What Is A Medicare Deductible
A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. There are deductibles for both the Part A and Part B portions of Medicare. Your deductible is taken out of your claims when Medicare receives them. Medicare will not start paying on your claims until you have met your annual deductible. If you have any questions on the status of your deductible please contact your Medicare carrier.
What Does Medicare Cover
Medicare helps pay for certain health care services and durable medical equipment. To have full Medicare coverage, Medicare beneficiaries must have Part A and Part B .
The following is a partial list of Medicare-covered services. The covered services listed below may require payment of deductibles and Co-Payments.
If you have questions about covered services, call Medicare at 1-800-633-4227.
How Long Does It Take For A Medicare Application To Be Approved
Once your application has been reviewed, you should receive a letter in the mail to confirm whether youve been enrolled in the program or not. If your application has been denied, the letter will explain why this decision was made and what to do next.
If your application has been approved, youll receive a red, white, and blue Medicare card in the mail. Your card will show your name, Medicare number, which Medicare plans you benefit from, and the start dates for each plan.
Youll receive your card within about 3 weeks from the date you apply for Medicare. You should carry your card with you whenever youre away from home.
You can sign in to your MyMedicare.gov account if you need to print a replacement card.
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What Types Of Services Are Covered Under Medicare Part B
Medicare Part B helps pay for doctors’ services, outpatient hospital care, blood, medical equipment and some home health services. It also pays for other medical services such as lab tests and physical and occupational therapy. Some preventive services such as mammograms and flu shots are also covered. Medicare Part B does NOT cover routine physical exams eye glasses custodial care dental care dentures routine foot care hearing aids orthopedic shoes or cosmetic surgery. It also does not cover most prescription drugs or health care you get while traveling outside the United States .
Special Enrollment Available For 5
Medicare utilizes a star rating system for Medicare Advantage and Part D Prescription Drug Plans. Each Medicare contract is assigned a rating of one to five stars, with the best contracts receiving five stars. If you live in an area where a 5-star Part D or Advantage plan is available, you can join or switch to the 5-star plan up to once per year, between December 8 and November 30.
In 2021, there are a total of 28 Medicare contracts nationwide that have a 5-star rating. Two are Medicare cost plans, five are stand-alone Part D plans, and the rest are Medicare Advantage plans.
Most plans do not receive five stars, and in most years, most areas of the country do not have 5-star plans available. For 2021, however, theres a UnitedHealthcare contract with a five-star rating, available in most of the US.
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Who Is Eligible For Medicare
Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease . Medicare has two parts, Part A and Part B . You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:
- You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
- You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
- You or your spouse had Medicare-covered government employment.
To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.
If you did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:
- You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
- You are a kidney dialysis or kidney transplant patient.
While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.
Does Medicare Cover Testing For Covid
Yes, testing for COVID-19 is covered under Medicare Part B. Under rulesannounced on April 30, 2020, an order from a beneficiarys treating physician is no longer required for COVID-19 testing to be covered under Medicare, which will better enable beneficiaries to use community testing sites, such as drive-through testing at hospital off-site locations. Medicare Advantage plans are required to cover all Medicare Part A and Part B services, including COVID-19 testing. Medicare will also cover serology tests that can determine whether an individual has been infected with SARS-CoV-2, the virus that causes COVID-19, and developed antibodies to the virus.
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What Medical Supplies And Equipment Does Medicare Part B Cover
Medicare Part B helps pay for durable medical equipment such as oxygen equipment, wheelchairs, and other medically necessary equipment that your doctor prescribes to use in your home. Other items covered by Medicare include:
- Arm, leg, back and neck braces
- Medical supplies such as ostomy pouches, surgical dressings, splints and casts
- Breast prostheses following a mastectomy
- One pair of eyeglasses with an intraocular lens after cataract surgery
Medicare pays for different kinds of durable medical equipment in different ways. Some equipment must be rented, other equipment must be purchased. Your Durable Medical Equipment Regional Carrier can provide more specific information. Check the Important Phone Numbers section of this web site for the phone number for your Durable Medical Equipment Regional Carrier.
