Category: Medicare

You can obtain prescription drug coverage if you are currently enrolled in the Medicare program. Individuals with limited resources, including income, may also qualify for Extra Assistance to cover the expenses of a Medicare prescription medication coverage. Monthly premiums, pharmaceutical co-payments, and annual deductibles are all examples of this. Extra Help is valued at approximately $4,900 per year. You may be eligible for these savings and be completely unaware of it. To be eligible for Extra Assistance with prescription drug costs, you must meet the following criteria:

• You must be a resident of one of the 50 United States of America or the District of Columbia.
• Your financial resources must be limited to $14,100 for an individual and $28,150 for a married pair cohabiting. Bank accounts, equities, and bonds are all examples of resources. They do not consider your residence, automobile, or any life insurance policy to be resources.
• Individuals must earn no more than $18,210 per year; married couples must earn no more than $24,690 per year. Even if your annual income is larger, you may still qualify for assistance. You may have a greater income yet still qualify for Extra Help if you or your spouse support other family members who live with you, earn money through work, or live in Hawaii or Alaska.

How can I apply for Additional Assistance?

You may submit an application at your local office. Utilize our Social Security office locator to locate one near you. After you apply, Social Security will analyze it and give you a letter indicating whether you qualify for Extra Help. Once you meet the eligibility requirements, you can enroll in a Medicare prescription medication plan. The Centers for Medicare & Medicaid Services will choose a plan for you if you do not. The sooner you become a member of a plan, the sooner you will begin receiving benefits. If Extra Help is ruled to be ineligible, you may still be able to enroll in a Medicare prescription medication plan.

Penalty for Medicare Prescription Drug Plans

If you do not enroll in a Medicare prescription drug plan when you first become eligible, you may be subject to a late enrollment penalty if you subsequently join. You will be responsible for this penalty for the duration of your Medicare prescription drug coverage. However, if you receive Extra Help or another eligible prescription medication plan, you will not be penalized.

Please note that the late enrollment penalty for the Medicare prescription drug plan is distinct from the late enrollment penalty for Medicare Part B. If you do not enroll in Part B when you first become eligible, you may be subject to a late enrollment penalty for the duration of your Part B coverage. Additionally, you may be required to wait to enroll, delaying your Part B coverage.

 

Why should I submit an online application for Extra Help?

Their online application is safe and secure, and it comes with a number of benefits. It guides you step by step through the process via a series of self-help windows. The screens will notify you of the information required to complete the application and will help you through the process of answering all questions completely. You may submit an application from any computer. You can start and stop the procedure at any point during it, allowing you to exit the application and return later to amend or complete any essential information. They take great care to safeguard your personal information.

Are state agencies able to assist me with my Medicare costs?

When you submit an application for Extra Help, you can also begin the process of applying for Medicare Savings Programs. These state initiatives assist with additional Medicare expenditures. Unless you indicate otherwise on the Extra Help application, Social Security will transmit information to your state. Your state will contact you to assist you in submitting an application for the Medicare Savings Program.

 

These Medicare Savings Programs assist those with limited financial resources and income in paying for Medicare charges. The Medicare Savings Programs assist you in paying for the premiums for Medicare Part B (medical insurance). For some individuals, the Medicare Savings Programs may also cover their Medicare Part A (hospital insurance) premiums, if applicable, as well as their Part A and B deductibles and co-payments.

 

Medicaid, or medical assistance, is a combined federal-state program that assists some persons with limited means and income with paying for medical expenses. Each state has its own set of rules regarding Medicaid eligibility and application. For further information, contact the Medicaid office in your state.

Medicare is the United States government’s health insurance program for seniors 65 years of age and older. According to the Centers for Medicare & Medicaid Services (CMS), the Medicare system currently has more than 60 million enrolled participants. This health care organization provides its members with a variety of Medicare coverage options to help them maintain a comfortable retirement lifestyle.

Are you prepared to apply for Medicare? If this is the case, continue reading to learn more about the various Medicare alternatives accessible to you so that you may make an informed choice about your future medical care needs. Today, do some homework to safeguard your future.

In a Nutshell, Medicare

Medicare covers its members’ hospital, health specialist, and physician visits in Medicare-accepting facilities. Medicare is a “fee-for-service” plan, which means that members pay a small, up-front price for each service they use. The remainder of the cost will be covered by Medicare.

Options for Medicare Coverage

Medicare provides coverage for a variety of different benefits through a variety of different plans. Each of these plans is designated with a unique letter.

Several of these policies are available through private insurers. These companies work in collaboration with CMS to provide these varied levels of coverage. Certain of these plans may be available just to individuals and not to couples.

All Medicare participants are eligible for two types of basic coverage. These fundamental coverage components are referred to as Medicare Parts A and B. You may hear Medicare Parts A and B referred to as “Original Medicare” because the benefits contained in these two portions were included in the program’s inception in 1965.

 

Medicare Part A covers the costs of home health care, hospitalization, and some hospice care. To be eligible for Medicare Part A, you or your spouse must have worked for a minimum of ten years. Members of Part A are responsible for a $1,340 deductible every benefit period.

Part B of Medicare covers the costs of medical equipment, diagnostic tests, and doctor visits. Enrollees in Part B pay monthly premiums based on their monthly income. These monthly premium payments typically range between $134 and $428.

 

Supplemental or “Gap” Insurance Plans

Additionally, Medicare enrollees have access to a network of supplemental coverage options known as Medigap policies.

Medigap policies can cover the medical expenses of a single person. If married partners choose to get Medigap coverage jointly, they must each purchase a separate insurance.

There are now eight Medigap plans available to members to augment the services provided under Parts A and B. Supplemental Medigap policies are denoted by the letters C, D, F, G, K, L, M, and N.

Occasionally, Medicare beneficiaries confuse Medigap insurance with basic Medicare Parts A and B coverage. Occasionally, you’ll hear someone refer to a Medigap plan as a “part,” similar to how “Part A” or “Part B” are titled. Original Medicare components are correctly referred to as “parts,” whereas Medigap plans are referred to as “plans.”

Medicap now offers eight distinct gap plans that cover additional medical treatments not covered by Medicare Parts A-B. Among these Medicare supplemental insurance programs are the following:

C Plan

Plan C gap policies cover additional medical expenses such as routine hearing and vision examinations. Plan C may also cover additional expenses not covered by Parts A and B, such as dental office visits.

