What is Medicare?
Medicare is a health insurance program administered by the Federal Government. Medicare beneficiaries can opt for either an Original Medicare policy or a Medicare Advantage Plan. Original Medicare usually refers to Medicare Part A and Medicare Part B.
Medicare Part A covers inpatient hospital stays, short-term skilled nursing facility care, certain medically necessary home health care services, and hospice care. Typically, Medicare enrollment in Part A is automatic for those who reach the Medicare eligibility age. The federal government provides Medicare Part A to most Medicare beneficiaries for free. Medicare Part B covers visits to the doctor, outpatient medical and surgical services, diagnostic tests, clinical laboratory services, durable medical equipment, certain medically necessary home health care services, outpatient hospital services, and certain preventative services. Medicare beneficiaries who reach the Medicare eligibility age or who are eligible for another reason must choose whether they want to enroll in Medicare Part B. Medicare Part B requires a monthly premium that runs around $100 per month for most beneficiaries.
A Medicare Advantage Plan is also known as Medicare Part C. Medicare Advantage Plans offer combined Medicare Part A and Part B coverage through private companies that are under contract with Medicare. Health Maintenance Organization (HMO) plans are the most common type of Medicare Advantage Plans, but other options are available. Generally, anyone who meets the Medicare eligibility requirements can enroll in a Medicare Advantage Plan. Additional options include: Preferred Provider Organization (PPO) plans, Private Fee-for-Services (PFFS) plans, and Special Needs Plans (SNP). Medicare enrollment in a Medicare Advantage Plan typically requires payment of a monthly premium in addition to the Medicare Part B premium. However, some Medicare Advantage Plans will pay the Medicare Part B premiums of any beneficiary enrolled in the plan.
Medicare Part D is a prescription drug plan that is offered through private companies that are under contract with Medicare. An additional monthly premium is typically required for Medicare Part D coverage. Medicare enrollment in Part D can be obtained as a supplement to an Original Medicare plan, as a supplement to a Medicare Advantage Plan, or as part of a Medicare Advantage Plan. Medicare Advantage Plans that include prescription drug benefits are often referred to as MA-PD plans. Approximately 80% of Medicare Advantage Plans include prescription drug coverage. Medicare eligibility requirements are the same for Part D as for any other Medicare policy.
Who can enroll?
Anyone who meets the Medicare eligibility requirements can enroll in a Medicare plan. Medicare eligibility is determined primarily by age, but can be determined by disability or diagnosis under certain circumstances. In general, you are eligible for Medicare enrollment if you are a U.S. citizen or permanent resident of the United States and have worked (or have a spouse who has worked) for at least 10 years in Medicare-covered employment. In addition, you must either:
- Be over the age of 65
- Be under the age of 65 with a particular disability, or
- Have been diagnosed with End-Stage Renal Disease (i.e. kidney failure).
How do you apply?
Most people receive automatic Medicare enrollment in Part A, Part B, or both once they reach their 65th birthday. If you receive retirement benefits from the Social Security Administration or the RRB, you will almost certainly be automatically enrolled in Medicare Parts A and B on the first day of the month in which you turn 65. Automatic enrollment will also occur on the first day of the 25th month you receive disability payments, if you collect disability benefits from either the SSA or the RRB. Under Medicare guidelines, you may also be automatically enrolled if you receive a diagnosis of Lou Gehrig’s disease.
If you wish to enroll in Medicare, and were not automatically enrolled, you should plan to complete your Medicare application during your Initial Enrollment Period in order to avoid late enrollment penalties. Your Initial Enrollment Period refers to the seven-month period surrounding the month you turn 65. This includes the three months prior to your 65th birthday, the month of your birthday, and the three months after your 65th birthday.
If you are automatically enrolled in Medicare Parts A and B, and you do not wish to keep the Part B Medicare policy, you will need to notify Medicare immediately. Failure to do so may result in a monthly bill for premiums.
If you want to apply for Medicare and your Initial Enrollment Period has already passed, you will need to wait until either the General Medicare Enrollment Period or until you qualify for a Special Enrollment Period. The General Enrollment Period runs from Jan. 1 through March 31 of every year. During this time, you complete a Medicare application to enroll in Medicare Parts A and/or B. Your coverage would then begin on July 1 of that year. Under Medicare guidelines, you may be eligible to enroll during a Special Enrollment Period if you (or your spouse) lose your healthcare coverage through your employer or union. During the Special Enrollment Period you can enroll in both Part A and Part B without penalty.
For assistance determining your Medicare eligibility or for help with Medicare enrollment, contact your local social security office. For information on the medicare supplement plans available with Benefit Link, Call 866-630-0626 ext 108.