When Am I Available For Medicare

Medicare Disability Eligibility Requirements

Am I Eligible for Medicare Part D?

At the start of the 25th month that you obtain 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.

Medicaid Or Medicare Savings Programs

Medicare beneficiaries with limited income or very high medical costs may be eligible to receive assistance from the Medicaid program. There are also Medicare Savings Programs for other limited-income beneficiaries that may help pay for Medicare premiums, deductibles, and coinsurance. There are specified income and resources limits for both programs. Contact your local county Department of Social Services or SHIIP to apply for one of these programs.

Sorting Out Your Options

All of this can lead to confusion about which sign-up options are best for you. Most people sign up for A, B, and D, with many adding Medigap coverage as well. Others choose Medicare Advantage instead of A, B, and D. If you choose a Medicare Advantage plan and want prescription drug coverage, make sure it is provided by your MA plan. If not, you may need to add Part D coverage to your plan.

Because Medicare normally pays first , chances are that any available retiree policy will require you to have, at minimum, Medicare Part A and Part B. Check out costs and coverage before signing up for Medicare.

If you decide to go back to work after retirement and are eligible for group health plan coverage, it will likely work differently with Medicare. Check with the human resources department of your new employer to avoid overlaps or lapses in coverage. If you have retiree health insurance from a former employer, find out what happens if you cancel that coverage but want it back at a later date.

Costs for Medigap coverage depend on the type of policy you have and where you live they can range from $50 per month to several hundred dollars. Learning about drug pricing tiers and Part D can help you decide on an optimal plan.

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Will My Health Insurance Premium Go Down If I Enroll In A Different Medicare Part D Prescription Drug Plan

Retirees only: No. Your health insurance premium includes both medical and prescription drug coverage. If you choose to enroll in a different Medicare Part D plan, you will be dropped from the Navitus MedicareRx plan and you will have to pay an additional premium to the other plan you enroll in. However, you will still have secondary coverage with the supplemental wrap benefits under the State of Wisconsin Group Health Insurance Program. There is no partial refund of the State of Wisconsin Group Health Insurance Program premium if you choose to enroll in a different PDP. Navitus will coordinate coverage with Medicare and pay secondary claims after Medicare processes your prescription claims from the other Medicare Part D plan, minus the applicable copayments and coinsurance that are your responsibility. If you enroll in another Medicare Part D plan, and you intend to stay in that program, notify ETF immediately. If ETF enrolls you in Navitus MedicareRx, you may be automatically disenrolled from your other plan by CMS.

When Am I Eligible For Medicare Supplement Coverage

Am I Eligible For Medicare Part A and Part B?

Because Medicare Supplement policies complement your Original Medicare coverage, you must be enrolled in Part A and Part B to be eligible for this type of policy. Youll also need to stay enrolled in Original Medicare for your hospital and medical coverage. Medicare Supplement plans arent meant to provide stand-alone health coverage these plans just help with certain out-of-pocket costs that Original Medicare doesnt cover.

If youre under 65 and have Medicare because of disability, end-stage renal disease, or amyotrophic lateral sclerosis, your eligibility for Medicare Supplement coverage may depend on the state that you live in. Not every state offers Medicare Supplement plans to beneficiaries under 65 .

In addition, keep in mind that Medicare Supplement plans dont include prescription drug benefits . In the past, some Medicare Supplement plans may have included this coverage, but plans sold today dont include prescription drug benefits. If you have an older Medicare Supplement policy with prescription drug coverage, make sure this coverage is creditable , or you could pay a late-enrollment penalty later on if you sign up for Part D later on.

Since Medigap plans dont include prescription drug benefits, if youre enrolled in Original Medicare and want help with prescription drug costs, you can get this coverage by enrolling in a stand-alone Medicare Prescription Drug Plan.

Who Is Eligible For Medicare Part C

Now, lets look at Medicare eligibility for Part C, or Medicare Advantage. Youre eligible to enroll if you already have both Part A and Part B.* Coverage is provided through Medicare-approved private insurance companies. Every plan has a service area that you must live in to receive benefits.

*You typically arent eligible for Medicare Advantage if you have ESRD . However, some insurers offer Special Needs Plans that cover ESRD. That will change in 2021 when enrollment restrictions are lifted for enrollees with ESRD.

Medicare Supplement Plan Eligibility

Medicare supplemental insurance, often called Medigap because it fills in the out-of-pocket coverage gaps in Medicare Parts A and B, is purchased from private insurers.

Medigap helps cover copayments, coinsurance and deductibles from Medicare Part A and Part B.