Beginning in 2020. Plan C will no longer be available to newly enrolled Medicare beneficiaries. Medicare participants who began their coverage prior to 2020 may continue to sign up for these Plan C benefits. After 2020, no new members will be admitted to the system.

D’s plan

Plan D provides additional coverage for prescription medication costs. Preventative care costs such as flu shots and other common vaccines may also be covered by Part D pharmaceutical plans.

Plan D is a relatively recent Medigap insurance provider, having been founded in 2006. Prior to that, Medicare beneficiaries had to pay for prescription drugs out of pocket.

F and G plans

Beyond Medicare Parts A and B, Plans F and G provide comparable coverage. After Part A and B benefits are exhausted, both Plans F and G cover hospitalization costs for an extra year. Plans F and G can also assist with the cost of other medical services not provided by general practitioners, such as specialist referrals and blood transfusions.

However, when it comes to augmenting Part B expenditures, Plans F and G differ. For instance, Plan G cannot be used to offset the annual deductible amounts associated with Part B. This is a possible application of Plan F.

Additionally, Plans F can assist in covering a variety of other medical care bills. For instance, Plan F can cover the cost of your first three pints of blood transfusion. Additionally, you can use Medigap Plan F to cover medical expenses incurred when traveling outside the United States.

Plan G would also assist you in covering any medical expenses incurred when traveling abroad. Additionally, Medigap Plan G will assist in covering the first $185 in out-of-pocket medical expenses. Ambulance services, diabetes supplies, and x-rays are all examples of out-patient medical services.

K, L, and M plans

Medigap Plans K, L, and M all provide comparable coverage. Each plan only covers a percentage of the expenses not covered by Medicare Parts A and B. Plan K covers 50% of nursing facility co-pays and hospice payments, whereas Plan L covers 70% of these same costs. Plan M assists in covering 20% of these similar costs.

Medigap Plan N Plan N is an additional advantageous option for Medicare subscribers. Monthly premiums are reduced in return for increased co-payments and annual deductibles under Plan N. Plan N may cover up to $20 in co-pays for doctors’ exams and up to $50 in co-pays for emergency department visits.

Medicare Supplemental Insurance Plans

A Medicare Advantage Plan is a supplement to Medigap insurance. You can enroll in a Medicare Advantage plan via a commercial insurance firm that has been authorized by the Centers for Medicare and Medicaid Services (CMS). These businesses operate in the same manner as a health maintenance organization (HMO) or a preferred provider organization (PPO.)

A Medicare Advantage plan reimburses for health care on a monthly basis per enrollee rather than on a per-service basis. Medicare Advantage plans can supplement the coverage provided by Medicare Parts A and B. Additionally, some Medicare Advantage plans include prescription drug charges in addition to routine medical visits for dental and vision exams.

What Is the Difference Between Medicare Advantage and Medigap Plans?
The fundamental distinction between Medicare Advantage and Medigap plans is the manner in which they are paid. Members of Medicare Advantage will pay a standard monthly or billing period premium (whether they use the covered medical service or not.) Members of Medigap pay for medical services only when they utilize them.

Another distinction is the location of medical treatment available to members. Enrollees in Medicare Advantage plans must use doctors and medical facilities within their HMO or PPO network. Members of Medigap plans may see any doctor or institution that currently accepts Medicare.

Consider the Differences Between Medigap and Medicare Advantage Plans
When determining if a Medigap or Medicare Advantage plan is best for you, there are several lifestyle considerations to consider. Consider the following factors to assist you in making your choice:

Medications on Prescription

Members of Medigap insurance will not be covered for prescription medications. To access this benefit, Medigap members must supplement their Parts A and B coverage with Plan D. Medicare Advantage plans, on the other hand, will automatically include coverage for prescription medication expenditures.

Restriction on Medical Service Providers

Medicare Advantage plans operate similarly to PPO or HMO plans. Enrollees in Advantage plans are required to see physicians or specialists who are part of the same Advantage plan networks. Medigap plans offer greater flexibility in that they allow you to see any physician who accepts Medicare.

Medical Emergencies While Traveling Out of Town

Medicare Advantage restricts members’ access to providers who are also members of the same network. This criterion restricts one’s ability to obtain medical treatment while traveling outside of town. Medigap plans do not impose network restrictions on members as long as the provider accepts Medicare enrollees.

Following Steps

Selecting a Medicare plan does not have to be a difficult endeavor. Conduct research today to ensure that you are fully educated about the many coverage options available to you.

To learn more about the many Medicare coverage alternatives available, consult our Medigap plan comparison chart. You’ll find a summary of the advantages included in each plan. Utilize this chart to assist you in developing a strategy for meeting your future medical insurance coverage needs.

Additionally, you can visit your retirement financial planning counselor. You should seek their guidance on the most suitable Medicare plan for your future needs.

Don’t forget to visit our website for additional information about the Medicare process. We want you to appreciate the well-earned milestone for which you have worked a lifetime.

Medicare is a national health insurance program operated by the Centers for Medicaid and Medicare Services, a division of the United States federal government that operates under the auspices of the Social Security Administration. The program is separated into sections A and D, and applicants must have been a permanent resident of the United States for at least five years to be eligible for either. For parts A and B, you must be at least 65 years old and eligible for Social Security benefits. You may also qualify if you are under the age of 65 but are chronically incapacitated and have been receiving disability benefits for at least two years, or if you have end-stage renal disease.

Part C, often known as Medicare advantage, is obtained through private insurers, although one must already be enrolled in Part A or B to qualify. Part D, which is also available through private insurers, covers prescription medications and is also available to members of parts A and B.

 

How to Appeal a Denied Application

Determine the Appropriateness of an Appeal

If you’ve already applied for Medicare and are receiving benefits but have been denied coverage for a medical bill, you may want to consider filing an appeal. Appeals are measures done in response to a dispute with a Medicare coverage or payment decision. You have the right to appeal to any of Medicare’s four components if:

• It denies your request for a health care service, supply, or medication that you believe you are entitled to.
• The amount you should pay for health care services, prescription medications, supplies, or other products is refused, OR
• Payment is denied for a health care service, item, supply, or prescription medication that you already own.

