What Is The Medicare Savings Program
There are four types of Medicare Savings Programs:
- Qualified Medicare Beneficiary Program
- Specified Low-Income Medicare Beneficiary Program
- Qualifying Individual Program
- Qualified Disabled and Working Individuals Program
If you answer yes to these 3 questions, to see if you qualify for assistance in your state:
If you qualify for the QMB program, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare drug coverage.
Qualifying For Different Types Of Coverage
Medicare is a federal insurance program that helps pay medical bills from a fund to which users have contributed. It covers people 65 and older, people younger than 65 with certain disabilities and patients with end-stage kidney disease and other conditions requiring dialysis. Participants usually pay part of the cost.
Medicaid is an assistance program provided jointly by federal and state agencies. It helps with medical expenses for eligible people with limited income and resources.
There are different rules for each state, but in most states, you may be eligible for Medicaid if you are under certain income levels and/or are:
- 65 and older
- A parent or adult caring for a child
- An adult with dependent children
- An eligible immigrant
Participants usually pay nothing for covered medical costs, although they may sometimes be responsible for a small copayment or cost share.
Can I Select An Insurance Plan For My Medicare And Medicaid Benefits
If you are dual eligible, you are can enroll in a dual eligible special needs plan that covers both Medicare and Medicaid benefits. These plans may also pay for expenses that Medicare and Medicaid dont over individually, including over-the-counter items, hearing aids, and vision or dental care.
Read more about the Medicaid benefits available to Medicare enrollees.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement health insurance exchanges at the technology firm hCentive. He also has held consulting roles, including at Sachs Policy Group, where he worked with insurer, hospital and technology clients.
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If I Have Other Health Insurance Do I Need Part B
65 Incorporated came across this question from a Medicare beneficiary.
I just heard that if I have other insurance, I need only Medicare Part A. Part B is not necessary. Is this true?
It depends on the type of insurance an individual has. If the insurance is a COBRA or individual policy, or retiree coverage provided by a union or employer, enrollment in both Part A, hospital insurance, and Part B, medical insurance, is necessary. These types of insurance are secondary to Medicare, paying for any covered care after Medicare has paid its share.
But if the insurance comes through current employment of either the beneficiary or his or her spouse with a large employer , Medicare recommends enrollment in premium-free Part A. Part B enrollment is not necessary. When this coverage ends, Medicare provides special periods to enroll in Part B and obtain other coverage, such as a Part D prescription drug plan, a Medigap policy, or a Medicare Advantage plan.
Medicare out-of-pocket costs
Nearly three-fourths of middle-income Boomers under age 65 do not know that Medicare comes with out-of-pocket costs.
Think you know Medicare? Put your knowledge to the test!
Medicare is a national health insurance program that covers millions of people and involves an even greater number of healthcare providers and services. Its size alone invites confusion and misinformation. Find out if you can identify Medicare fact from fiction.
Do You Need Medicare Part B
Ever wonder if you really need Medicare Part B? For most people over 65 the answer is: Yes, you need to enroll in Part B and you should do so when first eligible. If you miss your Part B deadline, you could be subject to penalties. Check out our Medicare deadline Calculator here
When to enroll in Medicare Part B largely depends on whether you has qualifying job-based or retirement insurance that can act in place of Part B. If so you may be able to waive Part B due since you have credible coverage through work. If you dont have access to credible coverage from a work or spouse, it is usually recommended that you enroll in Medicare Part B when first eligible .
Even if you have retirement insurance, you may still have to enroll in Part B. Most retirement programs require it. Check with your HR team and confirm your situation. Make sure that if you waive Medicare Part B due to retirement insurance, that you are not subject to Part B penalties if you enroll later.
For those who have retirement coverage, You have 8 months to enroll in Medicare once you stop working OR your employer coverage ends . If you do not enroll in Part B within 8 months of losing your coverage based on current employment, you may have to pay a lifetime late enrollment penalty and have a gap in coverage.
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Medicare Part B Enrollment And Penalties
Medicare Part B is optional, but in some ways, it can feel mandatory, because there are penalties associated with delayed enrollment. As discussed later, you dont have to enroll in Part B, particularly if youre still working when you reach age 65.
