The basics of Medicare eligibility are simple. First, you must be a United States citizen or a permanent, legal resident for at least five years. Second, you must meet at least one of the following criteria:
- Be age 65 or older and eligible for Social Security; or
- Be permanently disabled and receive Social Security disability insurance benefits for at least two years; or
- Have End-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD) and require dialysis treatment or a kidney transplant; or
- Have Lou Gehrig’s Disease (Amyotrophic Lateral Sclerosis).
Most people are automatically enrolled in Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. (hospital insurance) as soon as they meet the eligibility requirement. Most people are not required to pay a monthly A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. for Medicare Part A. As long as you or your spouse paid Medicare taxes while working for a minimum of 10 years, you’re covered. If you did not pay your fair share of taxes, you will be required to pay a monthly premium, up to $499.
Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. (medicare insurance) is different. Most seniors turning 65 will get their Medicare Part B automatically, and most pay the full Part B premium. If you live in a U.S. territory, or if you qualify for any reason other than age, enrollment is not automatic. The Part B premium changes each year. Seniors earning up to medicare_costs value=”irmaa-single-t1″] per year pay $170.10 per month. High-income earners pay more, up to $578.30 per month.
In all cases, you must enroll in Medicare Part B as soon as you become eligible. Your reason for qualifying determines when you are required to enroll. The The General Enrollment Period (GEP) allows beneficiaries to enroll in Medicare Part A and Part B from January 1 to March 31 if they missed their Initial Enrollment Period. Beneficiaries can also enroll in a... is 1 January through 31 March. Your Individual Enrollment Period is within two months (before or after) of the qualifying event (e.g., your 65th birthday or 25th month receiving Social Security benefits).
If you fail to enroll in Medicare Part B when you are first eligible, you may be asked to pay a penalty equal to 10 percent of the premium for each 12-month period you were not enrolled. Some exceptions apply, including credible insurance through an employer.
As you likely already know, Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. — that’s your Medicare Part A and Part B combined — does not pay for 100 percent of your healthcare needs. In fact, it only pays for a little less than 80 percent of the health benefits that it does cover, and it does not cover prescriptions, hearing, vision, or dental insurance.
To pay for some or most of the fees, A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., and coinsurances not covered by Medicare, many seniors buy a supplemental policy called a Medigap plan (aka, “Medicare Supplement“). A Medigap plan can’t offer additional health benefits, but it will shield you from the liability of high health care costs, should you become hospitalized or critically ill for an extended period.
The key to a Medigap plan is your Guaranteed-issue is a right granted to Medicare beneficiaries and applies to Medicare Supplement insurance (aka, Medigap plans). All states and the federal government enforce this essential right, which protects Medicare beneficiaries from medical underwriting.. You have a six-month window when you are first eligible for Medicare Part A and B to buy a Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. plan without underwriting. In other words, the insurer of your choice can’t turn you down, regardless of preexisting conditions. If you miss your guaranteed issue right window, you can be turned down and your monthly premium will likely be higher.
Medicare Advantage (Part C) Eligibility
Medicare Advantage (Part C) is the private health plan alternative to Medicare Part A and Part B private fee for service health insurance. To qualify for Medicare Part C is Medicare's private health plan option. Also known as Medicare Advantage, Medicare Part C plans are a type of Medicare health plan offered by companies that contract with Medicare to provide all... enrollment you must be enrolled in Medicare Parts A and B. You can buy a Medicare Advantage plan through Medicare.gov or through a qualified Medicare insurance agent.
With Medicare Part C coverage, you don’t need and can’t buy a Medigap policy. That’s because Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). typically cover more than Original Medicare. When you buy a Part C plan you are dis-enrolled from Medicare Part A and B.
Medicare Part C is optional coverage. You are not penalized for not signing up, and you can switch back and forth between Part C and Original Medicare annually.
Coverage, deductible, copays, and Coinsurance is a percentage of the total you are required to pay for a medical service. vary by the insurance carrier and specific plan, so you must do your homework. Most counties with Medicare Advantage plans have at least on $0 or low-cost plan. However, be aware that these plans typically have a high deductible or high copays, so make sure it’s in alignment with your true health needs.
Also, be aware that the Medicare Advantage plan premium is above and beyond your Part B premium. The Social Security Administration will continue to deduct your Part B premium from your Social Security check each month. So, if you choose a Part C plan that has a $74 premium, and your Part B premium is $104.90 (2013 rate), then your actual monthly payment for the health plan is $178.90 per month.
Medicare Part D Eligibility
Medicare Part D covers your prescription medications. Like Medicare Advantage plans, Part D is an optional coverage that’s available through private insurers, and you must already have Medicare Parts A and B to qualify. Also, Part D plans are regional. That means you must be living in a plan’s service area to enroll.
Even though Medicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... is optional, Medicare can penalize you if you don’t enroll when first eligible and then want to enroll later. The only In a Medicare Part D plan, an exception is a type of prescription drug coverage determination. You must request an exception, and your doctor must send a supporting statement explaining the medical reason for the... is if you have credible prescription drug coverage through another group plan, such as your employer’s health coverage. You will have to pay this penalty for as long as you have a Medicare Part D plan.
If you have a Medigap plan you can enroll in a Part D plan. These two types of insurance policies are completely compatible.
Individuals with low income can qualify for Social Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... with Medicare prescription drug costs through the Social Security Administration. If you qualify, Extra Help will cover some or all of the costs for your Part D copays, coinsurance, deductibles, and all or most of your monthly premium.