Familiarizing yourself with the basics of how Medicare works, will better prepare you to be able to manage your health care expenses.
Medicare is a government health care program designed for people aged 65 and over or those with qualifying disabilities under the age of 65. Medicare provides coverage for most medical procedures and services to include hospital and skilled nursing but has many large gaps that can run havoc over an unprepared beneficiary who has no additional coverage.
Here is some basic information you should know about the Medicare program.
What is Medicare?
As stated before, Medicare is a public health care program that is administered by the federal government. It offers health care benefits to the senior demographic as well as those who have Social Security Disability. It has been reported that 94% of all doctors accept Medicare patients, however only 74% are accepting new patients. Medicare receives high marks from beneficiaries who understand how their insurance benefits work and what their financial responsibilities are when using their coverage.
Who Qualifies For Medicare Benefits?
To qualify for Medicare benefits, you must be a U.S. citizen, or permanent legal resident of the United States for a minimum of five years. Those who have been receiving Social Security or Railroad Disability for a minimum of 2 years and under age 65 would also qualify for Medicare beginning the 25th month of receiving Social Security Disability payments. Individuals who have not paid into Medicare for 10 years or more may be eligible if their spouses have earned enough Medicare credits. This is a common way for stay-at-home Moms and Dads to become Medicare eligible. Dependent children over the age of 18 may qualify for Medicare under a parent or legal guardian’s contributions.
Those who have not earned enough Part A Medicare credits to meet requirements for free premium can buy Medicare Part A. In 2021, Medicare Part A premium will either be $259 or $471 each month depending on how many years the applicant or their spouse worked and paid into Medicare. Medicare Part B Medical coverage is voluntary, and you have an option to purchase Medical Part B even if you would decide to forgo Medicare Part A purchase. Government employees and spouses who are under Medicare contracts are also eligible.
Immediate Medicare eligibility occurs when an individual under age 65 has been diagnosed with either (ESRD) End Stage Renal Disease (kidney dialysis or transplant) or (ALS) Amyotrophic Lateral Sclerosis commonly known as Lou Gehrig’s Disease.
If a person is eligible for Medicare and elects not to purchase Medicare Part B or a Medicare Part D Drug plan, they may be subject to a late enrollment fee when deciding they have a need for this coverage. Having continuous creditable group health insurance coverage from an employer will exempt one from the late enrollment fees when purchasing Medicare Part B or a Medicare Part D drug plan. Veteran’s benefits are considered creditable coverage for Medicare Part D drug plan, however, do not provide an exemption from the Medicare Part B late enrollment fees.
To determine whether you are qualified to receive Medicare benefits go to medicare.gov/eligibilitypremiumcalc or it may be just as easy to give us a call; we would love to help assist you in any way we can.
How Can I Enroll In Medicare?
Social Security administers Medicare enrollments among other things for the Centers for Medicare and Medicaid Services. If you are receiving early Social Security Retirement benefits prior to age 65 you will have an automatic enrollment into Medicare Part A and Part B upon your 65th birthday. You should receive your red, white, and blue Medicare card approximately 3 months prior to your 65th birthday.
However, most eligible Medicare beneficiaries will need to be proactive and enroll in Medicare no earlier than 90 days prior to your Medicare start date. Medicare effective date is normally the first day of the month you were born in.
Example: Birthday, November 20, 1956, your Medicare effective date would be November 1st of that year you turn 65 or in this case 2021. Please be aware if your birthday begins on the first day of the month your effective date is forwarded 1 month.
Example: Birth Date 02/01/1957, your Medicare eligibility date is one month prior beginning on January 1st.
There are three ways to enroll in Medicare.
- Call your local Social Security office to set up an in-person appointment. Use the Social Security Office Locator.
- Call National Social Security Administration set up phone appointment 1-800-772-1213
- Go online and register than apply for Medicare benefits at Apply for Benefits, Social Security (ssa.gov)
Please do not wait until the last minute to apply for Medicare as it will take a couple weeks for a scheduled appointment and another two or three weeks to get your card. Many Medicare supplemental plans and Medicare Advantage plans will not enroll you until you have a verified Medicare Identification Number.
Contributions in the form of Medicare taxes paid over a 10-year period will entitle you and your spouse Medicare Part A Hospital insurance at no premium cost. If you have not paid into Medicare for a minimum of 10 years, Part A can be purchased for a monthly premium of $471 (2021 tax year) may be less, depending how many years you paid into Medicare.
Medicare Part B Medical insurance has a premium that must be paid by each person enrolled. The premium in 2021 starts at $148.50 and monthly premiums increase when individual income reaches $88,000 and household joint income reaches $176,000. There are several levels of adjustments based on different levels of income earned. The income is determined by the last two years of adjusted gross income.
CMS announces in December /January of each year the new Medicare Part A and Part B coverage terms and premiums to include Part B IRMA – Income Related Monthly Adjustment Amounts for those who have higher incomes. See 2021 Medicare Parts A & B Premiums and Deductibles | CMS
Low-income beneficiaries can have their Medicare Part B premium paid for through the Medicare Savings Program and participate with Medicaid as a SLMB, Specified Low Income Medicare Beneficiary. State Medicaid programs pay this premium when income and assets meet Federal Medicare & Medicaid guidelines. In 2021, a single person’s gross income must be $1308 or less with liquid assets; cash, checking, savings, stocks, bonds IRA 401Ks CD’s cash value life insurance etc. $7970 or below. Married couple’s gross income must be $1762 or less with $11,960 maximum liquid assets.
We have helped hundreds of Medicare beneficiaries enroll in state Medicaid since 2006 and we would love to see if we can help assist you too. Give Larry Klein a call today.
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If you are eligible, now is the best time to enroll in Medicare. Get in touch with a talented insurance agent like Larry Klein to get started with a free consultation.
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For more information about your coverage options in Iowa and across the Nation, reach out to Larry Klein of Iowa Medicare Group today!