Evaluate the Medical Summary Notice you have received.

Appealing begins with an examination of the Medical Summary Notice (MSN) that is mailed to you every three months. It summarizes all services and materials invoiced to Medicare by providers throughout a quarter. You can ascertain the amount paid by Medicare and what is refused using the MSN. It is typically a preliminary assessment made by the company that handles Medicare billing.

Objecting to the Decision

The initial judgment may be appealed in one of the following ways:

• Completing a Redetermination Request Form and submitting it to the contractor assigned to your case on the MSN
• Adhere to the appeals guidelines as specified on the MSN. You may choose to consult your physician or healthcare professional regarding any information that may be pertinent to your situation.
• Making a written request to the organization that processes Medicare claims (the contact information for this organization can be found on the MSN under the Appeals Information section. The petition must state why you disagree with the original finding and the specifics you require to be determined in advance.

On a signed form, you must enter your name, address, phone number, and Medicare number. All documentation presented in support of the appeal must include the Medicare number. After the initial redetermination request is filed, more information or supporting evidence may be submitted.

What Can I Expect Following an Appeal?

UnitedHealthcare evaluates all appeals received before to the expiration of sixty calendar days from the date of receipt of the MSN. Claims are processed in around 30 days. However, if further information is submitted following the original appeal, an additional 14 days may be required. In time-sensitive situations, one may request an accelerated decision. When the regular timescale for decision-making might threaten your health, the expedited method is implemented. These determinations are made within 72 hours.

You’re scheduled for a medical checkup shortly, but you’ve misplaced your Medicare card. A misplaced Medicare card can cause a great deal of stress. You’re aware that your healthcare provider will want you to present your health insurance card at your visit; however, how can you obtain a replacement Medicare card if you’ve lost your original? Additionally, do you have time to obtain a replacement before the appointment? Fortunately, acquiring a Medicare replacement card is pretty straightforward, and there are even some steps you may take if you require one immediately. If you’re in need of a new card, continue reading to learn about your alternatives.

What You’ll Need to Complete the Replacement of Your Medicare Card 

Requesting a replacement Medicare card is a simple process. The documentation required to obtain the new card is significantly less complicated than, for example, requesting a new Social Security card. Essentially, the only evidence required is proof of identity when applying for a new card. The method through which you apply for your card has an effect on the type of documentation required.

If you request your card online via the Medicare.gov website, all you need to do is log in to your account. Because you validated your identity when you created the account, no additional verification is necessary. This is one of the reasons you should always keep your account information and password secret and in a secure location. Once you’ve requested a replacement, it will be mailed to the address listed on your Social Security card.

Additionally, you can obtain a replacement card through your my Social Security account. If you choose this method, you will be required to give verification of your identity, including your full name, Social Security number, and address. Additionally, you may be requested for additional verification information, such as your birthplace or mother’s maiden name. Thus, the good news is that you do not need to assemble a mountain of papers in order to obtain a new Medicare card!

Is It Possible to Order a Replacement Medicare Card Online?

Yes! Indeed, this is the simplest method of obtaining a replacement card. You can request the new card in a few different methods online. The quickest method is to connect into your MyMedicare.gov account. There, you can request a replacement card. While you wait for your new Medicare card to arrive in the mail, you can even print an official duplicate from your account.

If you need to update your mailing address, you must contact the Social Security Administration. You can update your address and obtain a new card by logging into your mySocialSecurity account at SSA.gov. The process may take a little longer if you are changing your address. If you require the card sooner, Social Security can mail you a temporary letter confirming your Medicare benefits coverage within ten days. If you require immediate assistance, you must visit your local Social Security office.

The preceding paragraphs presume that you are enrolled in Original Medicare. If you have Medicare supplement insurance or a Medicare Advantage Plan, contact your insurance company for details on how to receive a replacement card. In many circumstances, you will still require a red, white, and blue Medicare health card regardless of whether you are enrolled in Medicare Part A, Part B, Part D, Medigap, or another company’s prescription drug plan. If you receive Railroad Retirement Board (RRB) benefits, you must contact them directly rather than the Social Security office to update your information.

Is It Possible To Obtain A Replacement Medicare Card From A Local Social Security Office?

Technically, no, but it is possible to come very close. If you find yourself in a scenario where you want replacement documents immediately, the best course of action is to visit your local Social Security Administration office. While a replacement card cannot be obtained straight from the office, you can obtain the next best thing.

By visiting your local office, you will not only be able to request your new card in person, but you will also be one step closer to receiving it. They can print you a temporary letter confirming your coverage until your replacement card arrives in the mail. Your replacement card should be mailed within 30 days, but in most circumstances, the printed letter will suffice until you receive your replacement card.

What Happens If My Local Office Is Closed As a Result of COVID-19?

You should be aware that due to the COVID-19 outbreak, local offices are presently closed. As a result, your only other choice aside from online assistance is to phone. The SSA can be reached toll-free at 800-772-1213. (TTY Users 800-325-0778). Certain local offices will allow appointments in certain instances, but only if your request cannot be completed online or over the phone. If you require an instant replacement Medicare card, your best choice is to print one from your online Medicare account.

To Request a Replacement Medicare Card, Who Do You Contact?

If you require a new card but do not require any changes to your information, contact the Centers for Medicare & Medicaid Services. Their complete contact information is available on their website. However, the Medicare phone number is simple to remember. Medicare’s toll-free number is simply 1-800-Medicare. Your new card can be requested over the phone and will be shipped to your address within 30 days. To update your address or other personal information, you must contact the Social Security Administration.

Conclusion

If you’re unable to locate your Medicare card, have no fear! Requesting a replacement is simpler than you may believe, and you have various possibilities. You can make a request online, by phone, or in person. While it may take up to 30 days to receive your new card, you can print an official copy from Medicare’s website or seek a temporary letter from the Social Security office confirming your coverage. In either case, you should have everything you need and your replacement card should arrive shortly. If you require a replacement card, you may begin the process today!

Are you unsure whether you can enroll in Medicare yet all you read makes no sense? We understand your aggravation with the cumbersome Medicare enrollment rules! Not to mention Part A, B, C, D, Medicare Advantage Plans, and Medigap coverage. This just complicates matters and makes it more difficult to determine whether you qualify or not.