To be eligible for Medigap coverage, you must meet one of these qualifications:

You must be 65 or older.
You have been diagnosed with Lou Gehrigs disease.

You have been receiving Social Security or Railroad Board disability payments for 24 months.
You must have been diagnosed with end-stage renal disease, requiring regular dialysis or a kidney transplant.

You cannot enroll in a Medicare Advantage plan and a Medigap plan at the same time. You have to choose one or the other.

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Senior Living: Navigating Medicare Open Enrollment Help Is Available

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Senior News

During Medicare Open Enrollment you may be searching for objective and helpful information to decide whether your current plan is still the best one for you. There are several options. There are local insurance brokers who understand the complexities of Medicare and can help you choose the best plan. Or you can call 541-288-8341 to speak with a SHIBA volunteer counselor whos not trying to sell you anything and can guide you through the Medicare maze.

Another option is to search for Medicare plans online. But as with anything online, be cautious. For example, when I searched for Medicare plans the first site listed was at ehealthmedicare.com. And then when I searched for Advantage Plans in my zip code, no Advantage Plans were listed even though I am currently enrolled in one.

Another site listed was Medicare Advantage 2022 where you can Compare plans, prices, and star ratings online. Some premiums as low as $0/month. That sounds good, so I click on that link where I learn ,By entering my contact information and clicking Next above, I consent to receive e-mails, telephone calls, text messages and artificial or pre-recorded messages from Well, forget that website. I dont need any more unwanted phone solicitations I have enough!

But to avoid the sales pitches and misinformation, the best website to visit for unbiased and accurate Medicare information is Medicare.gov.

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Am I Eligible For Medicare Part B

Medicare Matters: When Am I Eligible?

When you receive notification that youre eligible for Medicare Part A, youll also be notified that youre eligible for Part B coverage, which is optional and has a premium for all enrollees.

Part B costs $148.50/month for most enrollees in 2021, although Part B costs more if your income is more than $88,000 . For 2022, the standard Part B premium is projected to be $158.50/month, and the high-income threshold is projected to increase to $91,000 for a single individual and $182,000 for a couple.

Its important to enroll in both Part A and Part B. You have an enrollment window that runs for seven months . And while you can enroll in the three months following your 65th birthday, its best to enroll in Part B early, or you could have gaps in health coverage. If you wait too long, you could end up locked out of Part B and have to wait until the next general Medicare enrollment period.

If you dont enroll during your initial window, you wont lose eligibility for Part B, but you will be penalized with an increased premium when you eventually enroll, which climbs 10% for each year that youre eligible but dont enroll in Part B . The General Enrollment Period for Medicare A and B runs from January 1 to March 31 each year, for coverage effective July 1 with an increased premium if the late enrollment penalty applies.

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Employer Or Military Retiree Coverage

If you or your spouse has an Employer Group Health Plan as retiree health coverage from an employer or the military , you may not need additional insurance. Review the EGHPs costs and benefits and contact your employer benefits representative or SHIIP to learn how your coverage works with Medicare.

How Much Does Medicare Cost

Original Medicare

Original Medicare is divided into Part A and Part B .

Part A helps pay for inpatient hospital care, some skilled nursing care, home health care and hospice care.
Part B helps pay for doctor services, outpatient hospital care, durable medical equipment, home health care not covered by Part A, and other services.Medicare was never intended to pay 100% of medical bills. Its purpose is to help pay a portion of medical expenses. Medicare beneficiaries also pay a portion of their medical expenses, which includes deductibles, copayments, and services not covered by Medicare.The amounts of deductibles and copayments change at the beginning of each year.

Part A – Monthly Premium

If you are eligible, Part A is free because you or your spouse paid Medicare taxes while you were working. You earn Social Security “credits” as you work and pay taxes. For each year that you work, you earn 4 credits.


$458	$471

You are 65 or older, and you receive or are eligible to receive full benefits fr om Social Security or the Railroad Retirement Board

You are under 65, and you have received Social Security disability benefits for 24 months You are under 65, and you have received Railroad Retirement disability benefits and you meet Social Security disability requirements You or your spouse had Medicare-covered government employment You are under 65 and have End-Stage Renal Disease

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What Is Medicare Part A When Can You Enroll

Medicare Part A is hospital insurance. It covers inpatient hospital, hospice, and skilled nursing facility care. Part A also covers home health care.

