Think you may be eligible for Medicare? Not quite sure where to start? We make getting Medicare easy and understandable. Let’s go through the process on how you can get the Medicare coverage you need.
What You Need to Know About Medicare
First things first — when you go to get Medicare, what exactly are you signing up for? At its core, Medicare is a federal government program set in place to provide those without employer health insurance to receive coverage when they aren’t working.
There are five main parts of Medicare:
- Medicare Part A
- Medicare Part B (together, Part A and Part B are called Original Medicare)
- Part C (often called Medicare Advantage)
- Part D
- Medicare Supplements (often called Medigap)
Within these different parts, there are individual plans you can also choose from. Original Medicare benefits are provided equally across the United States. As long as you fall within the average income bracket, your costs are also equal.
For Medicare Advantage, you have a few options:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Medicare Savings Account (MSA)
- Private Fee-For-Service (PFFS)
- Special Needs Plan (SNP)
- Dual-eligible Special Needs Plan (D-SNP)
- Chronic Special Needs Plan (C-SNP)
- Institutional Special Needs Plan (I-SNP)
These plans, unlike Original Medicare, will vary in cost and coverage depending on the plan and provider you choose, as well as various personal factors such as age and residence location. No matter what, however, every Advantage plan is required to cover the same benefits as Original Medicare — if you are considering getting an Advantage plan, think of it as a way to coordinate your Original Medicare benefits to get a better price on your care.
Medicare Part D covers prescription drugs. You can get this plan either alongside your Original Medicare coverage, alongside a Medicare Advantage MSA or PFFS plan, or find an Advantage plan that includes Part D coverage.
Finally, Medigap can be added to your Original Medicare coverage. There are 10 different types of supplements, each of which varies in cost and benefits — plans A, B, C, D, F, G, K, L, M, and N.
Who is Eligible for Medicare
Now you know what you can get — now, the question is, who can get it? As mentioned earlier, Medicare was made to provide coverage for those who are not receiving healthcare coverage through their employer. What groups come to mind? The retired and the disabled.
You are eligible for Medicare if you have a disability, End-Stage Renal Disease (ESRD), or if you are 65 years old or older.
Enrolling with a Disability
You can get Medicare with a disability once you have received at least 24 months of Social Security Disability Insurance (SSDI) payments. Once this happens, you should receive a letter in the mail informing you of your automatic enrollment in Original Medicare.
You can enroll in additional Medicare plans as well, but your options may be limited till you turn 65. Once you do turn 65, if you are still receiving Medicare on a disability, your coverage will flip over to regular Medicare.
Enrolling with ESRD
You’re also eligible for Medicare if you are experiencing End-Stage Renal Disease (ESRD). You should get both Medicare Part A and Part B to receive the most coverage for your kidney treatments.
These are the specific eligibility requirements you must meet before you can enroll:
- Your kidneys no longer work
- You need regular dialysis or have had a kidney transplant
- One of these applies to you:
- You’ve worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
- You’re already getting or are eligible for Social Security or Railroad Retirement benefits
- You’re the spouse or dependent child of a person who meets either of the requirements listed above
Enrolling at Age 65
Finally, the most common and well-known way to qualify for Medicare is by age. Once you turn 65, you can enroll in any Medicare plan of your choice.
65 years old is also the best time to enroll in Medicare (for those who don’t qualify with a disability or ESRD). 3 months prior to your 65th birthday, you will begin what is called your Initial Enrollment Period (IEP). This will continue through your birthday month through the three months following, for a total 7 month period.
During this time, you can enroll in Original Medicare, as well as any Medicare Advantage and/or Part D plan of your choice. You must have both Part A and Part B to get any additional coverage. You will be automatically enrolled in Original Medicare if you have been retired for at least 4 months prior to your 65th birthday.
If you want to purchase a Medicare Supplement, the best time to do so is during the 6 months following your 65th birthday called your Medigap Open Enrollment Period.
If You Missed Enrollment
Whether you purposefully or unintentionally missed your Initial Enrollment Period (IEP), what do you do when your 7-month window has passed, and you’re not enrolled?
It is best to enroll in Original Medicare as soon as possible. You can enroll in Original Medicare during the General Enrollment Period (GEP) that takes place from January 1st through March 31st. However, keep in mind that enrolling during the GEP may add a late penalty to your Medicare monthly premium — that’s why it’s best to enroll during your IEP if you’re able.
The late enrollment fee is calculated by taking a percentage of the national average premium. For Part B, your premium will increase by roughly 1% each month you don’t enroll past your IEP, for about a 10% total increase for the 12 months you could have had Part B.
Part D late penalties are calculated by multiplying 1% of the national average premium, which is currently $33 in 2022.
Most people will receive premium-free Part A. You get this for working at least 10 years while paying Social Security taxes. If you do pay a Part A premium, your late enrollment penalty is calculated the same way as Part B, for a roughly 10% increase for each year you aren’t enrolled.
What if you want to enroll in additional coverage later on? The Annual Enrollment Period (AEP) lets you make changes to your Medicare coverage, including:
- Enroll in a Medicare Advantage plan instead of just Original Medicare
- Enroll in a Part D plan in addition to Original Medicare
- Unenroll in Medicare Advantage and/or Part D and go back to just Original Medicare
- Change Medicare Advantage or Part D plan
- Change Medicare Advantage or Part D plan providers
If you are considering getting Medicare Advantage or Part D during the AEP, make sure you are comparing all the plans available in your area. The same applies to any potential changes you may make. Doing a thorough evaluation of your needs, budget, and most of all, available providers, will ensure that you are still getting your best Medicare coverage.
Getting Medicare with Employee Benefits
There is an exception to the late enrollment penalty, however, if you are still working by the time you turn 65, or if you are still receiving health insurance from your former employer.
As mentioned earlier, Medicare enrollment is contingent on whether or not you are able to receive health insurance through an employer. So, if you still have employee health insurance, you may not need Medicare. You can choose to keep your employee benefits over Medicare.
Medicare Part A covers emergency hospital and skilled nursing facility visits. Part B covers general medical needs, including preventative care. For Original Medicare alone (assuming you have premium-free Part A), you will pay $170.10 a month in 2022. You also have deductibles. For Part A, the deductible is $1,556 in 2022. For Part B, it is currently $233. You will also have various out-of-pocket costs, typically about 20% of the total cost of the healthcare item or service.
If you are working and exempt from the late enrollment penalty, why are we telling you all about Medicare? Well, you have the full power of choice — the power to choose employee benefits over Medicare, Medicare over employee coverage, or both. It’s all about getting the best coverage that works for your needs and budget.
Perhaps your employee benefits are fine and inexpensive enough to justify not needing Medicare. You are perfectly in your right to do so without a penalty. Once your employee coverage ends, you have 6 months to enroll in Medicare. After that, the penalty will begin to accrue.
On the other hand, maybe the health insurance through your employer isn’t cutting it. Medicare is an excellent insurance plan, and you can absolutely fully switch over.
However, the best option may be to simply do both. Knowing the cost and coverage of Medicare is important to decide whether or not your current coverage would supplement Medicare, and whether or not you can budget the additional cost.
With Medicare added to your employer coverage, this could mean far more health coverage and a much bigger safety net to get the care you need before you retire.
Get the Medicare Help You Need — Call Affordacare
Affordacare specializes in helping others. We don’t just want you to get Medicare, we want you to understand it. With us, you can rest assured knowing that you are getting the best advice out there. Call today!