Fortunately, you have arrived at the correct location if you are attempting to determine your eligibility. We will explain the basic eligibility requirements in detail, as well as any unusual situations that may apply. You’ll also learn about some of the distinctions between the various components and when you can enroll in each. Continue reading to determine if you qualify for coverage.

Medicare Eligibility – Who Is Eligible?

Let’s begin with the fundamentals and then move on to particular rules and scenarios. Medicare was established to assist in providing health insurance for older adults who were no longer employed and so did not have access to an employer-sponsored health plan. Because the majority of health insurance plans in the United States are employer-sponsored, these older adults did not have many options. Medicare is normally available to those aged 65 or over who are citizens or permanent residents of the United States. This is in contrast to Medicaid, which is jointly administered by the state and federal governments and aimed at assisting low-income families in obtaining healthcare.

Medicare is comprised of two distinct components: Medicare Part A and Medicare Part B. There are further sections C and D, but we shall discuss them later. For the time being, understand that Original Medicare is comprised of Parts A and B. Part A covers hospitalization and inpatient services such as hospice care or nursing facility care. Part B provides typical health insurance coverage for physician visits, outpatient services, and medical equipment.

To qualify for Part A under typical circumstances, you must be 65 years old and a citizen or permanent resident of the United States. If you or your spouse has worked and paid Medicare taxes for at least ten years, you or your spouse are not required to pay a Part A premium. If you do not meet the work requirement, you may still be able to purchase Part A coverage by paying a monthly payment.

Thus, if you meet any of the following conditions, you will automatically receive premium-free Part A coverage when you reach the age of 65:

• Social Security or the Railroad Retirement Board provide retirement benefits to you.
• You are eligible for these benefits but have not yet made an application.
• You or your spouse worked for a government agency that was covered by Medicare.

Additionally, if you have been receiving Social Security disability benefits for 24 months or have end-stage renal illness or Lou Gehrig’s disease, you may be eligible for premium-free Part A coverage. Even if you are under the age of 65, certain conditions will qualify you for coverage. After 24 months of receiving disability compensation, you will be automatically enrolled in Part A. The 24-month waiting period does not apply if your disability was approved owing to ESRD or Lou Gehrig’s illness. You immediately become eligible. If you have been diagnosed with ESRD, you must apply manually; however, if you have Lou Gehrig’s disease, you will be automatically enrolled.

Apart from the reasons indicated above, you can also qualify for premium-free Part A coverage if you are a dialysis or transplant recipient. If you fall into one of these categories, you do not have to be 65 years old to qualify for coverage.

The wonderful news is that if you qualify for Part A benefits, you are also eligible for Part B benefits! Part B coverage, on the other hand, carries a charge. This payment may be taken from your Social Security or Railroad Retirement Board benefits upon retirement. If you do not receive these benefits, Medicare will send you a bill every three months for your premium. The monthly premium for Medicare Part B in 2021 is $148.50. If your annual income exceeds $88,000, the premium increases proportionately. Additionally, Part B needs a $203 annual deductible.

When Will I Be Eligible to Receive Medicare Part A Benefits?

Medicare benefits begin on the first day of the month following your 65th birthday. If you have been receiving Social Security or Railroad Retirement Board benefits for at least four months, you will be enrolled in Part A coverage automatically. If you are not currently receiving these benefits, you can still enroll manually. If your birthday falls on a month’s first day, your benefits will begin on the first day of the month preceding your birthday. When you are ready to begin coverage, you can quickly apply for Medicare online.

If you are under the age of 65 and receive SSDI benefits, you will be automatically enrolled in both sections A and B after receiving 25 months of disability compensation. If you are disabled due to Amyotrophic Lateral Sclerosis (ALS), you will be enrolled immediately once your disability benefits begin. The rules are slightly different in the case of ESRD. You will need to apply for benefits manually. Your eligibility is determined by a variety of circumstances, including whether you are on dialysis, have had a kidney transplant, and have worked and paid Medicare taxes. To determine your eligibility, you can go directly to Medicare’s website and use the eligibility checker.

When Am I Eligible to Begin Receiving Part B Benefits?

Due to the fact that Part B coverage is voluntary, the enrollment requirements are slightly different than those for Part A. Due to the fact that Part B is an optional benefit that requires a premium, you will not be automatically enrolled. If you desire to enroll in this coverage within your original enrollment period, you can do so. This seven-month period begins three months prior to your 65th birthday, includes your birth month, and ends three months following your 65th birthday.

Many people nowadays continue to work past the age of 65, and they prefer to delay the commencement of their Part B coverage while they remain covered by their employer’s health plan. You are eligible to a special enrollment time upon retirement in this circumstance. When you lose your job, you have eight months to enroll in Medicare Part A/B after your employer-provided coverage expires.

If you do not enroll in coverage during your initial enrollment period or during a special enrollment period when your Medicare eligibility begins, Medicare offers open enrollment periods from January to March each year. You can enroll now for coverage to begin on July 1. However, you will very certainly be charged a late enrollment penalty for failing to enroll when you were eligible.

After enrolling in Part B coverage, you should consider purchasing a Medigap policy. This is supplemental Medicare insurance that helps pay for out-of-pocket expenses and other goods not covered by Medicare. This extra insurance can help you save money over time, and you will receive the cheapest rates if you enroll as soon as you become eligible.

Eligibility for Medicare Part C

Medicare Part C is sometimes referred to as a Medicare Advantage plan. It is a hybrid of Medicare Parts A and B, or hospital insurance, and standard health insurance. To receive Medicare coverage under Part C, you must be eligible for and enrolled in Original Medicare (Parts A and B). Additionally, you must reside within the service region of the chosen advantage package.

Private insurance companies that contract with Medicare manage and administer Part C. Part C normally has the same seven-month enrollment period as Original Medicare (3 months before turning 65, the month of your 65th birthday, and three months after turning 65). If you opt to enroll later, each year from October 15 to December 7 there is an Annual Election Period for coverage beginning on January 1.