However, if you dont qualify for a Special Enrollment Period , then you may incur penalty charges. These penalty charges are indefinite for as long as you keep Medicare Part B. When should you enroll in Medicare Part B? If youre not automatically enrolled because of the aforementioned conditions, then here are your enrollment options:
- You have a seven-month initial period to enroll in Medicare Part B. The seven months include the three months prior to your 65th birthday, the month containing your 65th birthday and the three months that follow your birthday month. If you turn 65 on March 8, then you have from December 1 to June 30 to enroll in Medicare Part B.
- If you delay enrollment, then you have to wait until the next general enrollment period begins. For Medicare Part B, you have from January 1 through March 31 to enroll. Coverage doesnt begin until July.
Do I Need Medicaid If I Have Medicare
Medicaid and Medicare are the two largest publicly funded health programs in the country, with different missions that often overlap. Medicare provides health coverage to seniors and some individuals with disabilities. Medicaid covers adults and children who cannot afford insurance, or who have health care costs they cannot afford. Often, an individual will be eligible for coverage through both programs. The following blog will describe how Medicare and Medicaid interact. Part one gives an overview of Medicare, what it covers, and what options are available for more coverage. Part two will describe how Medicare and Medicaid work together.
Part 1: Medicare, MediGap, and Medicare AdvantageFor many seniors, health insurance coverage can be very confusing. Most seniors know that they are eligible for Medicare when they reach age 65, but its easy to get confused about what is and isnt covered. Lets dive into the different Medicare options to help make things clear.
Seniors who are retired should enroll in both A and B as soon as they are eligible. If they enroll late, they may be penalized by having to pay Part A premiums or a higher premium for Part B. Seniors who are still working or whose spouse is still working may be able to delay enrolling in Medicare and keep the insurance provided by the employer.
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What The Part B Late Enrollment Penalty
If you do not have creditable coverage after you first become eligible for Medicare Part B, you incur a penalty that you will pay when you eventually do enroll in Part B.
The late enrollment penalty fee amount is a 10 percent increase in your Part B premium for each 12-month period you could have enrolled in Part B but did not.
- For example, if you did not enroll in Part B when first eligible and delayed your enrollment for 14 months , your standard Part B premium amount including your late enrollment penalty would be $187.11 per month.
- This total includes the standard Part B premium of $170.10 per month, plus your late enrollment penalty of $17.01 per month .
If you qualify for a Medicare Special Enrollment Period, you may not be required to pay the late enrollment penalty.
What Are Dual Special Needs Plans
Dual health plans are also known as dual special needs plans. Theyre offered by private insurance companies, so you can find a dual health plan that best meets your health insurance needs. Being on a dual health plan does not change your Medicaid eligibility or benefits.
See UnitedHealthcare plans in your area.
Please note that the specific benefits dual health plans include can change depending on where you live. Search by your ZIP code to find the right plan to meet your health care needs.
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Looking for the federal governments Medicaid website? Look here at Medicaid.gov.
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Medicaid Recipients And The $50000 Pip Option
Under the new auto no-fault law, recipients of Medicaid can select a $50,000 PIP medical expense option. This option is only available if:
Does Medicaid Cover Auto Accident Injuries Under the New Law?
If you are considering opting for this level of PIP coverage, it is absolutely crucial you first understand which services are not available through Medicaid but may be needed in the event of an auto accident. Again, CPAN has created a remarkable brochure for consumers to compare coverages.
Please visit .
Sign Up: Within 8 Months After You Or Your Spouse Stop Working
- Most people dont have to pay a premium for Part A . So, you may want to sign up for Part A when you turn 65, even if you or your spouse are still working.
- Youll pay a monthly premium for Part B , so you may want to wait to sign up for Part B.
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
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What Might Medicaid Pay For That Medicare Doesnt
- The premium for Medicare Part B, which covers doctor visits and other outpatient services. That monthly premium will be $135.50 in 2019.
- The Medicare Part B deductible, which will be $185 for 2019.
- The Medicare PartA deductible, which for 2019 will be $1,364 for hospital stays.
