Should I Enroll In Part A Only
Because Part A offers a unique way to receive your benefits without paying premiums, it can sometimes seem like a good idea to only enroll in Part A. However, this won’t be a good idea for most people.
If you choose to enroll in Part A but not Part B, and you aren’t under a group plan, then you may experience a gap in coverage or face a Part B late enrollment penalty. This can end up costing even more than enrolling in Part B from the outset.
If you have a group health plan from your employer, you will be able to defer Part B but enroll in Part A and not face a late penalty. When you no longer have your employer-based plan, you will trigger a Special Enrollment Plan and be able to enroll in Part B without paying a late fee.
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.
What Does Medicaid Cover
- If you have Medicare and full Medicaid coverage, most of your health care costs are covered. You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan.
- If you have Medicare and/or full Medicaid coverage, Medicare covers your Part D prescription drugs. Medicaid may still cover some drugs that Medicare doesnt cover.
- People with Medicaid may get coverage for services that Medicare doesnt cover or only partially covers, like nursing home care, personal care, transportation to medical services, home- and community-based services, anddental, vision, and hearing services.
PACE is a Medicare and Medicaid program offered in many states that allows people who otherwise need a nursing home-level of care to remain in the community. To qualify for PACE, you must meet these conditions:
- Youre 55 or older.
- You live in the service area of a PACE organization.
- Youre certified by your state as needing a nursing home-level of care.
- At the time you join, youre able to live safely in the community with the help of PACE services.
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What Is Part B Medicare
Part B mainly covers Doctor and Outpatient services. Part B can include more costs. If you already have good insurance through your school or work, it may be better to stick with what you have.
Part B Medicare covers services such as:
- Clinical research
- Mental health
- Ambulance services
- Limited outpatient prescriptions
Part B covers two different types of services. Medically necessary services or preventative services. Some preventative services may need to be paid for out of pocket but most preventative services are covered by Medicare if you receive them from a medical professional that accepts assignment.
Make sure to discuss what your plan covers with your doctor.
Understanding Medicare And Medicaid
Medicare is health and hospitalization insurance for people age 65 and older and those under 65 with certain disabilities or end-stage renal disease. Some portions of Medicare are free and others cost money, with premiums typically deducted from your Social Security benefit checks.
Even if you have private insurance you should apply for Medicare. If you wait until after your 65th birthday to apply, you may end up paying a late penalty or higher premiums. For most people, the initial enrollment period is the seven-month period that begins three months before the month in which they turn 65. If you miss that window, you may enroll between January 1 and March 31 each year, although your coverage won’t begin until July 1.
There are four types of Medicare coverage available.
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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.
Types Of Medicare/health Insurance
Enrolling in Medicare is all about finding the right balance of coverage to meet your needs. CoverRight can help you determine whether you need to stay in Original Medicare or enroll in Medicare Advantage. It can also assist with enrolling in Medicare Advantage , Medigap , or Prescription Drug Plans .
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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.
You Automatically Get Medicare When You Turn 65
- Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.
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 of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.
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What Do I Need To Qualify For Medicare
Medicare coverage is for adults 65 and older and those with certain qualifying medical conditions or disabilities. To qualify, you would need proof of age, proof of income , residency or citizenship documentation, and more. Since Medicare is a government insurance program, anyone aged 65 or older can apply and receive insurance through this program.
Medicare premiums are based on your income and your work history. The eligibility requirements for Medicare Part A are very simple. If you or your spouse worked and paid Social Security taxes for ten or more years, your Medicare Part A premium is free. If not, you will pay a monthly premium for Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care…..
With Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare…, all Medicare beneficiaries pay a monthly Part B premium, however, if you are a high-income earner you will pay a little more. You can find the current schedule on this Medicare.gov page.
Explore Your Medicare Coverage Options
Did you know that Medicare Advantage plans offer the same benefits that are covered by Medicare Part A and Part B ?
And did you know that most Medicare Advantage plans also offer addition benefits not covered by Original Medicare, such as:
- Dental coverage
- Vision coverage
- Prescription drug coverage
Many Medicare Advantage plans are also available with $0 premiums and $0 deductibles, though these plans may not be available in all locations.
To learn more about how you may be able to save on some of your out-of-pocket health care costs, compare Medicare Advantage plans available in your area with the help of a licensed insurance agent.
Find Medicare Advantage plans in your area
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
1 SSA. Quarter of Coverage. Retrieved Feb. 2020 from www.ssa.gov/oact/cola/QC.html.
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What Are Medicare Quarters And How Do They Affect My Coverage
When learning about your Medicare costs, you may have come across the mention of quarters. Medicare quarters refer to the amount of qualified time that you paid Social Security and Medicare taxes.
To qualify for Medicare Part A hospital insurance coverage without having to pay a premium, you typically must have paid Medicare taxes for 40 quarters, equal to 10 years.
But what counts as a qualified Medicare quarter? Do you need 40 quarters to qualify for Medicare? Read this helpful guide to learn more about your Medicare coverage options and how Medicare quarters work.
Paying For A Prescription Drug Plan
If you qualify for any of the Medicare Savings Programs described above, then you also automatically qualify for a program called Extra Help designed to assist with paying for your prescription drugs. Prescription drug coverage is provided through Medicare Part D, which is why Extra Help is also known as the Part D Low-Income Subsidy. Part D coverage generally comes with a premium, a deductible and a copayment. Learn more about Medicare Part D here.
But you dont have to be in a Medicare Savings Program to receive help paying for your prescriptions under Extra Help. If your annual income in 2021 as an individual is up to $19,320, or as a married couple is up to $26,130, you may be eligible. Asset limits in 2021 are up to $14,790 for an individual or $29,520 for a couple.