Part C coverage is optional, and enrollment in an Advantage plan is not required. Each insurance company that administers a Part C plan may establish its own out-of-pocket maximums. If you’re considering a Part C plan, you should shop around to see which plan is the best fit for your circumstances.

Eligibility for Medicare Part D

Traditional Medicare does not cover prescription drugs, but Medicare Part D does. Part D, like Part C, is handled by private insurance companies under contract with Medicare. As with Part C, you must reside within the service area of the Part D plan you select.

You must be enrolled in either Part A, Part B, or both to enroll in Part D coverage. Medicare has authorized these private insurers to handle these plans. To enquire about Part D coverage, contact your local insurance agent or use the Medicare.gov website to identify a provider.

Medicare Eligibility for Individuals Under the Age of 65

Because Medicare is designed for adults 65 and older, is it possible to obtain coverage if you are younger than 65? You very certainly can! If you are under the age of 65, you may be eligible for Medicare under certain circumstances. If the Social Security Administration (SSA) determines that you are handicapped for a period of 24 months, you are eligible to enroll in Part A and/or Part B coverage. Additionally, you are eligible if you have been receiving Railroad Retirement Board Disability benefits for a period of 24 months.

Additionally, you qualify for coverage if you have persistent renal failure and are on dialysis or have had a kidney transplant. Additionally, if you have been diagnosed with ALS, or Lou Gehrig’s illness, you may qualify. Coverage normally begins immediately following an ALS diagnosis, but if you have renal failure, you must enroll manually.

I’ve Never Worked, Am I Eligible for Medicare?

The short answer is yes, even if you have never worked, you are still eligible when you reach the age of 65. You will, however, be asked to pay an additional fee for Parts A and B. If you have never worked, you will not be eligible for the free Part A premium. Additionally, you may be eligible if your spouse meets the work criteria for premium-free coverage. Another way to qualify is if your spouse worked in a government-covered position.

If you have never worked, you will be ineligible for Social Security disability benefits, and hence will be ineligible for Medicare as well. Even if you have never worked and are under the age of 65, you may qualify for Medicare if you have kidney failure or ALS.

 

Conclusion

While the Medicare requirements may appear difficult at first, they can be simplified significantly by taking them one element at a time. To begin, determine your eligibility based on your age and job experience. If not, check to see if you meet one of the exceptions. If you are eligible, you may want to investigate enrolling in a private insurance company’s Medicare Advantage and/or Part D programs as well. If you have any questions, you may always check the Medicare website or call them.

This website contains instructions on how to enroll in Medicare online through the Social Security Administration. It’s simple and convenient; there’s no need to drive to a local Social Security office or schedule an appointment with a Social Security employee.

 

It only takes a few minutes. Generally, once your application has been filed online, you are finished. There are no signature forms, and, in most cases, no documentation is necessary. Social Security will evaluate your application and will notify you if additional information is required. Otherwise, your Medicare card will be mailed to you.

The Centers for Medicare and Medicaid Services administer Medicare (CMS). Social Security collaborates with CMS to enroll beneficiaries in Medicare. Visit Applying for Medicare Only – Before You Decide for additional information on applying for Medicare only and deferring retirement benefits.

If you’re currently enrolled in the Medicare Part A and desire to enroll in Medicare Part B, please complete form CMS 40-B, Application for Enrollment in Medicare – Part B (Medical Insurance) and submit it in person or you can mail it to your local Social Security office.

 

Who is eligible to apply for Medicare online?

You may use the online Medicare application if you meet the following criteria:

• Have a minimum age of 64 years and 9 months
• Are you interested in enrolling in Medicare but do not already have any other type of Medicare coverage?
• Are not interested in beginning to receive Social Security payments at this time and
• Are not receiving Social Security retirement, disability, or survivor benefits at the time of application

When should I make a Medicare application?

You should enroll in Medicare three months before reaching the age of 65, even if you intend to work and delay obtaining retirement benefits. Otherwise, your Medicare medical insurance and prescription drug coverage may be delayed, and you may face increased premiums.

You can enroll in Medicare even if you are not yet eligible for retirement benefits. Once you’ve completed the online application, you can opt out of receiving cash retirement benefits. Then, at a later date, you can apply online for retirement benefits.

 

Why would you want to apply for Medicare online?

The following are some of the advantages of applying for your Medicare card online:

• Avoid travels to the Social Security Administration.
• By starting and stopping the application, you can respond to questions at your leisure.
• Prior to submission, make necessary adjustments to the application.
• Electronically submit your application.
• You will be emailed a receipt for your application, which you may print and save for your records.
• Utilize your confirmation number to check the status of your application online.

Once you’ve established your online account, you’ll be able to access your credit report. This can assist you in the future, once you begin collecting benefits, in protecting your Social Security information.

 

What happens after I submit my application for Medicare?

Once they get your Medicare application, they will examine it and contact you if additional information or documentation is required. Once they have received all of the required information and papers, they will process your application and mail you a decision letter. Use the Medicare application checklist to determine which documents and information you will need when applying for Medicare.

If you have a Health Savings Account (HSA) or health insurance, you may want to inquire about the impact of enrolling in Medicare with your personnel office or insurance company.

If you are unable to apply for Medicare online, you may use one of the following alternative methods:

By phone

call 800-772-1213 between the hours of 7 a.m. and 7 p.m., Monday through Friday. You may contact TTY 800-325-0778 if you are deaf or hard of hearing.

In Person

Visit the Social Security office closes to you. Call to schedule an appointment beforehand. If you are not a resident of the United States of America or one of its territories, you may also contact the nearest US Social Security office, US Embassy, or US Consulate.

Medicare and Medicaid are two phrases that are regularly used in discussions about health insurance coverage. Many individuals appear to use them interchangeably, despite the fact that the two programs are fully distinct. Medicare is a health insurance program, whereas Medicaid is a public assistance program. Therefore, what are the distinctions between the two? Several significant distinctions include qualifying conditions and coverage fundamentals. Continue reading to learn more about each program, what it covers, how to apply for either, and the significant distinctions between the two. Additionally, we’ll explain what to do if you qualify for both programs. Let we begin.

How Are Medicare and Medicaid Differ?

