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.
Also Check: Does Medicare Pay For Mobility Scooters
When Is My Fehb Plan The Primary Payer
There are some cases when your FEHB plan would be the primary payer, meaning it pays for the cost of services first and Medicare covers the rest. If you or your covered spouse are age 65 and have Medicare, your FEHB plan is the primary payer when you:
- Have FEHB coverage on your own as an active employee, or through your spouse who is an active employee
- Are a reemployed annuitant with the Federal government and your position is not excluded from the FEHB
- Are enrolled in Part B only, regardless of employment status
- Have Medicare because of ESRD and it’s within the first 30 months of eligibility for or entitlement to Medicare. If you’re eligible for Medicare due to ESRD and the FEHB plan was already the primary payer, it will continue to be for the 30-month coordination period
- Are eligible for Medicare due to a disability and have FEHB coverage on your own as an active employee, or through a family member who is an active employee
Most of the time, the primary payer depends on your employment status, as well as other factors. You should share with OPM if you or a covered family member has Medicare so they can ensure requirements are administered correctly.
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.
Read Also: What Age Can I Apply For Medicare
When Is Medicare The Primary Payer
If you or your covered spouse are age 65 and have Medicare, it is the primary payer when you:
- Have FEHB coverage on your own as an annuitant, or through your spouse who is an annuitant
- Are a reemployed annuitant with the Federal government and your position is excluded from the FEHB, and you are not covered under FEHB through your spouse
- Are a Federal judge who retired under title 28, U.S.C., or a Tax Court judge who retired under Section 7447 of title 26, U.S.C.
- Are enrolled in Part B only, regardless of employment status
- Have Medicare because of end stage renal disease and are beyond the 30-month coordination period when you’re entitled to Medicare
- Are eligible for Medicare due to a disability and have FEHB coverage on your own as an annuitant
- Are covered under the FEHB Spouse Equity provision as a former spouse
After Medicare pays its share, your FEHB plan pays the remaining costs. This could help reduce your out-of-pocket costs since many FEHB plans waive cost sharing for enrollees who have Medicare. Cost sharing is the out-of-pocket costs you’d have such as deductibles, co-payments, and co-insurance.
Ways To Apply For Disability Benefits:
- If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
Once your disability benefits start, well mail you a welcome package with your Medicare card.
Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months after your Part A starts, you might have to wait to sign up for Part B and pay a monthly late enrollment penalty.
Recommended Reading: What Is The Number For Medicare
Recommended Reading: Does Aetna Medicare Cover Eye Exams
Eligibility And Enrollment Part B Vs Part C
Original Medicare and Advantage plans vary in their eligibility and enrollment requirements.
After a person gets Social Security benefits at age 65, Medicare automatically enrolls them in Part A and Part B. If a person meets the age requirement but does not receive Social Security benefits, they will not automatically get Medicare and will need to sign up for it.
If someone does not sign up for Part A and Part B during the Initial Enrollment Period when they first become eligible, they may sign up during the general enrollment period, which is from January 1 to March 31 every year.
An individual may apply for Medicare online here.
A person who has Medicare Part A and Part B and does not have end stage renal disease is eligible for an Advantage plan. An individual may switch from Part A and Part B to an Advantage plan during the initial enrollment period or the open enrollment period, which is from October 15 to December 7 of every year.
To enroll in an Advantage plan, a person first needs to select a plan in their area. After they decide on a plan, they may request an enrollment form from the insurance company offering it or enroll on the companys website.
When You Should Consider Enrolling In Medicare Part B
If you qualify to delay enrolling in Medicare, deciding to do so is a personal choice.
Some may choose to delay, and for others, it may still be a good fit for your health and lifestyle to enroll in Part B. Consider the following when trying to decide whether to enroll in Part B or delay while still working:
- Is Medicare less expensive than your current health insurance?
- Does Medicare offer better coverage than your current health insurance?
- Do you want to keep your current insurance but also take advantage of Medicare benefits
- Do you want to enroll in either a Medigap or Medicare Advantage plan?
