Medicare Advantage Eligibility Requirements
While regular Medicare Advantage does not cover ESRD, you may qualify for a Medicare Special Needs Plan. SNPs are special types of Advantage plans specifically designed for a particular condition or financial situation.
You can keep your Medicare Advantage plan if you purchased it before developing ESRD. And you can buy an Advantage plan after being medically determined to no longer have ESRD usually from a successful kidney transplant.
Special Enrollment Or Election Periods
Some special circumstances might qualify you to sign up for Medicare during a Special Election Period .
For Original Medicare, Part A and Part B, some examples of these situations include, but arent limited to:
- Youre covered through an employers or unions group health plan . You can sign up for Original Medicare anytime, as long as you is working.
- Your coverage through an employers or unions group health plan ends. You have eight months to sign up for Medicare, starting the month after the employment ends, or the employment-based health plan insurance ends, whichever happens first.
Other Medicare plans, such as Medicare Advantage plans and Medicare Prescription Drug Plans, have other specific Special Election Periods. Some examples of these situations for Medicare Advantage and Medicare Prescription Drug Plans include, but arent limited to:
- Moving to a new location thats not in your plans service area
- Moving to, living in, or moving out of a facility such as a long-term care hospital or skilled nursing facility
- Losing your coverage for example, Medicare cancelling your plans contract
Medicare Mythbuster: ‘i Must Enroll In Medicare At Age 65’
Sample Medicare Card
medicare.gov
Many people thinking about Medicare enrollment experience stress. Adding to that stress is a variety of Medicare myths and misunderstandings. Perhaps one of the biggest myths is I must enroll in Medicare at age 65, no matter what.
Lets look at a few facts of Medicare enrollment.
Fact #1: Those who are already receiving Social Security benefits before age 65 will be enrolled in Medicare automatically when they turn 65. They do not have to do anything they will get their Medicare card in the mail.
Depending on the type of coverage one has, suspending Part B, medical insurance, in this situation, might be advantageous.
Fact #2: Those who plan to enroll in Social Security at age 65 must also enroll in Medicare.
In both cases , enrollment in Medicare, at a minimum Part A, hospital insurance, is required because it is a condition of receiving benefits. If you dont want Medicare, then you cant get Social Security.
Fact #3: Those who do not plan to enroll in Social Security at age 65 and who have an employer group health plan, be it as the employee or a dependent, can delay enrolling if the coverage meets two criteria:
A company with 20 or more employees sponsors the group health plan, and
The owner of the policy is still working.
When its time to retire, these individuals can qualify for a special enrollment period. They can enroll in Medicare, without delay or penalty.
Don’t Miss: Does Medicare Cover Assisted Living In Illinois
Do I Have To Take Medicare If I Receive Social Security
For various reasons, there are some who choose to put off Medicare enrollment when they turn 65. If they also delay Social Security benefits, there will be no problem. However, if they get Social Security but do not enroll in Medicare Part A, there can be problems.
In 2011, a district court decision determined that, if you want Social Security, you must also take Medicare. An appeals court in spring 2011 reaffirmed this decision. Here are some facts from the decision, known as Hall vs. Sebelius.
- Medicare Part A, hospital insurance, is mandatory for those who receive Social Security, and may have an impact on existing health coverage.
- A person who does not participate in Medicare Part A must forego all Social Security retirement benefits and repay any benefits already received.
- Medicare Part B, medical insurance, is an optional benefit. Failing to enroll will not jeopardize Social Security benefits.
Can I Decline Medicare Altogether
Medicare isnt exactly mandatory, but it can be complicated to decline. Late enrollment comes with penalties, and some parts of the program are optional to add, like Medicare parts C and D. Medicare parts A and B are the foundation of Medicare, though, and to decline these comes with consequences.
The Social Security Administration oversees the Medicare program, and recommends signing up for Medicare when you are initially eligible, even if you dont plan to retire or use your benefits right away. The exception is when you are still participating in an employer-based health plan, in which case you can sign up for Medicare late, usually without penalty.
While you can decline Medicare altogether, Part A at the very least is premium-free for most people, and wont cost you anything if you elect not to use it. Declining your Medicare Part A and Part B benefits completely is possible, but you are required to withdraw from all of your monthly benefits to do so. This means you can no longer receive Social Security or RRB benefits, and must repay anything you have already received when you withdraw from the program.
