10,000 people turn 65 every day and understanding Medicare Eligibility and Medicare Enrollment is a challenge for every single one of them. That is why we are here to help. Here is how it works.
Medicare eligibility begins when you turn 65 years old if you are a U.S. citizen for at least five consecutive years. There are a few special situations where you can become eligible earlier with certain disabilities or health issues. If you meet these eligibility requirements, then you qualify for Medicare Parts A and B, automatically available and managed by the federal government. The initial Medicare enrollment period is available three months before, the month of, and three months after your birthday when you turn 65.
Medicare Parts A and B are considered to be “original Medicare” offered as a federal health insurance program. However, Parts A and B do not cover all of your healthcare costs. This is where you have the option to buy Medicare Supplemental Insurance, Medicare Part D, or Medicare Advantage from private companies to help cover additional healthcare costs.
Medicare Part A is provided by the federal government to pay for:
- Inpatient hospital stays
- Skilled nursing services
- Hospice care
- Certain blood transfusions
- Inpatient mental health
Most people do not pay premiums with Part A because they have paid into Social Security for at least 10 years. If you have not made contributions to Social Security or if you enroll in Medicare Part A late, your monthly premiums will be high. There are certain costs that come with Part A, such as:
- You pay a deductible before Part A starts paying costs for each hospital stay.
- If you stay in a hospital for longer than 60 days, you will pay a daily copay. The copay rises after 90 days in a hospital.
- If you stay in a skilled nursing facility for longer than 20 days, you pay a copay.
- There is a copay for outpatient prescription drugs received in hospice care.
- You pay coinsurance for inpatient respite care for hospice patients.
There is a possibility that multiple hospital stays mean multiple deductibles. There are other coverage limits for Medicare Part A, including:
- Hospital care outside of the U.S. (usually)
- Doctor services in the hospital
- Personal in-hospital costs (ie: custodial care)
- Prescription drug costs
- Additional Medicare benefits, such as hearing, dental, and vision
Medicare enrollment in Part A cannot be denied based on medical history or pre-existing conditions. To sign up for Medicare Part A, enrollment is automatic if you have been paying into Social Security. If you have not paid into Social Security, you can sign up at your local Social Security office.
Medicare Part B goes hand-in-hand with Medicare Part A and is provided by the federal government if you have been paying into Social Security at the time of Medicare eligibility. Medicare Part B pays for:
- Necessary doctor visits and services
- Outpatient hospital visits, mental health, physical therapy, occupational therapy, speech-language therapy
- Laboratory services
- Durable medical equipment including wheelchairs, oxygen tanks, etc.
- Some preventive care, diagnostic screenings, and skilled nursing
- Dental, vision, and hearing only in certain limited situations
For Medicare Part B, you will pay a monthly premium based on your yearly income. Joining after the initial enrollment period for Medicare Part B can make your monthly premium higher. If you receive Social Security, it will be deducted automatically from your Social Security benefits. Other costs associated with Medicare Part B include:
- A deductible paid for the year before Medicare Part B starts paying a share of your costs.
- A copay for outpatient hospital visits.
- Coinsurance after a deductible is paid. Part B covers 80% of the Medicare-approved coinsurance and you pay 20%, generally speaking.
There is no maximum out of pocket for Medicare Part B. There are some coverage limits depending on each situation. Care outside the U.S. is not usually covered.
Certain things, like the amount Part B will pay for occupational therapy or depending on when you get a screening, may not be covered. There are often excess charges that Part B will not cover.
To sign up for Medicare Part B, you can enroll as soon as you are eligible or certain times of the year during open enrollment. There may be a penalty if you do not enroll at the time of Medicare eligibility. Enrollment is usually automatic, or you can sign up at your local Social Security office. Medicare Part B cannot be denied because of your medical history or pre-existing conditions if you already have eligibility for Medicare.
Medicare Parts A and B do not cover many things, including deductibles, coinsurance, premiums, and excess charges from Part B, prescription drug coverage, vision, hearing, and dental. This is where additional Medicare coverage plans offered by private Medicare providers come into play. You have two main options when it comes to additional Medicare plans for coverage.
Medicare Supplemental Insurance which covers some or all of the costs that are not covered by Parts A & B and/or Medicare Part D which covers prescription drug costs.
Medicare Advantage, also known as Medicare Part C, which combines Parts A & B to provide additional benefits. Most Part C plans cover prescription drug costs, dental, vision, hearing, fitness benefits , over the counter benefits and much more.
BAC Associates, LLC provides these Medicare plans through the many Medicare providers we work with. Our personalized service and face-to-face consultations ensure we will find the perfect plan that meets your needs.
“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”