Medicare is a federally funded national healthcare program. The program was established by Congress in 1965 as part of amendments to the Social Security Act. This is to provide coverage to people 65 years and above who did not have health insurance. Currently, this program is managed by the Centers for Medicare and Medicaid Services (CMS). It includes people with certain disabilities, as well as those with end-stage renal disease and amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
Medicare is divided into four sections. Each of these provides different types of services to the insured. They are Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D.
Eligibility is determined by a number of factors. However, anyone who has lived legally in the United States for at least five years and is 65 or older is eligible for Medicare coverage. Anyone receiving Social Security benefits is automatically enrolled in Parts A and B. Individuals can enroll in Part D coverage, which is optional.
Things to Know Before Signing up for Medicare?
Before signing up for Medicare, you should be aware of a number of details and factors.
Knowing these details will assist you in your Medicare journey.
1. You Can Choose Your Hospital
Before signing up, it’s important to know this fact. Once you are eligible, you can choose your own doctors and hospitals as long as they recognize Medicare payments. Finding a doctor shouldn’t be hard. A simple Google search on Primary Care doctors near me can give you a lot of options.
However, it’s important to choose a hospital that can care for your needs. If you have a special condition, then you should be more intentional in choosing the right doctor. Make the most of your doctor’s appointments to understand your condition and health care needs.
2. Missing Major Deadlines May Result in Additional Costs
You have a seven-month “initial enrollment period” if you intend to enroll in Medicare as soon as you turn 65 and become eligible. This period begins three months before your 65th birthday and ends three months after it.
You have eight months to enroll after your employer plan expires if you delayed enrolling at age 65 because you continued to work and your coverage met Medicare requirements.
No matter what enrollment regulations apply to you, missing the deadline to enroll in Part B could result in a permanent late enrollment penalty. You will be required to pay 10% of the standard Part B monthly premium for each full year that you should have been enrolled in but weren’t.
Moreover, if you miss the deadline, there is a late enrollment fee for Part D as well. You get the same seven months for Part D as you do for Part B if you enroll during your initial enrollment window at age 65. In contrast, if you miss that deadline and your employer-provided coverage is about to expire, you have two months to sign up for Part D. It could be as a stand-alone policy or through an Advantage Plan.
Each month you should have Part D coverage or other creditable coverage. But if you don’t, you will be penalized 1% of the national base premium.
3. Medicare Coverage for People With Disabilities
Medicare is available to certain disabled people under the age of 65. These people must have been receiving Social Security Disability benefits for at least 24 months. Or they must have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis.
After a beneficiary is determined to be disabled, there is a five-month waiting period before they can begin receiving Social Security Disability benefits. In contrast to other causes of disability, people with ESRD and ALS do not have to claim benefits for 24 months in order to be eligible for Medicare.
The following are the Medicare eligibility requirements for people with ESRD and ALS:
- ESRD – Usually 3 months after starting regular dialysis or after a kidney transplant.
- ALS – Immediately after receiving Social Security Disability benefits.
People who meet all of the Social Security Disability criteria are usually automatically enrolled in Parts A and B. People who meet the eligibility requirements but do not qualify for Social Security benefits can purchase Medicare. They’ll have to be paying a monthly Part A premium in addition to a monthly Part B premium.
Moreover, people who qualify for Medicare based on disability have the same coverage as those who qualify based on age. The full range of Medicare benefits is available to those who are eligible. When finding a doctor, note that certain hospitals, nursing homes, home health, physician, and community-based services are included. To be covered, health care services do not need to be related to the individual’s disability.
4. It’s not Totally Free
Many people have paid [income] taxes throughout their working careers. They’ll be disappointed if they think that Medicare would be “paid up” by the time they turn 65.
If you have at least a 10-year work history of paying payroll taxes into the system, you are eligible for premium-free Part A. If not, your monthly premiums in 2022 could reach $499, depending on whether you’ve contributed any taxes to the Medicare system.
Even spouses who have never worked may be qualified for Part A without having to pay a premium. The initial 60 days of inpatient hospital care during a benefit period are also subject to a $1,566 Part A deductible. Also, beneficiaries pay $389 per day for the 61st through 90th days. Then they’ll pay $778 per day for the final 60 “lifetime reserve” days.
Medicare Part B’s standard monthly premium is $170.10. However, income-adjusted surcharges make some beneficiaries pay more. When deciding whether you will have to pay more, the government looks at your tax return from two years prior. However, the Social Security Administration has a form you can fill out to request a reduction in that income-related amount. This is because of a life-changing event like retirement.
The deductible for Medicare Part B is $233 in 2022. Once that is achieved, beneficiaries typically pay 20% of the cost of covered services. The specific details of the coverage determine the Part D premiums, deductibles, and copays. The Centers for Medicare & Medicaid Services estimate that the average premium this year is about $32. Additionally, just like with Part B, IRMAAs add an additional fee for higher earners.
5. Set up a safe Medicare account
You can always access your information. In addition:
- To better compare health and drug plans in your area, add your prescriptions.
- As soon as your Original Medicare claims are processed, you can view them.
- Make a printout of your valid Medicare card.
- Examine a list of the preventive services that Original Medicare entitles you to.
- If you receive a bill from Medicare, familiarize yourself with your premiums and pay them online.
- To register, you’ll need your Medicare Number. If you don’t yet have a Medicare card, you can access your Medicare Number by logging into your secure Social Security account.
- If you sign up for a Medicare drug or health plan, your plan might provide an online account to monitor your claims.
Medicare began as a basic insurance program for Americans without health insurance. However, they have evolved over time to give an increasing number of Americans access to the high-quality, reasonably priced health care they require. Nevertheless, there are certain details you must understand before signing up for Medicare.