Depending on which Medicare Part D plan you choose, the program can reduce or eliminate your plans premium and deductible, and also lower the cost you pay for the prescription drugs covered under your plan.
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Do You Have To Apply For An Msp During Medicare’s Annual Election Period
No. You can apply for MSP assistance anytime. As noted above, youll do this through your states Medicaid office, which accepts applications year-round.
But the marketing and outreach before and during Medicares annual election period can be a good reminder to seek help if you need it. You might decide to make a change to your coverage during the annual open enrollment period, and simultaneously check with your states Medicaid office to see if you might be eligible for an MSP or Extra Help with your drug coverage.
Medicare Eligibility At 65 And Older
The year you turn 65, you can apply for Medicare starting three months before your birth month until three months after. You generally have to meet three eligibility requirements to qualify for full Medicare benefits when you turn 65.
The chief requirement is that you must be a U.S. citizen or permanent legal resident who has lived at least five years in the United States.
In addition, you have to meet one of the following other requirements:
- You or your spouse must have worked long enough to also be eligible for Social Security benefits or for railroad retirement benefits. This usually means youve worked for at least 10 years. You must also be eligible for Social Security benefits even if you are not yet receiving them.
- You or your spouse is either a government employee or retiree who did not pay into Social Security but did pay Medicare payroll taxes while working.
Paying Medicare payroll taxes for 10 full years means you wont have to pay premiums for Medicare Part A, which covers hospital care.
You dont need the work credits to qualify for Medicare Part B, which covers doctor visits or outpatient services, or Medicare Part D, which covers prescription drugs. But everyone has to pay premiums for both.
You can still get Medicare if you never worked but it may be more expensive depending on your spouse or total work history.
Prepare for the Medicare Advantage Open Enrollment Period
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Extra Help To Pay For Medicare Prescription Drug Costs
Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help if your yearly income and resources are below these limits in 2021:
- Single person – yearly income less than $19,320 and less than $13,290 in other resources per year
You may qualify even if you have a higher income . Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual RetirementAccounts . Resources dont include your home, car, household items, burial plot, up to $1,500 for burial expenses , or life insurance policies.
If you qualify for Extra Help and join a Medicare drug plan, you’ll:
- Get help paying your Medicare drug plan’s costs.
- Have no late enrollment penalty.
You automatically qualify and will receive Extra Help if you have Medicare and meet any of these conditions:
- You have full Medicaid coverage.
- You get help from your state Medicaid program paying your Part B premiums .
- You get Supplemental Security Income benefits.
Drug costs in 2021 for people who qualify for Extra Help will be no more than $3.70 for each generic drug and $9.20 for each brand-name drug.
Medicare Disability Eligibility Requirements
At the start of the 25th that you collect Social Security Disability checks, youll automatically have Medicare. Certain circumstances dont require patients to wait for 24-months.
Those on disability because of Amyotrophic Lateral Sclerosis automatically start Medicare the same month that disability benefits begin. Medicare isnt responsible for determining if you qualify for disability Social Security oversees that decision as they are the ones who administer the checks.
If you have any questions regarding this matter, you should contact your local Social Security Administration office, as they can better assist you.
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Who Are The Dual
People who are dual-eligible for Medicare and Medicaid are referred to as dual-eligible beneficiaries. Moreover, each state determines Medicaid coverage, and as a result, Medicaid benefits may differ.
Receiving both Medicare and Medicaid can assist in lowering healthcare expenditures for individuals who are in need.
According to general practice, Medicare pays for healthcare services first, with Medicaid covering any gaps that exist up to Medicaids payment flexibility limits.
According to an article in the journal Health Affairs, an estimated two-thirds of those who are dual-eligible meet the standards for Medicare based on age. The remaining one-third of dual-eligible people meet the criteria due to a disability.
There are a few main distinctions between Medicare and Medicaid.
Do You Need 40 Quarters To Qualify For Medicare
You do not need to have earned 40 quarters to qualify for Medicare coverage. Medicare eligibility is based primarily on your age .
The number of quarters you paid Medicare taxes will affect your Medicare costs, however. Your Medicare Part A premium is partly based on the number of quarters for which you worked and paid Medicare taxes.
As mentioned above, you qualify for premium-free Medicare Part A if you paid Medicare taxes for 40 quarters. If you paid Medicare taxes for less than 40 quarters, you will typically have to pay a premium for your Part A coverage.
The full breakdown for 2022 Medicare Part A premiums is as follows:
If you paid Medicare taxes for…
…your 2020 Medicare Part A premium will be:
At least 40 quarters
$499 per month
Most Medicare beneficiaries do not pay a premium for their Part A benefits.
You would need to pay Medicare taxes for at least 7.5 years to qualify for the $274 premium in 2022. Anything less than 7.5 years would require you to pay a $499-per-month premium in 2020.
The number of quarters counted do not have to be consecutive in order to count towards your qualified total.
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Can I Have Both At The Same Time
If you qualify for both Medicare and Medicaid, you can have them both simultaneously. When you have both it means that you are unlikely to have any out-of-pocket medical expenses. Around 20 percent of Medicare beneficiaries are also eligible for Medicaid. They are called dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program….. You would need to apply for each one separately to determine if you can qualify for both.
Dual-eligibles are categorized based on whether they receive full or partial Medicaid benefits. Full benefit dual-eligibles receive comprehensive Medicaid coverage, while partial benefit dual-eligibles receive help with their Medicare premiums and cost-sharing through one of four Medicare Savings Programs.