You can sign up for Part A:

During your Initial Enrollment Period , if youre not automatically enrolled, or

At any time after youre first eligible. If you qualify for premium-free Part A, you wont have a penalty if you enroll past your IEP.6

When Am I Eligible For Medicare If I Have Another Disability

If you are eligible for Medicare because you have a disability other than ALS or ESRD, there is generally a two year waiting period. Once you have been getting disability benefits from Social Security for 24 months or certain disability benefits from the Railroad Retirement Board for 24 months, you may be automatically enrolled in Medicare Part A and Part B. Youll get your Medicare card in the mail three months before your 25th month of disability. You can also sign up for a Medicare Advantage plan or a Medicare Part D Prescription Drug Plan at this time. Your Medicare Open Enrollment Period is three months before you first get Medicare, includes your 25th month of receiving disability, and extends three months after your 25th month of getting disability. If you miss your Medicare Initial Enrollment Period, you can sign up for a Medicare Advantage plan or a Medicare Part D Prescription Drug Plan during the Medicare Open Enrollment Period, which is October 15-December 7 each year.

If you are younger than 65 and are eligible for Medicare because of a disability, you may have to wait until you are 65 to enroll in a Medicare Supplement insurance plan. Federal law does not require the private insurance companies that sell Medicare Supplement to offer these plans to people under 65.

New To Medicare?

Becoming eligible for Medicare can be daunting. But dont worry, were here to help you understand Medicare in 15 minutes or less.

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Delaying Enrollment Could Result In A Permanent Penalty

As described above, you can’t reject premium-free Medicare Part A without also giving up your Social Security benefits. But since your work history is allowing you access to Medicare Part A without any premiums, few people consider rejecting Part A coverage.

The other parts of Medicare, however, do involve premiums that you have to pay in order to keep the coverage in force. That includes Medicare Part B and Part D , as well as supplemental Medigap plans. Medicare Part C, otherwise known as Medicare Advantage, wraps all of the coverage into one plan and includes premiums for Part B as well as the Medicare Advantage plan itself.

So it’s understandable that some Medicare-eligible people, who are healthy and not using much in the way of medical services, might not want to enroll in Part D and/or Part B. Similarly, people who are eligible for Part A but with premiums might want to avoid enrolling in order to save money on premiums. But before deciding to postpone enrollment in any part of Medicare, it’s important to understand the penalties and the enrollment limitations that will apply if you decide to enroll in the future.

There are penalties associated with delaying your Medicare enrollment unless the reason you’re delaying is that you are still working and you’re covered by the employer’s health plan. If that’s the case, you’ll be eligible for a special enrollment period to sign up for Medicare when you eventually retire.

Medicare Eligibility For Nursing Home Care

Although Medicare does cover skilled nursing care, coverage is generally for a short-term stay. Many limitations come with Medicare eligibility for Nursing Home Care.

However, you may qualify for coverage if you meet the following Medicare eligibility rules:

You must have Part A hospital insurance

You must have stayed inpatient for a minimum of 3 days in a row before nursing home admission
A nursing home must be Medicare-certified
Your nursing home start date is within 30 days after spending three days in the hospital

Your doctor must order nursing home care and services
Skilled professionals must provide services

Sign Up: Within 8 Months After Your Family Member Stops Working

If you have Medicare due to a disability or ALS , youll already have Part A .
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 until you turn 65. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?

If You Have A Disability

Am I Eligible For Medicare?

If youve been receiving either Social Security disability benefits or railroad retirement board disability benefits for at least 24 consecutive months, youre eligible to enroll in Medicare at any time, no matter your age.

If you have amyotrophic lateral sclerosis or end stage renal disease , youre also eligible for Medicare at any time, independent of your age.

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Retirees And Those Still Working

If you paid into a retirement system that didnt withhold Social Security or Medicare premiums, youre probably still eligible for Medicareeither through your retirement system or through your spouse. To receive full Medicare coverage at 65, you must have earned enough credits to be eligible for Social Security.

Each $1,470 you earn annually equals one credit, but you can only earn a maximum of four credits each year. You will receive full benefits at retirement if you have earned 40 credits10 years of work if you earned at least $5,880 in each of those years.

If you continue to work beyond age 65, things get a bit more complicated. You will have to file for Medicare, but you may be able to keep your companys health insurance policy as your primary insurer. Or, your company-sponsored insurance plan might force you to make Medicare primary, or other conditions may apply to you.

Theres a lot to consider that makes it prudent to talk to a person knowledgeable in Medicare about your specific choices. This could be your Human Resources department or a Medicare representative.

If you continue to work beyond 65, theres a lot to consider that makes it prudent to talk to a Medicare expert about your choices.

Sign Up: Within 8 Months After Your Family Member Stopped Working

Your current coverage might not pay for health services if you dont have both Part A and Part B .

If you have Medicare due to a disability or ALS , youll already have Part A coverage.

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