- Is your prescription drug coverage considered creditable by Medicare?
Answering the above questions can help you decide whether or not to delay enrollment. Its important to carefully consider the last item regarding prescription drug coverage. While most employer coverage is considered creditable, you should still verify if it is or could end up facing a late enrollment penalty for Medicare Part D.
You May Like: How To Check Medicare Payments
How Much Does Social Security Take Out For Medicare
If you receive SSDI benefits, when you become eligible for Medicare, Social Security will take money out to pay for Medicare premiums, in most cases. , but it doesn’t pay your premiums.)
For most people, Social Security deducts a Part B premium of $170.50 each month. But for those whose adjusted gross income is over $142,000 , the monthly premium can be double that amount. A few people who don’t have enough work credits may have to pay part of the Part A premium too. Read more about how much you have to pay for Medicare when you’re on disability.
Disability recipients who have low income can receive help from their states in paying for Medicare premiums, which keeps Social Security from deducting any money from their SSDI benefit. The programs that help pay Medicare premiums are called Medicare Savings Programs. You can check with your local social service offices to determine if you might be entitled to help with your Medicare premiums.
What Medicare Part B Covers
First, lets take a look at what Medicare Part B actually covers. Medicare Part B covers medical treatments and services under two classifications: medically necessary services and preventive services. What qualifies something as medically necessary? In general, medically necessary services must be medical treatments that are required to treat a recognized medical condition or illness. Necessary services and items might include the following:
- Diagnostic equipment
- Supplies, such as walkers or wheelchairs
For example, diabetics need regular doctor visits to ensure appropriate blood levels, as well as appropriate diagnostic coverage to ensure accurate readings.
Medicare Part B beneficiaries also gain access to preventive services, like yearly screenings for the flu or certain cancers. In addition, Part B may cover other medical procedures and treatments that fall within the necessary or preventive range. Ambulance services, clinical research, mental health counseling and some prescription drugs for outpatient treatment may all be covered under Medicare Part B.
As of the 2019 plan year, the Centers for Medicare and Medicaid Services has lifted coverage caps on critical services covered under Medicare Part B. These include physical therapy, speech language pathology and occupational therapy.
But original Medicare doesnt cover everything. You may need to obtain supplemental insurance, such as Medigap, if you need coverage for the following:
Recommended Reading: What Does Medicare Do For You
What Does Medicare Part B Cover
Part B provides coverage for a mixture of outpatient medical services. This includes coverage for preventive vaccines, cancer screenings, annual lab work, and much more.
It will cover preventive services in addition to specialist services. Part B even covers services for mental healthcare, durable medical equipment that your doctor finds medically necessary.
Also, Part B will cover some services you receive while in the hospital. This includes surgeries, diagnostic imaging, chemotherapy, and dialysis if you obtain drugs while at the hospital, it will also provide coverage for those.
Choosing My Type Of Medicare Coverage
Your first decision when it comes to health coverage after 65 is between Original Medicare and Medicare Part C.
Original Medicare covers most hospital and doctor expenses. The balance is left to you, with no cap on how high your out-of-pocket costs can go.
Original Medicare allows you to see any doctor in the U.S. who accepts Medicare. It provides excellent flexibility: it has no networks or referral requirements.
Medicare Part C bundles hospital, doctor and drug coverage. It covers most of those expenses, but you pay deductibles, copayments, and coinsurance. Medicare Advantage plans cap out-of-pocket expenses.
Medicare Advantage is all-encompassing, even offering dental and vision coverage . But, you are limited to its doctor network and need referrals to see specialists.
Recommended Reading: How Many Mastectomy Bras Are Covered By Medicare
Is Medicare Part A Mandatory
Technically, no Medicare Part A is not mandatory.
If you dont sign up for Medicare Part A, however, you must withdraw from all federal benefits programs. That means you cannot receive Social Security or Railroad Retirement Board benefits. You must also repay any benefits you have already received if you decline Medicare. This is one reason why most people keep their Part A coverage once their eligible.