Can Medicare Beneficiaries Get Extended Supplies Of Medication
The Department of Homeland Security recommends that, in advance of a pandemic, people ensure they have a continuous supply of regular prescription drugs. In light of the coronavirus pandemic, a provision in the CARES Act requires Part D plans to provide up to a 90-day supply of covered Part D drugs to enrollees who request it during the public health emergency.
According to CMS, for drugs covered under Part B, Medicare and its contractors make decisions locally and on a case-by-case basis as to whether to provide and pay for a greater-than-30 day supply of drugs.
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Changes During Annual Open Enrollment
There are many plan changes that Medicare beneficiaries might want to make from one year to the next.
For most of them, the applicable open enrollment period is October 15 to December 7, with changes effective on January 1. During that timeframe, you can:
- Switch from Original Medicare to Medicare Advantage, or vice versa.
- Switch from one Medicare Advantage plan to another.
- Enroll in a Part D Prescription Drug Plan for the first time
- Switch from one Part D plan to another.
- Drop your Part D coverage altogether .
Read more about the four ways you can upgrade your Medicare coverage during open enrollment. And take a minute to read about Medicare enrollment mistakes that could cost you money.
General Eligibility For Medicare
Medicare eligibility goes hand-in-hand with Social Security eligibility.
Individuals in the below-listed categories can get Medicare coverage.
- Persons age 65 or older eligibility begins four months before their 65th birthday
- Disabled persons 64 and under can qualify if receiving disability benefits from Social Security or the RRB for 24 months
- Persons with end-stage renal disease can get premium-free Medicare Part A. Eligibility based on End-Stage Renal Disease requires current dialysis treatment, a kidney transplant, and filing an application for Medicare.
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Will I Automatically Be Enrolled In Medicare When I Turn 65
If you are receiving Social Security or Railroad Retirement or disability benefits, you will be automatically enrolled in Medicare Part A and Part B. About 3 months prior to your 65th birthday or 24th month of disability, you will be sent an Initial Enrollment Package that will contain information about Medicare, a questionnaire and your red, white and blue Medicare card. If you want both Medicare Part A and Part B , you should sign your Medicare card and keep it in your wallet. If you don’t want Part B coverage, you must put an X in the refusal box on the back of the Medicare card form sign the form and return it with the card to Social Security at the address shown. You will then be sent a new Medicare card showing that you only have Part A.
What Is A Medicare Card
The red, white and blue Medicare card shows whether a person has original Medicare Part A, Part B, or both. It also shows the start date of a persons coverage.
Individuals should carry the card with them when away from home. A doctors office, hospital, or other healthcare providers will ask to see the card. If a person has forgotten to take it with them, a provider can look up their Medicare number online.
There are scams that involve calls to people with Medicare to try to get their card number and other personal information. Individuals should take care to not give this information to anyone over the phone. According to Medicare, it never makes unrequested calls to beneficiaries.
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You Declined Part B During Your Initial Enrollment Period And It Wasnt Because You Had Other Health Plan Coverage
You didnt sign up for Medicare Part B during your Initial Enrollment Period for some reason other than because you had health plan coverage, but now want Part B? You may sign-up for Part B during the Open Enrollment Period .
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 . Send your application to your local Social Security Office. Find your local field office at www.ssa.gov.
How To Apply Online For Just Medicare
If you are within three months of turning age 65 or older and not ready to start your monthly Social Security benefits yet, you can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses benefits later. It takes less than 10 minutes, and there are no forms to sign and usually no documentation is required.
To find out what documents and information you need to apply, go to the .
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Understanding Medicare Based On Disability
Persons entitled to monthly Social Security or Railroad Retirement Board benefits are automatically entitled to Medicare Part A after twenty-four months of disability benefits.
If disabled government employees are not otherwise eligible for Social Security Benefits through their history of work or contribution to payroll taxes, they get automatic eligibility for Part A after twenty-nine months of receiving disability benefits.
There is a special rule for People with Lou Gehrigs disease. They get eligibility with no waiting period upon the first month of RRB or SSA benefits.
Child disability eligibility begins the month of the 20th birthday except for ALS which is set for age 18.
