If you are soon to turn 65, it’s time to enroll in Medicare! For many, the enrollment process is actually automatic. Even so, Medicare will remain important for the rest of your life so it is crucial that you understand eligibility, coverage, and, of course, costs!
When you enroll in Medicare, you enroll in Medicare Part A & Medicare Part B (also known as Original Medicare).
Once I Enroll in Medicare, What Does Part A Cover?
Medicare Part A covers your hospital insurance. It will help cover:
- Inpatient care in a hospital
- Nursing facility care
- Nursing home care
- Hospice care
- Home Health Care
Once I Enroll in Medicare, What Does Part B Cover?
Medicare Part B helps to cover your outpatient insurance. These are namely medically necessary services and preventative services. Medicare Part B will help cover:
- Doctors visits
- Mental health services
- Outpatient surgery
- Ambulance services
- Durable medical equipment, like wheelchairs or walkers
- Limited outpatient prescription drugs such as:
- Injections you get in a doctor’s office
- Certain oral cancer drugs
- Drugs used with some types of durable medical equipment—like a nebulizer
- Clinical research such as limited drugs, procedures, and services
Basically, Medicare will cover the basic medical care needed for the treatment that the clinical trial is studying.
What is NOT Covered By Original Medicare?
Medicare parts A & B do not cover coinsurance, copayments, or deductibles. These costs can stack up so you may want to consider supplementing your coverage. We recommend that you enroll in a Medicare supplement plan (also known as Medigap) or Medicare Advantage. Additionally, Medicare parts A & B do not cover long-term care, dental, vision, or hearing. Coverage for all of these items is available separately.
Am I Eligible to Enroll in Medicare?
So, how do you know if you are eligible for Medicare? Most people approach retirement knowing that they will be enrolling in Medicare. In fact, you may be automatically enrolled without you having to do a thing!
You are eligible for Medicare benefits if:
- You are over 65 and a U.S. citizen or permanent legal resident who has lived in the United States for at least five years
- You are receiving social security or railroad retirement benefits. You are also eligible if have worked long enough (40 quarters) to be eligible for benefits even if you are not collecting them yet
- You (or your spouse) is a government employee or retiree who has not paid into social security, but who has paid into Medicare payroll taxes while working (meaning a Medicare-covered job)
If you are under 65, you are eligible for Medicare Parts A & B benefits if:
- You have received social security benefits for at least 24 months. These months do not have to be consecutive. There can be breaks in between, but it must be at least 24 months total.
- You have ALS
- You have end-stage renal disease
Once I Enroll in Medicare, How Much Does It Cost?
It’s important to note, that for many people, Medicare Part A has no monthly premium. However, if you have not worked at least 40 quarters, you can pay a monthly premium. Currently (in 2020), this may be up to $458. However, it may be less dependent upon your specific circumstances. If you are currently working, once you have reached the 40 quarters, you will no longer be charged these monthly premiums.
The monthly premium for Medicare Part B is based on your income.
How Do I Enroll in Medicare?
Now let’s discuss exactly how to enroll in Medicare Parts A & B. If you are receiving social security benefits, you will automatically be enrolled. You will receive your card in the mail three months before your 65th birthday. If you are eligible for Medicare through disability, you will be automatically enrolled and sent your card on the 25th month of your disability benefits.
If you are not automatically enrolled, you will need to contact your social security office at 800-772-1213 or www.ssa.gov.
Also, if you are a resident of Puerto Rico, Medicare Part A enrollment is automatic, but not Part B. To sign up for Medicare Part B, you will need form CMS-40B (click here for English, click here for Spanish). Anyone signing up for Medicare B will need this form. Additionally, if you are a US resident currently living abroad, you will need to head to your nearest social security office, consulate or embassy. In most cases, Original Medicare will only cover your medical care while you are in the United States.
What If I Want to Defer?
Should you decide that you do not want part B at that time, follow the instructions on the card. If you keep the card, you will keep Part B and, unfortunately, you will have to pay for it! For those wishing to defer Part B, it is very important that you make sure to re-enroll in Part B within eight months of the termination of employment-based health coverage. If you miss this deadline, you will incur a late enrollment penalty. This is not a one-time fee, but rather it is tacked on to your monthly premiums forever. You certainly don’t want to be paying more for no reason, so plan ahead!
For any additional questions, please feel free to call iHealthBrokers at (888) 918-0518 or schedule a call today! For more info, please check out our youtube video below!
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.