Sunday, June 16, 2024

When Can You Get Medicare Health Insurance

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Medicare & You: Understanding Your Medicare Choices

Premiums for Medicare Part A are $0 if youâre getting or are eligible for federal retirement benefits. Itâs also premium-free if youâre under 65 and receiving Social Security disability benefits for 24 months, or are diagnosed with end-stage kidney disease. If youâre eligible for Medicare, but not other federal benefits, youâll pay a Part A premium of $259 or $471 each month, depending on how long youâve paid Medicare taxes.

The deductible for Medicare Part A is $1,484 per benefit period. A benefit period begins the day youâre admitted to a hospital and ends once you havenât received in-hospital care for 60 days.

The Medicare Part A coinsurance amount varies, depending on how long youâre in the hospital. Coinsurance is typically a percentage of the costs, but Medicare designates the coinsurance as a flat fee.

Hereâs how much youâll pay for inpatient hospital care with Medicare Part A:

  • Days 1-60: $0 per day each benefit period, after paying your deductible.

  • Days 61-90: $371 per day each benefit period.

  • Day 91 and beyond: $742 for each “lifetime reserve day” after benefit period. You get a total of 60 lifetime reserve days until you die.

  • After lifetime reserve days: All costs.

The cost of a stay at a skilled nursing facility is different. This is what a skilled nursing facility costs under Medicare Part A:

Hospice care is free.

Read more about how Medicare Part A covers these costs here.

What Isnt Covered In Medicare

Original Medicare, sometimes called traditional Medicare, doesnt cover some health-related services. These include:

  • Long-term care
  • Hearing aids and exams for fitting them
  • Routine foot care

The governments official Medicare website offers a tool that can help you find out if your test, item or service is covered.

Medicare Before You Retire Maybe

Before you do anything about enrolling in Medicare, you need to talk with your employer benefits manager. You need to understand if your employer insurance qualifies as creditable coverage that could allow you to delay Medicare as well as find out how Medicare and your employer coverage may work together. In some cases your employer coverage will enable you to put off Medicare enrollment, and in other cases you may be required to take full Medicare benefits at age 65 even if you continue working. Quickly discover your options here.

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How Do I Become Eligible For Medicare Advantage

If youre eligible for Medicare benefits, you have to choose how to receive them either through the government-run Original Medicare program, or through Medicare Advantage. The majority of all Medicare beneficiaries use Original Medicare, but more than four in ten are enrolled in Medicare Advantage plans, and Advantage enrollment has been steadily climbing at a much faster pace than overall Medicare enrollment.

You need to have both Medicare Part A and Part B in order to enroll in Medicare Advantage, and you can select a plan during your Medicare initial enrollment period the seven months surrounding the month you qualify for Medicare .

Most Medicare Advantage plans also include Part D prescription drug coverage if you have a Medicare Advantage plan, you typically receive your Part D coverage together with the health and hospital benefits, in one single package, although the maximum out-of-pocket limits for Medicare Advantage do not include the cost of prescription drugs.

People with end-stage renal disease are eligible for Medicare, but used to be ineligible for most Medicare Advantage plans. This changed as of 2021, however, under the terms of the 21st Century Cures Act. As of 2021, people with ESRD have the same access to Medicare Advantage plans as other Medicare beneficiaries.

For More Information Specific To Your Medicare Policy

Can you get Medicare benefits if you

If you have Medicare and an additional insurance policy and youre still unsure which is primary and which is secondary, or if youd like to learn more about all of your insurance options even though you are or will be Medicare eligible, you can contact the Benefits Coordination & Recovery Center at 798-2627 .

You can also reach out to the State Health Insurance Assistance Program for assistance. To find your local SHIP, offers an easy-to-use online SHIP search tool that will provide the information you need.


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Your First Chance To Sign Up

Generally, when you turn 65. This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65.