To begin, let us examine the programs’ underlying structure. Medicare is a federally financed program that provides health insurance coverage to those 65 years of age and older, younger disabled individuals, and people undergoing dialysis treatment. The program’s history demonstrates that the majority of people obtain health care coverage through their employment, and that following retirement, individuals were unable to obtain adequate coverage on their own. As a result, Medicare was established to assist in bridging this divide and providing coverage for those folks. The same is true for disabled individuals who are no longer able to work.

Medicaid, on the other hand, is a federal-state partnership program. As a result, when individuals inquire about how Medicaid is supported, the answer is that both the federal and state governments contribute to its funding. While each state has the authority to establish its own Medicaid laws, there are some similar characteristics across all states. Medicaid’s overall goal is to assist in providing healthcare to individuals and families in financial need, regardless of age. This is in accordance with Medicare, which assists seniors regardless of their financial level. Let’s look at the eligibility conditions for each program in greater detail.

Medicare has no eligibility limitations based on income. Medicare eligibility can be accomplished in one of three ways. To begin, by age alone. Individuals 65 years of age and older are eligible for Medicare. Additionally, if the Social Security Administration has determined that you are disabled, you may qualify for Medicare. There is normally a 24-month waiting period between the start of your disability and the start of Medicare coverage. Finally, those with end-stage renal disease (ESRD) or who are on dialysis are immediately eligible for Medicare.

To be eligible for Medicaid, an individual or family must earn less than 138 percent of the federal poverty threshold (about $14,500 for individuals and $29,700 for a family of four). Each state has its own set of rules regarding precise eligibility criteria, but low income is the primary criterion. Numerous states have recently increased Medicaid eligibility, so even if you have previously been denied, you might try reapplying if you believe you qualify.

Another significant distinction between these two programs is the premium and service costs. Due to the fact that Medicaid is a needs-based program, there are no premiums. Health care services are frequently offered at no cost to the recipient. However, in some areas, certain services may demand minor copays or deductibles.

Medicare is only available for persons 65 and older who have accumulated sufficient work credits to qualify. Individuals receiving SSDI benefits and those over 65 with insufficient employment history are typically obliged to pay monthly premiums for their coverage. These Medicare premiums can range from $200 and $450, depending on the individual’s work credits. For the majority of medical procedures, Medicare needs a minimal copayment or deductible.

Finally, the coverage levels of the two programs differ. Original Medicare, or Medicare Part A, provides coverage for hospitalization. It includes hospitalization, inpatient services, hospice care, and care in a skilled nursing facility. Recipients may elect to purchase additional coverage under Part B, Part C, or Part D. Part B expands coverage to include physician appointments, outpatient care, medical equipment, and preventative or wellness care visits. Part C, sometimes referred to as Medicare Advantage Plans, combines Parts A and B into a single policy run by commercial insurance companies under contract with Medicare. Finally, Part D is an optional coverage option for prescription drugs. Many Medicare beneficiaries also choose to purchase a Medicare supplement, or Medigap, coverage plan to assist cover out-of-pocket expenses such as copayments and deductibles.

 

Medicaid provides coverage for a broad range of medical treatments. When you join in Medicaid, you gain access to hospital coverage, doctor visits, X-rays, essential medicine, long-term care, preventative care, mental health treatment, maternity care, and coverage for children’s dental and eye care. If you have any questions about your eligibility or coverage, you should contact the Medicaid office in your state.

Can You Have Medicare and Medicaid at the Same Time?

Yes, you can be eligible for coverage through both programs concurrently. This is referred to as being “dual eligible.” This often applies to individuals over the age of 65 or who are disabled and have a very restricted income. You may still enroll in either Original Medicare or a Medicare Advantage Plan. When a person qualifies for both programs, the majority of their medical expenses are covered in full by one or both of the programs. Generally, drugs are covered by a Medicare Part D prescription drug plan, however Medicaid may pay additional prescriptions or other medical treatments not covered by Medicare.

If you qualify for both government programs, it is often prudent to enroll in both. Enroll in Medicare and Medicaid. When a person enrolls in both programs, he or she often incurs very few out-of-pocket expenses.

What Are Medicare’s Four Sub categories?

Medicare coverage is divided into four components. These are the benefits of Original Medicare, often known as Medicare Part A. Additionally, Medicare Part B, Medicare Part C, and Medicare Part D are available. Each of these sections addresses a distinct aspect of health care expenditures, and each has a different price tag. Let’s take a closer look at each of them.

Part A of Medicare

Additionally, this is referred to as Original Medicare. It is supplied free of charge to individuals 65 years of age who meet the minimum work history requirements. In a nutshell, Part A offers coverage for hospitalization and other long-term care to its participants. Even if your spouse does not have sufficient job credits, you may qualify for premium-free coverage. Part A is comprised of the following categories of items:

• Hospital inpatient care
• Professional nursing care in skilled nursing facilities
• Palliative care
• Health care at home

Part B of Medicare

Part B is comparable to a regular health insurance plan in terms of physician visits and outpatient services. Part B includes optional benefits for which a monthly premium may be paid. A person registered in Part A is not required to obtain Part B coverage. Part B discusses the following:

• Visits by a physician Outpatient services
• Orthopedic treatment (outpatient)
• Visits to the wellness center
• Medical gadgets or medical equipment that is designed to last a long time

Part C of Medicare

Part C is essentially a synthesis of Parts A and B. Private insurance companies that deal with Medicare provide Part C coverage. You may enroll in a Part C plan if you are eligible for both Parts A and B. Medicare Advantage Plans are also referred to as Part C plans. This enables individuals to consolidate their hospital and standard insurance policies into a single policy, simplifying the process of maintaining and tracking their coverage and spending.

Part D of Medicare

Prescription medications are covered under Part D. This includes recommended vaccinations and injections. As with Parts B and C, Part D is administered by private insurance firms and is available as an add-on. This can be obtained independently of your other health insurance policies and helps keep medication costs down. If your income is limited, you should contact the Medicare office at Medicare.gov or 1-800-MEDICARE (1-800-633-4227) to inquire about additional services that may assist with health care expenses. Call 1-877-486-2048 if you are using a TTY.

Who Qualifies?

As previously stated, Medicare and Medicaid have distinct qualifying requirements. Medicare eligibility is mostly determined by age, whereas Medicaid eligibility is determined by income. Consider the needs for each.