You will qualify for premium-free Medicare Part A benefits if you worked and paid Medicare taxes for at least 10 full years .
Most beneficiaries qualify for premium-free Part A. Enrolling in Medicare Part A does not kick you off your existing health coverage.
Medicare works with other types of insurance, such as employer coverage, VA insurance and Tricare. If you are still working and have quality health insurance provided by your employer, you can have coordination of benefits to cover your health care costs.
- If your employer has fewer than 20 employees, Medicare will be the primary payer. That means Medicare will pay first for any covered care you receive, and then your employer insurance will pick up the rest of the services covered by that plan.
- If your employer has 20 or more employees, your employer insurance will pay first and Medicare will serve as the secondary payer to pick up any additional covered services.
Some Medicare beneficiaries have to pay a premium for their Part A coverage.
When You Must Enroll In Medicare Part B
You may be required to get Medicare Part B even when youre still working. There are two situations in which youmust get Part B when you turn 65.
In each of the above cases, you wont qualify for a Special Enrollment Period and cannot delay enrolling without incurring late enrollment penalties.
Additionally, some employer plans will automatically become secondary to Medicare when you become eligible. In this case, Medicare becomes your primary insurance and would pay first. If you do not have Medicare and need health care, you would essentially have almost no coverage from your employer plan. One such plan that operates like this is the militarys TriCare for Life.
Also Check: What Is Medicare Part G
If I Delay Taking Medicare Part B When Can I Enroll
You can sign up for Medicare Part B at any time that you have coverage through current or active employment. Or you can sign up for Medicare during the eight-month Special Enrollment Period that starts when your employer or union group coverage ends or you stop working . If you get COBRA insurance or retiree benefits after you stop working, keep in mind that this doesnât count as coverage based on current employment make sure you donât wait until your COBRA benefits end to enroll in Medicare Part B.
When Is My Initial Enrollment Period For Medicare Part D
You can enroll in a stand-alone Medicare prescription drug plan during your Initial Enrollment Period for Part D. You are eligible for prescription drug coverage if:
- You live in a service area covered by the health plan, and
- You have Medicare Part A AND/OR Medicare Part B.
Generally, your Initial Enrollment Period for Part D will occur at the same time as your Initial Enrollment Period for Medicare Part B .
Once you are eligible for Medicare Part D, you must either enroll in a Medicare prescription drug plan, Medicare Advantage Prescription Drug plan, or have creditable prescription drug coverage . Some people may choose to delay Medicare Part D enrollment if they already have creditable prescription drug coverage through an employer group plan.
However, if you do not sign up for prescription drug coverage when you are first eligible for Part D, you may have to pay a late-enrollment penalty for signing up later if you go without creditable prescription drug coverage for 63 or more consecutive days.
Also Check: Does Medicare A Have A Deductible
Recommended Reading: Will Medicaid Pay My Medicare Premium
Costs: Part B And Part C
Original Medicare and Advantage plans have different costs.
In 2021, an individual with Part B must pay a standard monthly premium of $148.50 and the yearly deductible of $203. They must also pay 20% of the cost of Medicare-approved services after they have met the deductible.
A person with Plan B also has Plan A, but most people with original Medicare do not pay a Part A monthly premium. However, a $1,484 deductible is payable for Part A hospital inpatient services for each benefit period, together with coinsurance that varies from $0 to $742.
As Part A and Part B do not cover most medications, an individual may wish to purchase Part D, which is prescription drug coverage.
Every year, each Medicare plan sets out the amount it will charge for premiums, deductibles, and services. The amount varies among plans, and some plans offer zero premiums.
Also, because a person must have enrolled in Medicare Part A and Part B to qualify for Medicare Advantage, they must pay the Part B monthly premium. Some plans may pay the premium, either in part or in full.
Deductibles and other out-of-pocket costs vary among plans. However, Advantage plans have a maximum out-of-pocket spending limit, which the government sets. After a person reaches their plans annual cap, the plan generally pays their covered healthcare expenses.