part B premiums, deductibles, and coinsurance. You automatically qualify for the Extra Help program if you qualify for a Medicare Savings Program.

 

Find out if you qualify for help

Many people assume they don’t qualify for financial help, and they never look into it. Don’t make that mistake. Visit Medicare.gov to learn more about financial assistance programs. You may also contact your local Social Security office, Medicaid office or State Health Insurance Assistance Program for help.

Medicare Part A & B 

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). It covers care received from any qualified provider in the United States that is enrolled in Medicare and accepting Medicare patients.

What you pay for Part A

Premium

You do not pay a Part A premium if you or your spouse made payroll contributions to Social Security for at least 10 years (40 quarters). Otherwise, your 2019 monthly premium will be up to $437.

 

Your Part A premium, if you owe one, might be higher if you don’t sign up for Medicare when you are first eligible.

 

Deductible

Part A deductibles are charged per benefit period. A benefit period begins the day you are admitted to the hospital and ends when you’ve been out of the hospital 60 days in a row.

 

You pay one deductible even if you have more than one hospital stay during a single benefit period. The 2019 Part A deductible is $1,364.

 

Copay

There is no copay for hospital stays up to 60 days in one benefit period. Copays for a longer stay may include:

  • $341 per day for days 61–90

  • $682 per day for up to 60 lifetime reserve days

 

Each lifetime reserve day may be used only once, but you may apply the days to different benefit periods. Lifetime reserve days may not be used to extend coverage in a skilled nursing facility.

 

Copays for skilled nursing facility stays are:

  • $0 for days 1–20

  • $170.50 per day for days 21–100

Copays during home hospice care may include up to $5 per prescription for pain and symptom management.

 

Coinsurance

Home hospice patients may pay a small coinsurance amount for inpatient respite care so the patient’s caregiver can rest or have time off.

What you pay for Part B

Premium:

The standard monthly Part B premium in 2019 is $135.50.

 

You’ll pay the standard amount if:

  • You enroll for the first time in 2019

  • You aren’t receiving Social Security benefits.

  • Your premiums are billed directly to you.

  • You have Medicare and Medicaid, and Medicaid pays your premiums.

 

Your premium may be less than the standard amount if you enrolled in Part B in 2018 or earlier and your premium payments are deducted from your Social Security check.

 

Your premium may be more than the standard amount based on your income. You will pay an income-related monthly adjustment amount (IRMAA) if your reported income from 2017 was above $85,000 for individuals or $170,000 for couples. Visit Medicare.gov to learn more about IRMAA.

 

Part B charges a penalty if you don’t sign up when you are first eligible. The penalty is 10% of the monthly premium amount for each full 12-month period that you could have had Part B but didn’t sign up for it. The penalty is added to your monthly premium payment for as long as you’re enrolled in Part B.

 

You may avoid the penalty if you qualify for and sign up during a Special Enrollment Period.

 

Deductible:

The annual Part B deductible is $185 in 2019.

 

Coinsurance:

You generally pay 20% of the Medicare-approved amount for the covered services you use, with no annual out-of-pocket maximum. Medicare pays the remaining 80%.

This website and its contents are for informational purposes only. Amaya Group is a licensed health insurance agency. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. Amaya Group and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies. gamayagroup.com is not affiliated with Medicare.gov or CMS.gov. Medicare.gov and CMS.gov have the .gov domain because they are official federal government websites.

Sources

“Health Insurance Plans for Individuals & Families, Employers, Medicare.” UnitedHealthcare, https://www.uhc.com/.

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