Don’t Miss: Does Medicare Cover Handicap Ramps
Medicare Part B Enrollment Options And Penalties
Medicare Part B is optional, but in some ways, it can feel mandatory, because there are penalties associated with delayed enrollment. As discussed later, you dont have to enroll in Part B, particularly if youre still working when you reach age 65.
However, if you dont qualify for a Special Enrollment Period , then you may incur penalty charges. These penalty charges are indefinite for as long as you keep Medicare Part B. When should you enroll in Medicare Part B? If youre not automatically enrolled because of the aforementioned conditions, then here are your enrollment options:
- You have a seven-month initial period to enroll in Medicare Part B. The seven months include the three months prior to your 65th birthday, the month containing your 65th birthday and the three months that follow your birthday month. If you turn 65 on March 8, then you have from December 1 to June 30 to enroll in Medicare Part B.
- If you delay enrollment, then you have to wait until the next general enrollment period begins. For Medicare Part B, you have from January 1 through March 31 to enroll. Coverage doesnt begin until July.
During Your Initial Enrollment Period
This lasts for seven months, of which the fourth one is the month in which you turn 65. For example, if your 65th birthday is in June, your IEP begins March 1 and ends Sept. 30.
To avoid late penalties and delayed coverage, you need to sign up for Medicare during your IEP in these circumstances:
- You have no other health insurance
- You have health insurance that you bought yourself
- You have retiree benefits from a former employer
- You have COBRA coverage that extends the insurance you or your spouse received from an employer while working
- You have veterans benefits from the Department of Veterans Affairs health system
- Youre in a nonmarital domestic relationship with someone of the same or opposite sex and you are covered by his or her employer insurance
If you enroll during the first three months of your IEP, your Medicare coverage begins on the first day of the month you turn 65 . If you sign up during the fourth month, coverage begins on the first day of the following month. But if you leave it until the fifth, sixth or seventh month, coverage will be delayed by two or three months. For example, if your birthday is in June and you sign up in September , coverage will not begin until Dec. 1.
You May Like: How Often Does Medicare Pay For A1c Blood Test
Outpatient Therapy Regulatory And Payment Updates
This webinar will teach participants the new payment changes for Medicare Part B outpatient therapy services for calendar year 2022 along with changes to supervision requirements of an assistant, the 2022 Medicare Part B deductible, 2022 therapy threshold dollar amount, the 15% payment reduction when services are provided in whole or in part by an assistant, an update on the current status of telehealth with traditional Medicare and commercial insurance carriers, the latest on the COVID-19 public health emergency and 2022 CPT code additions, deletions and changes that apply to all insurance carriers. For additional information, click HERE.
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.
Also Check: Does Medicare Medicaid Cover Dentures
Do You Have To Sign Up For Medicare When Youre 65
As long as you have creditable coverage, you dont have to enroll in Medicare when you are 65. Technically, you dont have to sign up for Medicare at all if you dont want to. Medicare is not mandatory, but it is important to be aware that if you choose to sign up later without creditable coverage, youll incur penalties that you may be stuck with for the rest of your life.
The most common reason a new beneficiary may delay enrolling in Medicare is that they have coverage through their employer. However, not all group coverage is creditable coverage. The size of your employer will determine if the coverage is creditable.
Turning Age 65 And Medicare Enrollment With Gic Health Coverage
When to enroll in Medicare Part A and Part B if you have GIC health coverage
This depends on your employment status with the state or a participating GIC municipality:
If you do not enroll in, cancel, or do not pay Medicare Part B within the required time, or cancel Part B and re-enroll at a later date, you will be ineligible for health coverage through the GIC. Also, you may be subject to pay federal government penalties.
You May Like: When Can You Apply For Part B Medicare
What Happens After I Register For Medicare Online
Once you have submitted your application, it will be reviewed by Medicare to ensure all the information is accurate and complete. You should double-check your contact information to make sure it is correct. This is important to ensure prompt delivery of your Identification Card, as well as in the event Medicare needs to contact you about your enrollment.
After your application is received and processed, a letter will be mailed to you with the decision. If you encounter any questions or problems during the process, you can always contact Social Security for assistance.
When To Sign Up For Medicare Part B
If youre retiring, the best time to enroll in Part B is during your Initial Enrollment Period. For those still working past 65, check with your health administrators whether your employer coverage is creditable.
If it is, you can enroll in Part B when you retire or leave your group health plan. Youll be eligible for a Special Enrollment Period when you can enroll without any penalties. If your group health plan is not considered creditable coverage, then you should register for Part B during your Initial Enrollment Period.
