Medicare Eligibility Due To Specific Illnesses
In addition to the above ways to qualify for Medicare health insurance, you may also be eligible if you have one of the following diseases:
- End-stage renal disease. To qualify, you must need regular dialysis or a kidney transplant, and your coverage can begin shortly after your first dialysis treatment. If you receive a transplant and no longer require dialysis, youll lose Medicare eligibility.
- Amyotrophic lateral sclerosis. Also known as Lou Gehrigs Disease, patients diagnosed with this terminal disease gain immediate Medicare eligibility.
How Do I Enroll In Medicare
Administration at 1-800-772-1213 to enroll in Medicare or to ask questions about whether you are eligible. You can also visit their web site at www.socialsecurity.gov.
The Medicare.gov Web site also has a tool to help you determine if you are eligibile for Medicare and when you can enroll. It is called the Medicare Eligibility Tool.
Did You Answer Yes To Question 2
If you are still working, then we immediately move to the next question, which is how many employees does the company that you work for have? Your answer will determine whether or not you will need to sign up for Medicare at age 65.
Was your answer, less than 20 employees?
Then you will need to as soon as youre eligible. If you fail to enroll in Medicare when you become eligible while working for a company that has less than 20 employees, you will incur late enrollment penalties. Medicare is primary when you work for a small company, so you need both Parts A and B.
Was your answer, 20 or more employees? Great, then you have options.
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When Your Coverage Starts
The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always starts on the first of the month.
If you qualify for Premium-free Part A: Your Part A coverage starts the month you turn 65.
Part B : Coverage starts based on the month you sign up:
If you sign up:
1 month after you turn 65
2 months after you sign up
2 or 3 months after you turn 65
3 months after you sign up
What Are Cases When Medicare Automatically Starts
Medicare will automatically start when you turn 65 if youve received Social Security Benefits or Railroad Retirement Benefits for at least 4 months prior to your 65th birthday.
Youll automatically be enrolled in both Medicare Part A and Part B at 65 if you get benefit checks. According to the Social Security Administration, more than 30% of seniors claim Social Security benefits early.1 For those seniors, Medicare Part A and Part B will automatically start when they reach the age of 65.
When do You Get Your Medicare Card?
You can expect to receive your Medicare card in the mail three months before your birthday. Your Medicare card will come with a complete enrollment package that includes basic information about your coverage. Your card wont be usable until you turn 65, even though youll receive the card before that time.
What Are Your Costs?
Keep in mind that youll still have to pay the usual costs of Medicare, even though youre automatically enrolled. Once your Medicare is active, the cost of your Part B premium will be deducted from your Social Security or RRB benefits.
What If You Already Enrolled in Medicare?
What about Medicare Supplement ?
What If I Switch to Medicare Advantage?
What I Have Part A?
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Documents You Need To Apply For Medicare
To begin the application process, youll need to ensure you have the following documentation to prove identity:
- A copy of your birth certificate
- Your drivers license or state I.D. card
- Proof of U.S. citizenship or proof of legal residency
You may need additional documents as well. Make sure to have on hand:
- Your Social Security card
- W-2 forms if still active in employment
- Military discharge documents if you previously served in the U.S. military before 1968
- Information about current health insurance types and coverage dates
If you are already enrolled in Part A and have chosen to delay enrollment in Part B, you will need to complete additional forms .
Medicare Vs Medicaid Compare Benefits
In the context of long term care for the elderly, Medicares benefits are very limited. Medicare does not pay for personal care . Medicare will pay for a very limited number of days of skilled nursing . Medicare will also pay for some home health care, provided it is medical in nature. Starting in 2019, some Medicare Advantage plans started offering long term care benefits. These services and supports are plan specific. But they may include:
- Adult day care
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Applying For Medicare With Employer Coverage
Can you still enroll in Medicare coverage, even if youre not yet seeking retirement? The answer is yes! Medicare coverage can coincide with your group coverage through your employer. If your employer has more than 20 employees, your group coverage will work as your primary insurance, and Medicare will be your secondary insurance.