- Both Medicare Part A and Part B copays and coinsurance.
- The Medicare Part D premium, deductibles and copays for prescription drugs. Coverage for those costs is available through the Extra Help program, which Medicaid and Medicare Savings Program enrollees automatically qualify for.
- Nursing home care and home- and community-based long-term services and supports.
- In some states, Medicaid will cover benefits that Medicare does not, such as dental care, transportation to and from doctor visits, eyeglasses, physical therapy and other services.
Medicare Faqs And Information To Consider
If you are already receiving Social Security benefits, Railroad Retirement benefits, or Federal Retiree benefits, your enrollment in Medicare is automatic. Your Medicare card should arrive in the mail shortly before your 65th birthday. Check the card when you receive it to verify that you are entitled to both Medicare Parts A and B.
Initial Enrollment Period:
If you are not eligible for Automatic Enrollment, contact the Social Security Administration at 800-772-1213 or enroll online at www.socialsecurity.gov, or visit the nearest Social Security office to enroll in Medicare Part A and Medicare Part B. You have a seven month window in which to enroll in Medicare without incurring a penalty. If youre not automatically enrolled in premium-free Part A, you can sign up for it once your Initial Enrollment Period starts. Your Part A coverage will start six months back from the date you apply for Medicare, but no earlier than the first month you were eligible for Medicare. However, you can only sign up for Part B during the times listed below.
General Enrollment Period:
- General Enrollment Period for Medicare Parts A & B
If you have coverage through a current employer, you are not required to enroll in Medicare Part A and B. Below are some things to keep in mind about each part of Medicare.
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Get Help Finding A Medicare And Medicaid Policy
Medicaid and Medicare are not that similar. Medicaid is available to individuals and families living below the poverty level. But, Medicare is for people 65 and older, as well as those on disability.
Once you have clarity on the facts regarding Medicare vs. Medicaid, you can make the right decisions. If you have questions about your Medicare options, contact us today.
Our agents can inform you of all your options. Call us at the number above and we can help you review your best options. Or, fill out an online rate form to see your rates now.
What If I Need To Be In A Nursing Home
Medicare covers most of the costs associated with skilled nursing after an inpatient stays in the hospital. If you have both Medicare and Medicaid, a stay at a skilled nursing facility will cost very little.
After inpatient treatment, many patients need more outpatient care in the home setting. To learn how to get financial assistance for home health care, read How to Qualify for Home Health Care & Get Financial Assistance.
If you require assisted living because you are no longer able to live independently, read Does Medicare Cover Assisted Living Costs? What About Independent Living?
If you need long-term care and have limited resources, Medicaid can help, however, strict asset limits do apply. We have a complete guide to long-term care if you need it.
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Can I Decline Medicare Altogether
Medicare isnt exactly mandatory, but it can be complicated to decline. Late enrollment comes with penalties, and some parts of the program are optional to add, like Medicare parts C and D. Medicare parts A and B are the foundation of Medicare, though, and to decline these comes with consequences.
The Social Security Administration oversees the Medicare program and recommends signing up for Medicare when you are initially eligible, even if you dont plan to retire or use your benefits right away. The exception is when you are still participating in an employer-based health plan, in which case you can sign up for Medicare late, usually without penalty.
While you can decline Medicare altogether, Part A at the very least is premium-free for most people, and wont cost you anything if you elect not to use it. Declining your Medicare Part A and Part B benefits completely is possible, but you are required to withdraw from all of your monthly benefits to do so. This means you can no longer receive Social Security or RRB benefits and must repay anything you have already received when you withdraw from the program.
Qualified Disabled And Working Individual
You may be eligible to purchase Medicare Part A benefits, but unable to afford it because of your low income. In this case, Medicaid will pay your Medicare Part A premium. This is more common with people under the age of 65.
In 2021, the maximum monthly income to qualify is $4,379 for an individual and $5,892 for a couple. The 2021 maximum asset level, however, is set at just $4,000 for an individual and $6,000 for a couple.
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Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . 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:
- State I want Part B coverage to begin 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 employers 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.
Some people with limited resources and income may also be able to get .