Medicare eligibility can be accomplished in one of three ways. Income is not a factor in determining eligibility for Medicare services. The following requirements apply:

• 65 years of age or older
• Under the age of 65 and disabled
• Anyone of any age with ESRD (requiring dialysis or kidney transplant)

Medicaid eligibility is a little different. Age is not a significant factor in determining who is eligible for Medicaid. Income is the primary criterion for qualification. Enrollment is open to citizens of the United States of America and lawful, permanent residents who meet the income requirements. If your income and resources are extremely limited, you may qualify if you meet any of the following criteria:

• 65 years of age and older
• Pregnant
• Individuals under the age of 19 who are disabled
• An adult providing care for a kid
• Adult who is not a parent (in certain states)

What Is Included?

We’ve already discussed briefly the services that Medicare and Medicaid insurance cover. As previously stated, Medicare is divided into four distinct components, each of which covers a different set of services. For the purposes of this section, we shall assume that a person is enrolled in all four portions of Medicare, or all available coverage. Therefore, let us get into the specifics.

Medicare coverage is fairly thorough for someone who is enrolled in all components of the program. The following is a partial list, but not exhaustive:

• Hospitalization
• Visits to the physician
• Services provided on an outpatient basis
• Orthopedic treatment
• Prescription medications
• Medical supplies
• Palliative care
• Professional nursing care in skilled nursing facilities

Medicare does not cover dental or eye treatment. If an individual chooses to participate in those services, they must be acquired outside of the Medicare system. Certain individuals may also be eligible for Medicare Savings Programs, which are state-run programs that assist Medicare recipients with limited financial resources with copays and deductibles.

After learning about Medicare, you’re probably wondering, “How does Medicaid work?” Medicaid, like Medicare, provides substantial coverage. It covers the majority of normal medical services and essentials. Several items are addressed under the program, including the following:

• Services provided by hospitals
• Visits to the physician
• Care throughout pregnancy
• Mental health treatment
• Preventive medicine
• Immunizations and Vaccines
• Prescription medications
• Dental surgical services

Unlike Medicare, Medicaid in some jurisdictions does cover routine dental and vision care for children.

 

How Do I Submit an Application?

After learning about the distinctions between the two programs, who qualifies, and what is covered, you’re undoubtedly asking how to apply. To begin, let us discuss Medicare. In many circumstances, enrollment in Original Medicare (Part A) is automatic. If you are already receiving Social Security retirement payments and reach the age of 65, you will be automatically enrolled in Medicare. Additionally, you will be automatically registered after receiving SSDI benefits for 24 months. If you do not get retirement benefits, you may enroll for Part A coverage and immediately begin receiving benefits upon payment of the premiums. You can apply for Medicare online or by phone.

If you wish to postpone enrollment, you may do so during the annual Medicare open enrollment period. If you wait too long, you may be required to pay a late enrollment penalty in order to acquire coverage. Additionally, if you wish to apply for Part B, C, or D coverage, you should speak with your insurance company or agent about your alternatives. Due to the fact that these plans are operated by private companies, they each have their own enrollment and price policies.

You can apply for Medicaid either by contacting your state’s Medicaid office or by visiting Medicaid.gov. Your application will be reviewed by a caseworker who will ascertain your eligibility status. Generally, if you get SSI benefits, you are automatically eligible for Medicaid. The Affordable Care Act, which was passed into law in 2010, increased the number of people covered by Medicaid. Therefore, even if you have previously been denied coverage, you should consider reapplying because you may be authorized under the new guidelines.

FAQ

Are Medicare and Medicaid synonymous?

No, these are two unique and separate projects. Medicare is a federal program that supports older adults in obtaining healthcare coverage, whereas Medicaid is a joint federal-state program that assists low-income individuals and families.

Is Medicare A free program?

If you or your spouse have earned enough work credits, you or your spouse will receive free Medicare A coverage. If you lack sufficient job experience, you may choose to acquire this coverage.

Can you have Medicare and Medicaid at the same time?

Yes, you can be “dual eligible” for both programs. Individuals enrolled in both plans are often covered for the majority of medical services and experience low, if any, out-of-pocket costs.

Is there a penalty for failing to enroll in Medicare?

There is no penalty for not joining up, but there may be a penalty if you subsequently decide to sign up. If you miss your automatic enrollment period, you may still enroll during a subsequent enrollment period, but a late registration fee will apply.

How do I obtain a replacement for my Medicare card?

Obtaining a replacement Medicare card is straightforward. You can obtain one by logging onto your Medicare account at Medicare.gov, contacting the Social Security Administration, or visiting your local Social Security Administration office.

Conclusion

Terms associated with Medicare and Medicaid might be scary and perplexing to individuals unfamiliar with the programs. Many people believe that these two programs are interchangeable; nonetheless, they are extremely distinct. These programs vary in terms of cost, scope of coverage, eligibility criteria, and funding. It is even feasible for an individual to be eligible for and enrolled in both programs concurrently. Now that you are aware of the distinctions between these two programs, you can determine your eligibility and whether you should apply for one or both. Educating yourself about accessible programs is the first step in ensuring that you have enough health care coverage and are taking advantage of all available perks.

According to the US Census Bureau, nearly 10,000 Americans retire each day and join America’s Medicare system. The majority of Americans are familiar with Medicare and believe it is a complicated system. Indeed, comprehending Medicare does not have to be difficult.

If you’re ready to apply for Medicare, you’ve come to the right place! We’ve produced a list of some basic Medicare facts for you. Study these fundamentals immediately to ensure that you are primed and prepared to take advantage of the benefit for which you have toiled your entire career.

Understanding Medicare

Medicare is a program funded by the United States government that provides health coverage to Americans aged 65 and above. The Medicare health insurance program is financed in a variety of ways, including payroll deductions from US workers and federal budget funds.

Medicare was created by the US government in 1965 with the passage of Title XVIII of the Social Security Act. Medicare was created in response to the fact that seniors in those days were unable to obtain adequate health care regardless of their medical history or monthly income. Today, the Centers for Medicare & Medicaid Services (CMS) handles Medicare, which serves over 60 million Americans.

Occasionally, individuals confuse Medicare and Medicaid. Medicaid is a joint federal-state health insurance program that provides health care to low-income individuals of all ages.

