What is Medicare?
Medicare is a social insurance program for people who are 65 or older and certain younger people with permanent disabilities. Additionally, people with end-stage renal disease, ALS (also called Lou Gehrig’s disease), and those receiving railroad retirement benefits are qualified for Medicare coverage. Knowing the various Medicare eligibility criteria is essential in forecasting your eligibility for the program and making informed enrollment decisions.
Medicare should not be mistaken for Medicaid because it is not a welfare program. Medicare beneficiaries’ income and assets are not considered while assessing their enrollment or benefits. Medicare is a federally funded program; therefore, state-by-state variations in its operations should be minimal.
Medicare Eligibility and Enrollment
A few folks automatically receive Medicare Part A (hospital insurance) and Part B (medical insurance), whereas others must enroll.
Individuals currently receiving Social Security benefits (retirement or disability) and residing in the United States and U.S. Territories (excluding Puerto Rico) are automatically enrolled in Parts A and B when eligible. These individuals will receive a packet of details a few months before turning 65 or receiving their 25th month of Social Security Disability or Railroad Retirement Board (RRB) funds. At that point, individuals will have the option of keeping or rejecting Part B, but they will not be able to reject Part A until they withdraw their initial application for Social Security and repay all Cash Benefits received.
There is no automatic enrollment into Medicare for those who have not started receiving Social Security benefits or are not qualified for Social Security Retirement. They need to call Social Security to enroll. Individuals who have Part A and reside in Puerto Rico or another country must fill out an Application for Enrollment in Part B to enroll in Part B.
When to Enrolling in Medicare
Any time after becoming first eligible for Medicare during the Initial Enrollment Period https://clearmatchmedicare.com/blog/medicare/medicare-enrollment, a person who qualifies for free Part A due to age may enroll in it (IEP). If the applicant or their family paid Medicare taxes while working, they could be qualified for Part A with no monthly fee. When someone applies for free Part A coverage, it must be no earlier than the first month after they qualify for Medicare. However, coverage for Part A does not start earlier than that.
Nevertheless, the law only permits fixed periods for premium-Part A (hospital insurance) and Part B (medical insurance) membership:
The initial Enrollment Period (IFP) – is a seven-month window when a person initially qualifies for Medicare. If a person is qualified owing to age, the eligibility period starts three months before their 65th birthday includes that month and ends three months after their 65th birthday. For persons receiving disability benefits, this time frame starts three months before the 25th month of benefits, includes the 25th month and concludes three months later. In accordance with the law, the commencement of cover can be put off for up to three months based on the month in which the individual enrolls.
General Enrollment Period – A General Enrollment Period (GEP) exists every year in which Medicare beneficiaries are entitled to enroll in Medicare Part A and B without penalty. Coverage begins on July 1 and runs from January 1 until March 31 every year.
Special Enrollment Period (SEP)-You may qualify for a Special Enrollment Period if you or your spouse has lost other coverage, such as Medicare, due to specific life changes. SEP can also apply if you or your spouse start working for a company that does not offer insurance or moves to a new area where Medicare is unavailable.
SEP allows individuals to enroll in Medicare program away from the General Enrollment Period and Initial Enrollment Period for individuals who didn’t sign up for Medicare when they became eligible since they or their partners were still employed and received coverage through an employer-sponsored Group Health Plan.
Medicare Is Not Free
This comes as a surprise to most people who have been paying taxes throughout their employment period. Most people believe paying taxes means their Medicare would be “paid up” by turning 65. However, there will be no Part A premiums due as a result of those taxes, but Part B and D recipients must pay monthly payments during their retirement period.
If you have a minimum of 10-year employment record of paying payroll taxes into the program, you are eligible for premium-free Part A. If not, your monthly payments in 2022 might reach $499, based on whether you’ve contributed any taxes to the Medicare program.
Additionally, Part A has a $1,566 deductible applied to the initial 60 days of inpatient medical assistance during a benefit period. Beneficiaries must pay $389 per day for the 61st through 90th days, followed by $778 per day for the final 60 “lifetime reserve” days.
The regular monthly premium for Part B is $170.10 as of 2022. However, through income-adjusted surcharges, some beneficiaries might pay extra. The government will look at your tax return from the last two years before determining if you will have to pay more. In addition, the Social Security Administration has a form that you can use to ask for a decrease in that income-related amount because of a significant life event, such as retirement.
Failure to Enroll
If you failed to enroll at age 65 because you continued working and your employer’s insurance was satisfactory, you have up to eight months to enroll once your employment program expires.
Irrespective of the enrollment regulations you are subject to, failing to enroll in Part B by the deadline could result in a permanent late membership fine. You will be required to pay 10% of the standard Part B monthly charge for every year you should have registered but weren’t.
You Have the Right to Appeal a Medicare Decision
You can appeal a ruling made by Medicare or a Medicare health plan about eligibility or payment. The appeals phase encompasses five stages, and if your appeal is rejected at one level, you can typically move up a level. Consult your physician or other healthcare professionals for any information that could be useful in your case. You can request a quick decision if you believe doing so might seriously jeopardize your health. Finally, you must assert your right to an appeal if you believe you are unfairly refused Medicare coverage.
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