If you missed your Initial Enrollment Period, the next enrollment window you can enroll in Part A and Part B is the General Enrollment Period.
You May Like: How To Apply For Medicare In Alaska
Get Someone On Your Side With Medicare
If youre able to answer the questions above, you will be equipped with the knowledge to answer whether it is mandatory to sign up for Medicare at age 65.
Medicare brings up many ifs, ands, and buts. Its easy to get lost in the chaos of it all. Thats why beginning the Medicare process is so frustrating to most.
Instead of doing a cannonball into the pool of Medicare, test the waters. Take it one step at a time and get the help of an experienced Medicare broker like Boomer Benefits. Our help is free.
Options For Employees With Large Employer Coverage
The first, and possibly the most favored option is delaying Medicare enrollment. The reason you can do this is that your employee group plan acts as your creditable coverage. When you have , you are able to delay signing up for Medicare until you lose that creditable coverage.
There are no penalties because your employer coverage is primary, and Medicare is secondary. Many people enroll in Part A and delay Parts B and D until they retire.
However, you may not want to delay Medicare. Your answer to the fourth and final question will help you determine whether you want to enroll in Medicare and let it coordinate with your employer coverage or delay Medicare to save yourself from paying unnecessary Part B and D premiums while you are still working.
Recommended Reading: Does Medicare Pay For A Caregiver In The Home
How Do I Enroll In Medicare
Some people are automatically enrolled in Medicare, and others must sign up.
You must sign up for Medicare if:
- You’re turning 65 and you dont already receive benefits from Social Security.
- You have end-stage renal disease . Coverage for ESRD works differently than in other situations. You should contact Social Security to see when you are eligible and when your coverage could end.
You will be enrolled automatically if:
- You are already receiving benefits from Social Security or the Railroad Retirement Board.
- You are under 65 and have received disability benefits for 24 months.
- You have ALS . Medicare benefits will begin at the same time your disability benefits begin.
Remember, if you are not included in the groups that are enrolled automatically, it is your responsibility to sign up for Medicare.
If you do not sign up when you’re first eligible, the cost of Medicare coverage could increase considerably.
To enroll in Medicare, contact Social Security at 800-772-1213. You may also apply online or in person at your local Social Security office.
Medicare Part B Financial Assistance
Because Medicare Part B requires a monthly payment for its services, some people may find it difficult to pay for the monthly costs associated with this portion of Medicare. Those with limited incomes, in particular, may wonder if there are cost assistance programs in place to help mitigate the financial burden.
In fact, there are a few ways that you can reduce your monthly premiums, or at least make your healthcare more affordable using different programs. One such way is to enroll in a Medicare Savings Program. Run by individual states in conjunction with Medicare, Medicare Savings Plans help you pay for medical costs associated with deductibles, coinsurance and copayments, in some cases. There are four Medicare Savings Programs available, but only three of them relate to Medicare Part B. They are:
The Qualified Medicare Beneficiary Program
- The Qualifying Individual Program
- The Specified Low-Income Medicare Beneficiary Program
Each program has its own eligibility requirements. For example, members of the QI Program must apply every year for assistance. Acceptance is based on a first-come, first-served basis, with priority given to past recipients. You also wont qualify for the QI Program if you receive Medicaid benefits. If you think that you qualify for one of these programs or need financial assistance, then you should contact the Medicaid program in your state to find out more information.
Also Check: What States Have Medicare Advantage Plans
Delaying Your Medicare Enrollment Could Be A Costly Mistake
Countless seniors rely on Medicare for health coverage in retirement. But knowing when to sign up can help you make the most of your benefits while avoiding needless penalties.
Your coverage under Medicare kicks in at exactly 65, but you don’t need to wait until your 65th birthday to sign up. Rather, your initial enrollment window starts three months before the month you turn 65 and ends three months after the month in which you turn 65. So, all told, you get a solid seven months to sign up.
Now if you miss that initial enrollment window, you can still sign up during Medicare’s general enrollment period that runs from Jan. 1 through March 31 each year. But not signing up during your initial enrollment period could end up costing you a higher Part B premium — for life.
Can You Sign Up For Medicare At Any Time
No, you can only enroll in Medicare during one of the enrollment periods. The first opportunity you have to enroll is during your Initial Enrollment Period. If you miss your Initial Enrollment Period, your second opportunity to sign up is during the General Enrollment Period. Outside both of these enrollment windows, you can sign up during a Special Enrollment Period if you qualify.
Read Also: Does Medicare Cover Rides To Medical Appointments
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.
