Medicare

MEDICARE ELIGIBILITY AND PREMIUM ESTIMATOR
What is Medicare?

Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare too, including those with disabilities and those who have permanent kidney failure.

The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. You have choices for how you get Medicare coverage. If you choose to have Original Medicare (Part A and Part B) coverage, you can buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company.

Parts of Medicare

Social Security enrolls you in Original Medicare (Part A and Part B).

  • Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care.
  • Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.

Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.

  • Supplemental (Medigap) policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
  • Medicare Advantage Plan (previously known as Part C) includes all benefits and services covered under Part A and Part B — prescription drugs and additional benefits such as vision, hearing, and dental — bundled together in one plan.
  • Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs.
Who Are Eligible?
  • Age 65 or older
  • Under 65 with certain disabilities
  • Any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant).

Most people age 65 or older are eligible for free Medical hospital insurance (Part A) if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read Medicare Premiums: Rules For Higher-Income Beneficiaries.

How Do I Apply?

There are several ways to enroll in Medicare:

When Should I Sign Up for Part A and B?

If you’re eligible at age 65, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday. If you are eligible for premium-free Part A as most people are, it is your advantage to enroll in Part A as early as possible. For Part B, you must pay a premium, and, therefore, you can delay enrollment. But you may have to pay penalty for late enrollment unless you qualify for a “Special Enrollment Period” (SEP). See the next section for detailed explanation.

If you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a “general enrollment period” from January 1 through March 31. Your coverage begins on July 1 of the year you enroll. If you have a Health Savings Account (HSA) or health insurance based on current employment, you may want to ask your personnel office or insurance company how signing up for Medicare will affect you.

Special Enrollment Period (SEP)

If you have medical insurance coverage under a group health plan based on your or your spouse’s current employment, you may not need to apply for Medicare Part B at age 65. You may qualify for a “Special Enrollment Period” (SEP) that will let you sign up for Part B during:

  • Any month you remain covered under the group health plan and you or your spouse’s employment continues.
  • The 8-month period that begins with the month after your group health plan coverage or the employment it is based on ends, whichever comes first.
Do I Pay Penalty for Late Enrollment in Part A or Part B?

Part A late enrollment penalty

Some people have to buy Part A because they don’t qualify for premium-free Part A. If you have to buy Part A, and you don’t buy it when you’re first eligible for Medicare, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you didn’t sign up.

Example

If you were eligible for Part A for 2 years but didn’t sign up, you’ll have to pay the higher premium for 4 years. Usually, you don’t have to pay a penalty if you meet certain conditions that allow you to sign up for Part A during a Special Enrollment Period.

Part B late enrollment penalty

If you didn’t get Part B when you’re first eligible, your monthly premium may go up 10% for each 12-month period you could’ve had Part B, but didn’t sign up. In most cases, you’ll have to pay this penalty each time you pay your premiums, for as long as you have Part B. And, the penalty increases the longer you go without Part B coverage. Usually, you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period. Read more about different situations that may affect when you decide to get Part B.

If you have limited income and resources, your state may help you pay for Part A, and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.

Example

Your Initial Enrollment Period ended December 2018. You waited to sign up for Part B until March 2021 during the General Enrollment Period. Your coverage starts July 1, 2021. Your Part B premium penalty is 20% of the standard premium, and you’ll have to pay this penalty for as long as you have Part B. (Even though you weren’t covered a total of 27 months, this included only 2 full 12-month periods.)

Medicare Advantage & Medicare Drug Plan Enrollment Periods

You may find the detailed information clicking the following link:
https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf

You can replace your Medicare card in one of the following ways if it was lost, stolen, or destroyed:

  • Log into your my Social Security account and request one.
  • Call 1-800-MEDICARE (633-4227)
  • Request a replacement Medicare card online.
  • Call or visit your local Social Security Administration office.
Medicare Cards

To help protect your identity, your Medicare card has a Medicare number that’s unique to you. If you did not receive your red, white, and blue Medicare card, there may be something that needs to be corrected, like your mailing address. You can update your mailing address by signing in to or creating your my Social Security account. Learn more about

Already Enrolled in Medicare

If you have Medicare, you can get information and services online. Find out how to Manage your benefits.

If you are enrolled in Medicare Part A and you want to enroll in Part B, you need to complete form CMS-40B, Application for Enrollment in Medicare – Part B (medical insurance). If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information. You can use one of the following options to submit your enrollment request under the Special Enrollment Period:

You can use one of the following options to submit your enrollment request under the Special Enrollment Period:

Note: When completing the forms CMS-40B and CMS-L564

  • State “I want Part B coverage to begin (MM/YY)” in the remarks section of the CMS-40B form or online application.
  • If possible, your employer should complete Section B.
  • If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employer’s signature and submit

one of the following forms of secondary evidence:

  • Income tax form that shows health insurance premiums paid.
  • W-2s reflecting pre-tax medical contributions.
  • Pay stubs that reflect health insurance premium deductions.
  • Health insurance cards with a policy effective date.
  • Explanations of benefits paid by the GHP or LGHP.
  • Statements or receipts that reflect payment of health insurance premiums.

You’ll have Original Medicare (Part A and Part B) unless you make another choice. You can decide to add a drug plan (Part D) or buy a Medigap policy to help pay for costs that Original Medicare doesn’t cover. You can choose to join a Medicare Advantage Plan (Part C) and get all your Medicare coverage (including drugs and extra benefits like vision, hearing, dental, and more) bundled together in one plan.

Some people with limited resources and income may also be able to get Extra Help to pay for Part D drug costs.

What Happens After I Apply?

The Centers for Medicare & Medicaid Services (CMS) manages Medicare. After you are enrolled, they will send you a Welcome to Medicare packet in the mail with your Medicare card. You will also receive the Medicare & You handbook, with important information about your Medicare coverage choices.

What Is a Medicare Broker and Why Should You Consider Talking to One?*
What is a Medicare broker?

A Medicare broker is an advisor who represents multiple insurance companies and can help you evaluate plan options, along with helping you enroll into a plan.

What is the difference between SHIPs (State Health Insurance Assistance Programs) and Medicare brokers?

SHIPs are funded by the federal government to provide free, local, objective insurance counseling and assistance for people to review Medicare coverage and plans. Unlike a broker, a SHIP counselor cannot actively enroll you into a Medicare health or drug plan. SHIPs can also help you find out about financial assistance programs you or your loved one might be eligible for.

Why should I work with a Medicare broker?

The Medicare process can be overwhelming. A licensed Medicare broker will listen to you and give you information about your coverage options that is based on your needs and preferences. Working with a trained broker can help you save time and money, ultimately helping you find the right plan.

How are Medicare brokers paid?

Typically, brokers are paid by the insurance companies they represent, with no extra fee or cost to you for enrolling in Medicare through a broker. Brokers are NOT compensated based on which product you choose. Their goal is to educate you on the plan(s) that best meet your needs. Because they aren’t paid based on the plan you choose, they won’t try to pressure you to purchase a specific Medicare plan.

How do I connect with a trustworthy Medicare broker?

You may find a list of local Medicare brokers for all 50 states here.

*This information is extracted from www.ncoa.org.

MEDICARE BROKER INFO