Avoid the penaltyIf you miss your 7-month Initial Enrollment Period, you may have to wait to sign up and pay a monthly late enrollment penalty for as long as you have Part B coverage. The penalty goes up the longer you wait. You may also have to pay a penalty if you have to pay a Part A premium, also called Premium-Part A.

Why Medicare Advantage Plans Can Fall Short

For many older Americans, Medicare Advantage plans can work well. A JAMA study found that Advantage enrollees often receive more preventive care than those in traditional Medicare. Advantage plans are competing not just on cost but on delivering quality care, says Kenton Johnston, PhD, associate professor of health management and policy at Saint Louis University, co- author of the study.

But if you have chronic conditions or severe health needs, you may want to think twice about Medicare Advantage because of the requirements for pre-authorization and staying in-network, says Melinda Caughill, co-founder of 65 Incorporated, a firm that provides Medicare enrollment guidance to financial advisers and individuals.

If you need to see multiple specialists, and you have to get referrals for each appointment or fight to overturn denials, it can be really challenging, Caughill says.

Steven Feld, 65, a retiree in South Pasadena, Fla., struggled to get coverage for an injection to treat his arthritic knee. The treatment, a prefilled injection administered in a doctors office, is deemed a medical device by the FDA, so the plan twice denied the coverage. When I was on my employers group plan, there was no problem getting the injection covered, says Feld, who joined his Medicare Advantage plan in May.

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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?

Choosing The Private Insurance Option

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If none of these situations apply to you and you want to use private insurance instead, its important to understand that there is only a seven-month window in which you can apply for Medicare benefits, according to

This period typically begins three months before your 65th birthday, includes the month of your birthday, and ends three months later. Apply at any other time and you may face a lapse in coverage or penalties.

These penalties appear as premiums that increase by 10 percent for each 12-month period youre eligible for Part B but do not sign up. Also, if you bypass your Initial Enrollment Period, you can only sign up for Part B during the General Enrollment Period, with is January 1st to March 31st each year, with coverage beginning in July.

Now, lets say that youre okay with this and still want private insurance versus Medicare. If you go through the Marketplace to get that insurance, warns that it is illegal for anyone to sell you a Marketplace plan if they know that you have Medicare.

So, if you have already signed up for Medicare, the Marketplace is not an option for finding a new insurance plan. The only exception is if you are paying a premium for Medicare Part A. In this case, you can drop Medicare and go with a plan that you find on the Marketplace.

Additionally, if you are able to sign up for Medicarewhether due to age or disabilitybut have not, you can purchase a Marketplace plan then, too.

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If You Have Retiree Health Benefits

If you have retiree coverage and want to buy a Marketplace plan instead, you can. But:

  • You cant get premium tax credits and other savings based on your income. This is true only if youre actually enrolled in retiree coverage. If youre eligible for but not enrolled in retiree coverage, you may qualify for premium tax credits and lower out-of-pocket costs based on your household size and income.

  • If you voluntarily drop your retiree coverage, you wont qualify for a Special Enrollment Period to enroll in a new Marketplace plan. You wont be able to enroll in health coverage through the Marketplace until the next Open Enrollment period.

What To Expect Once You Qualify For Medicare

For relatively healthy people, health insurance prior to Medicare can turn out to be a little-used safety net, giving you peace of mind, until your robust Medicare benefits kick in. Once on Medicare, you then have dependable health coverage for any big bills from day one.

Youll want to plan ahead. Its a good idea to read about Medicare well before your 65th birthday. Once you understand your options, youll be in a better position to size up your health needs and decide what to treat immediately and what to safely postpone until you join Medicare.

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What Else Do I Need To Know

  • Medicare can help cover your costs for health care, like hospital visits and doctors services.
  • Most people dont pay a premium for Part A, but you do pay a monthly premium for Part B.
  • If you cant afford the monthly premium, there are programs to help lower your costs. Get details about cost saving programs.

Are Children Eligible For Medicare

How can you get Medicare quotes easily? Read this ...