You can choose to apply for Part B, or you can wait until leaving your employer group coverage. For more information on the benefits of obtaining Medicare while receiving group coverage through work, give our team a call, and we can review the pros and cons.
Sometimes beneficiaries dont want to apply for Part B when they initially become eligible because of employer health coverage. Should you lose your health insurance through your employer, or if you prefer to switch over to Medicare, you can apply any time while receiving coverage through your employer.
In General Its 65 But You Might Be Eligible Sooner
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When you think of Medicare, you probably assume that its for people of retirement age. Thats true, but the program covers more than just those who have worked all their life. You might be eligible right now and not know it. Our research has found that while more than 80% of beneficiaries are people aged 65 or older, others receive services at a younger age due to a qualifying disability.
How Do You Enroll In Medicare Part D
When enrolling in Part D, it is important to make sure that you have considered all your options. Be sure to compare the plans in your area, both for costs and formularies. If there is a certain medication you need or expect to need one day, its important to make sure that it is covered.
Medicare offers a plan finder tool that can help you locate plans available in your area. You also should compare different providers near you to look into things like how well they are rated and how their customer service is.
You should also be sure to compare whether it makes more sense for you to purchase a stand-alone plan or switch entirely to Medicare Advantage. Depending on the plans available near you and your personal health needs, each option can make sense for you.
Signing Up For Premium
You can sign up for Part A any time after you turn 65. Your Part A coverage starts 6 months back from when you sign up or when you apply for benefits from Social Security . Coverage cant start earlier than the month you turned 65.
After your Initial Enrollment Period ends, you can only sign up for Part B and Premium-Part A during one of the other enrollment periods.
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How To Apply For Medicare Part A And Part B Before Age 65
Some people are automatically enrolled in Original Medicare. If youve been receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months in a row, you will be automatically enrolled in Original Medicare, Part A and Part B, when you reach the 25th month.
If you have ALS or Lou Gehrigs disease, youre automatically enrolled in Medicare the month you begin receiving your Social Security disability benefits.
Some people will need to sign up for Medicare themselves. If you have end-stage renal disease , and you would like to enroll in Medicare Part A and Part B, you will need to sign up by visiting your local Social Security Office or calling Social Security at 1-800-772-1213 . If you worked for a railroad, please contact the RRB to enroll by calling 1-877-772-5772 , Monday through Friday, 9 AM to 3:30 PM, to speak to an RRB representative.
If You Already Receive Benefits From Social Security:
If you already get benefits from Social Security or the Railroad Retirement Board, you are automatically entitled to Medicare Part A and Part B starting the first day of the month you turn age 65. You will not need to do anything to enroll. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If your 65th birthday is February 20, 2010, your Medicare effective date would be February 1, 2010.
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Medicare Special Enrollment Period
Special situations may come up that give you the chance to sign up for or change your Medicare plan outside of your Initial Enrollment Period or the Annual Enrollment Period.
There are several special cases that make you eligible for a Special Enrollment Period.
Here are some common situations:
- You move: If you move to an address outside your plans service area, into a nursing home, or you have different plan options at your new address, youll be able to apply for a new plan.
- You want to switch to a 5-star Medicare plan: Every year, Medicare evaluates plans based on a 5-star rating system. Medicare considers these plans excellent. You can make the switch once to a 5-star plan anytime from Dec. 8 through Nov. 30 if one is available in your area.
- You lose your current coverage: This applies if you or your spouse will retire or change to a job that doesnt offer coverage. It doesnt apply if your insurance company cancels your coverage because you didnt pay your monthly premiums.
- Your plan changes its contract with Medicare: Enrollment in a plan depends on the plans contract with Medicare, and for various reasons these contracts could change.
Your new coverage begins on the first day of the month after you sign up.
If You Are Younger Than Age 65 With A Disability
If you are younger than age 65 and receive disability benefits under Social Security Disability Insurance or Railroad Retirement, you will automatically be enrolled in Medicare Parts A and B in the 25th month of your disability payments, or sooner if you have either end-stage renal disease or amyotrophic lateral sclerosis . You will need to to cover your prescription drug benefits.
During the 24th month of your SSDI payments, Medicare will send you an initial enrollment package containing general information, a questionnaire and your Medicare card.