Is Medicare Available to Everyone or Just Retired Seniors?

Medicare is not a service reserved for retired seniors. Medicare services are also available to younger persons with special disabilities or medical conditions.

When Should You Apply for Medicare and How Long Does It Take to Get Started?

When you reach the age of 65, you can enroll in Medicare during your birthday month. Additionally, you can enroll in Medicare three months before or after reaching the age of 65. Coverage under Medicare begins on the day you enroll.

If you delay enrolling in Medicare for an extended period of time, you risk having a gap in your health care coverage. Additionally, you risk paying late enrollment fees.

After enrolling in Medicare, you’ll get a membership card in the mail with your unique, individual Medicare Number. Your Medicare card will indicate the effective date of your coverage. When you come for your visits, present this card to your health care providers.

If you require assistance in replacing your card, log onto the CMS website. They’ll include instructions on how to print a replacement.

Medicare’s Operation

Medicare members have access to physicians, experts in health care, and hospitals that accept Medicare payments. Medicare is a “fee-for-service” scheme.

A “fee-for-service plan” indicates that the Medicare client pays a little price for each service up to a particular amount. Medicare picks up the slack.

What Types of Services Does Medicare Cover?

Medicare offers a variety of plans for various benefits, each of which is designated by a different letter. For instance, Medicare Part A covers the costs of hospitalization, certain nursing facility fees, and home health care. Medicare Part B covers doctor visits, diagnostic testing, and medical equipment costs.

Members of Medicare Part A are not required to pay any monthly premiums. Members of the Part B plan typically pay a monthly premium of $134. Premium charges are reduced for households earning between $170,000 and $85,000 per year.

Medicare Parts A and B are regarded as the foundational elements of the original Medicare program. These components are still available to any Medicare enrollee who qualifies.

Supplementary or “Gap” Insurance Plans

Members of Medicare may also elect to enroll in a system of additional or supplemental coverage known as Medigap insurance. There are eight Medigap plans available to supplement the coverage provided by Medicare Parts A and B. Each of these Medigap policies is designated by a letter: C, D, F, G, K, L, M, or N.

Certain Medicare beneficiaries confuse these Medigap Plans with the original Medicare Parts A and B coverage. You may hear people refer to these Medigap policies as “parts,” as in “Part A” or “Part B.” Original Medicare is referred to as “part,” whilst Medigap plans are referred to as “plans.”

Each of these programs assists members in defraying their own unique out-of-pocket health care expenses in addition to those covered by original Medicare Parts A and B. Several of these expenses include additional assistance with prescription medicine costs or medical fees incurred when traveling outside the United States. You should be prepared to properly read each of these supplemental plan details to ensure that you understand the charges that Medicare will cover for you.

Plan C and Plan D are two of the most popular supplemental plans. Plan C gap policies can assist cover other health care costs that we may overlook, such as dental or vision screening fees. Plan C may also cover charges not covered by original Medicare Parts A and B, such as routine hearing exams.

However, Plan C is slated to undergo considerable revisions. Beginning in 2020, new Medicare members will be unable to enroll in Plan C. Members of Medicare who enrolled prior to this year will remain eligible to participate in Plan C coverage. After that year, new Medicare members will be unable to do so.

Prior to 2006, Medicare enrollees were responsible for paying for their medicine prescriptions out of pocket. All of that changed with Plan D. Plan D can cover these prescription drug costs as well as a variety of routine vaccinations, such as flu shots, to stave off potential illness.

Medigap insurance cover only one person. If married partners wish to acquire Medigap coverage, they must do it separately. Medigap insurance can be purchased from insurance firms that are licensed to sell these products in your state.

Medicare Supplemental Insurance Plans

Medicare Advantage Plans are a more complete option than Medigap insurance. You can enroll in Medicare Advantage coverage through private insurance firms that have been approved by the Centers for Medicare and Medicaid Services (CMS). These firms could be preferred-provider organizations (PPOs) or health maintenance organizations (HMOs) (HMOs.)

Medigap vs. Medicare Advantage Plans: What Are the Differences?

The primary distinction between Medigap and Medicare Advantage plans is the method of payment. Members of Medigap pay for health care services as they are required. Members of Medicare Advantage pay monthly premiums (whether they use these health care services or not.)

Another distinction is the location of health care services available to members. Medigap policies permit policyholders to seek care from any facility or physician that accepts Medicare. Members of Medicare Advantage plans are restricted to the facilities and physicians covered by their specific PPO or HMO.

Consider the Following When Selecting Medigap or Medicare Advantage Plans

Medigap and Medicare Advantage plans may provide coverage tailored to specific health care requirements. If you’re unsure which type of coverage is ideal for you, the following are some factors to consider:

Frequent Travel Plans

If you want to travel extensively during your retirement, keep in mind your plan’s restrictions on where you can receive medical care in the event of an emergency. Medicare Advantage companies will limit members’ access to providers who are also members of its network. This may make obtaining health care services more difficult if you are traveling.

Medigap is not subject to these restrictions. Members of Medigap plans are not restricted to certain doctors or facilities as long as both accept all Medicare enrollees.

Preferences for Service Providers

Due to the fact that Medicare Advantage plans operate similarly to PPOs and HMOs, members are obliged to see specialists or physicians within their network. Medigap policies are accepted everywhere Medicare is accepted. As a result, members may consult with any physician of their choice.

Prescription Drugs

Medicare Advantage programs cover the entire cost of prescription drugs for their subscribers at no additional expense. Members with Medigap plans do not receive automatic prescription medication coverage. Members of Medigap must enroll in supplemental Plan D to receive this coverage.

Following Steps

Regardless of how close you are to retirement, understanding Medicare will assist you in making informed decisions about your future medical insurance coverage needs. Prepare for the day you reach that well-earned milestone.

Refer to the chart here for a comparison of Medicare supplement plans. It summarizes several of the benefits associated with each Medigap plan. Consult your retirement financial planner. They can assist you in planning the steps necessary to enroll in the health care coverage that is best for you when you achieve this significant life milestone.

Don’t forget to visit our website for additional information about Medicare and the Medicare claim procedure. We’re here to provide you with all the information you need to enjoy the benefit for which you’ve worked your whole career.