If you want to qualify for Medicare, children must be disabled and checked through the Social Security Administration. They need to have been receiving social security for their benefits for two years before applying for Medicare. However, if your child has End Stage Renal Disease, which is a kidney condition that needs dialysis every day or a transplant for the affected kidney. Medicare pays for doctors visit and medical services that are provided for those disabilities and conditions that are allowed by Medicare.Quick Facts on Medicare for Kids

  • Parents are still responsible for paying Medicare programs
  • Some child healthcare programs are free through Medicare. For example, you may be eligible for CHIP or Childrens Health Program
  • Even if you have other types of insurance, you can still receive Medicare

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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

Will I Get Medicare At 62 If I Retire Then

If you retire before the age of 65, you may be able to continue to get medical insurance coverage through your employer, or you can purchase coverage from a private insurance company until you turn 65. While waiting for Medicare enrollment eligibility, you may contact your State Health Insurance Assistance Program to discuss your options.

Here are other ways you may be eligible for Medicare at age 62:

  • Or, you have been diagnosed with End-Stage Renal Disease
  • You may qualify for Medicare due to a disability if you have been receiving SSDI checks for more than 24 months
  • Are getting dialysis treatments or have had a kidney transplant

Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.

Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.

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Questions To Ask Your Employer Benefits Manager Include:

  • Will my health insurance change if I enrolled in Medicare? If so, how?
  • How much is deducted from my paycheck for my employer health insurance?
  • Do I have through my employer?
  • How will my covered dependents be impacted if I choose to get Medicare?

This information will help you weigh your choices and decide whats best for you. You may decide to enroll in Medicare Part A, Part B or both. Or you may be able to and want to delay enrolling in Medicare all together until you retire.

What Can I Do Next

How to Get Health Insurance (Health Insurance 3/3)

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.

Because the company has less than 20 employees, your job-based coverage might not pay for health services if you dont have both Part A and Part B.

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Time Limits On Getting Medicare For Kids

Medicare benefits have time restrictions for those who have end stage renal disease. In general, coverage ends about 12 months following the last dialysis treatment. It can also end after three years past from the date that your child received a kidney transplant. IF you have a child who is disabled, then he or she can keep benefits as long as they continue to be disabled. The law allows anyone over the age of 22 to qualify for Medicare through disability if it began before age 18 and even if you dont have any working credits.

How Do You Apply By Phone

Call 772-1213 or TTY 325-0778 between 7 a.m. and 7 p.m. from Monday through Friday.5 Keep in mind that this process takes longer because forms have to be mailed to you, which you then complete and send back. At peak times, applying for Medicare by phone could take a month or more.

If you worked at a railroad, you can enroll in Medicare by calling the Railroad Retirement Board at 772-5772 or TTY 751-4701, 9AM 3:30PM, Monday Friday.

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If You Retire Before Age 65 Without Health Coverage

If you retire before youre 65 and lose your job-based health plan when you do, you can use the Health Insurance Marketplace® to buy a plan.

Losing health coverage qualifies you for a Special Enrollment Period. This means you can enroll in a health plan even if its outside the annual Open Enrollment Period.

If you want to enroll because you lost your job-based coverage, see our Special Enrollment Period page for more information.

When you fill out a Marketplace application, you’ll find out if you qualify for a private plan with premium tax credits and lower out-of-pocket costs. This will depend on your income and household size.

Youll also find out if you qualify for free or low-cost coverage through the Medicaid program in your state.

When Can You Sign Up If You Missed The Initial Enrollment Period

Can You Have Other Insurance Besides Medicare?

If you didnt sign up when you were first eligible and you dont have current healthcare coverage elsewhere , youll have to wait for the next General Enrollment Period which runs each year from January 1 through March 31.

Your coverage will then begin in July of that year, and you may have to pay a late enrollment penalty on your Medicare Part B premium for as long as you have Part B coverage. Your premium will go up by 10% for every 12-month period you werent enrolled.

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