If you want both Medicare Part A and Part B , simply sign your Medicare card and keep it in your wallet.
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When Should You Apply For Medicare If You Have Employer Health Coverage
Most people should sign up for Medicare Part A when theyre first eligible because it rarely costs anything. But some people delay enrolling in Part B because they dont want to pay the monthly premium. The decision usually depends on the type of health coverage you already have.
You can put off enrolling in Part B at age 65 if you have group health coverage through your or your spouses job and the employer has at least 20 employees.6 Youll be able to enroll with no penalty during the Special Enrollment Period that follows the end of your employers insurance. You can also choose to enroll in Part B while still insured and pay the premium.
If your employer has fewer than 20 employees, you should apply for Part A and Part B as soon as youre eligible.7
Be sure to talk to your employers benefits administrator about how signing up for Medicare will affect your coverage or Health Savings Account .8 You cannot contribute to an HSA if you have Medicare Part A. Your administrator can help you time the beginning and end of your coverage through work and your new health insurance so theres no gap in your coverage.
When your group coverage is ending, youll need to complete documentation and submit it to your Social Security office. If you have questions, ask Social Security.
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When Can You Change Your Medicare Advantage Or Medicare Part D Prescription Drug Coverage
- During your Initial Enrollment Period for Medicare, described above
- During Medicares Annual Election Period
- During the Medicare Advantage Open Enrollment Period . You cant change from one stand-alone Medicare prescription drug plan to another during this time.
- During a Special Election Period , if you qualify for one. Medicare allows SEPs for certain situations, such as losing your health-care coverage
Read more about Medicare election periods here.
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When Do I Need To Sign Up For Medicare Part A
As stated above, if youre collecting Social Security benefits, youll automatically get Part A and Part B. If youre not automatically enrolled, the best time to enroll in Part A is during your Initial Enrollment Period.
As long as you worked a minimum of ten years, Part A will be premium-free. Even if youre still working, it makes sense to join Part A to help keep your out-of-pocket medical costs to a minimum.
Medicare For Individuals Who Are Divorced Or Widowed
Many individuals who are divorced or widowed are concerned that the loss of their spouse will somehow affect their ability to qualify for Original Medicare .
Rest assured your marital status does not affect your ability to qualify for Medicare. You are eligible for Medicare if:
- You are a U.S citizen or legal resident for at least 5 consecutive years and
- You are:
- Age 65 or older or
- Younger than 65 with a qualifying disability or
- Any age if you have end-stage renal disease or amyotrophic lateral sclerosis .
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Enrolling In Medicare Part D
Medicare Part D covers prescription drugs. You can add a stand-alone prescription drug plan to augment your Medicare A and B, or you can choose a Medicare Advantage plan that provides all of the benefits of Medicare A and B, plus prescription drugs and often other benefits as well.
Youre first eligible to enroll in Part D when youre first eligible for Medicare. When you apply, you will enroll in a private plan and must enroll during a seven-month period that starts three months prior to the month that you reach age 65. If you dont enroll during this period, you may pay a late-enrollment penalty that will raise your Part D premium when you do decide to purchase coverage .
If youre Medicare-eligible because youre disabled AND youve reached age 65, you can enroll in a Part D plan, switch Part D plans, or drop your Part D plan during this seven-month period.
If youre newly eligible because youre disabled, you can enroll starting 21 months after you began receiving RRB or Social Security benefits and have through the 28th month to enroll . Your Part D coverage will start at the beginning of your 25th month of receiving RRB or Social Security benefits.
And if, later on, you want to change to a different Part D plan, you can do that during Medicares Open Enrollment period that runs from October 15 to December 7 each year.
After youve chosen from the various PDP offerings, you can enroll by:
- filling out the paperwork sent by mail from Medicare, or
Have You Or Your Spouse Worked For At Least 10 Years At Jobs Where You Paid Medicare Taxes
Generally, youre first eligible to sign up for Part A and Part B starting 3 months before you turn 65 and ending 3 months after the month you turn 65.
Avoid the penalty If you dont sign up when youre first eligible, 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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