Those diagnosed with End-Stage Renal Disease are typically eligible to begin Medicare on the first day of the fourth month they receive dialysis treatments.
In addition, to get Part A premium-free, those with End-Stage Renal Disease must also meet one of three below-stated conditions:
What Is A Diagnosis Related Group For Medicare
Learn how to create an online Medicare account. You can use your online MyMedicare account to view your Medicare premium bills, check your payment history and set up Medicare Easy Pay for auto payments.
by Zia Sherrell | Published March 22, 2021 | Reviewed by John Krahnert
Senior Americans are embracing technology at a rapid rate. In 2000, just 14% of Americans aged 65 and older used the internet. A Pew Research Center report released in 2019 found that the number had grown to 73%.1
If youre one of these digitally-savvy people, youre probably interested in the ways technology can simplify your life. Signing up for Medicares MyMedicare online portal is a great way to save time and help you make and track your payments.
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What Are My Rights As A Medicare Beneficiary
As a Medicare beneficiary, you have certain guaranteed rights. These rights protect you when you get health care, they assure you access to needed health care services, and protect you against unethical practices.
You have these rights whether you are in Original Medicare or another Medicare health plan.
Your rights include, but are not limited to:
The Right to Receive Emergency Care
If you have severe pain, an injury, or a sudden illness that you believe may cause your health serious danger without immediate care, you have the right to receive emergency care. You never need prior approval for emergency care, and you may receive emergency care anywhere in the United States.
The Right to Appeal Decisions About Payments or Services for Medical Care
If you are enrolled in Original Medicare, you have the right to appeal denial of a payment for a service you have been provided. If you are enrolled in another Medicare health plan, you have the right to appeal the plan’s denial for a service to be provided.
The Right to Information About All Treatment Options
You have the right to know about all your health care treatment options from your health care provider. Medicare forbids its health plans from making any rules that would stop a doctor from telling you everything you need to know about your health care. If you think your Medicare health plan may have kept a provider from telling you everything you need to know about your health care options, then you have the right to appeal.
Should I Sign Up For Medical Insurance
With our online application, you can sign up for Medicare Part A and Part B . Because you must pay a premium for Part B coverage, you can turn it down.
If youre 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 choose not to enroll in Medicare Part B and then decide to do so later, your coverage could be delayed and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didnt sign up for it, unless you qualify for a “” .
If you dont 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. Read our publication for more information.
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Medicare Coverage Changes: Key Takeaways
- January 1 to March 31 General enrollment for Medicare Part B, for people who didnt sign up when they were first eligible .
- January 1 to March 31 Medicare Advantage open enrollment period: People who already have Medicare Advantage can switch to Original Medicare or to a different Medicare Advantage plan.
- December 8 to November 30 Special enrollment for 5-star plans
- First year of Advantage coverage One-time trial period during which its possible to switch from Medicare Advantage to Original Medicare, Medigap or Part D plan.
Am I Eligible For Medicare
To receive Medicare, you must be eligible for Social Security benefits.
Part A Eligibility
Most people age 65 or older are eligible for Medicare Part A based on their own employment, or their spouse’s employment. Most people have enough Social Security credits to get Part A for free. Others must purchase it.
You are eligible for Medicare Part A if you meet one of the following criteria:
- You are eligible for Social Security or Railroad Retirement benefits, even if you do not receive those benefits.
- You are entitled to Social Security benefits based on a spouse’s, or divorced spouse’s work record, and that spouse is at least 62 years old.
- You have worked long enough in a federal, state, or local government job to be eligible for Medicare.
If you are under 65, you are eligible for Medicare Part A if you meet one of the following criteria:
- You have received Social Security disability benefits for 24 months.
- You have received Social Security benefits as a disabled widow, divorced disabled widow, or a disabled child for 24 months.
- You have worked long enough in a federal, state, or local government job and meet the requirements of the Social Security disability program.
- You have permanent kidney failure that requires maintenance dialysis or a kidney transplant.
- You are diagnosed with ALS or Lou Gehrig’s disease.
Part B Eligibility
If you are eligible for Part A, you can enroll in Medicare Part B which has a monthly premium.
Will I Need To Prove My Age?
Automatic Enrollment
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