Understanding Medicare

Most people become eligible for Medicare in the months leading up to their 65th birthday, but this is not the only way to qualify for Medicare health insurance. Younger people may qualify if they have been entitled to Social Security disability Insurance (SSDI) benefits for at least two years, or if they have certain health conditions. You may even be automatically enrolled in Medicare if you meet certain criteria.

If you do not fully understand your Medicare enrollment options and you choose the wrong plan or do not enroll during the allotted enrollment period, you may find yourself incurring significant out-of-pocket expenses. If you enroll late in certain Parts of Medicare, you will have to pay a penalty each time you pay your premiums for as long as you are enrolled.

It depends. Medicare rules allow you to delay enrollment in Medicare Part B and Medicare Part D without penalty if you are covered by an employer group health plan that covers 20 or more employees, so long as that health coverage is based on your or your spouse’s current, active employment.

If your other health insurance coverage is NOT based on the current, active employment of yourself or a family member, you will likely need to enroll in Medicare. We recommend that you follow up with your current health insurance provider to see if you are required to enroll in Medicare Part B when you become entitled.

It’s possible. The Low-Income Subsidy (LIS) program, also known as “Extra Help,” is available to help pay a portion of Part D prescription drug costs, including premiums, copayments, and deductibles, for certain people with low income and minimal assets. Depending on your income and assets, the Extra Help program may provide a full or partial subsidy. Some people are automatically enrolled in the Extra Help program, while others must apply for the subsidy.

Medicare is a federal health insurance program for people age 65 and older, people under age 65 who are entitled to SSDI benefits, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Your income does not affect your eligibility for Medicare. Medicaid, on the other hand, is a joint federal and state program that helps with medical costs. To qualify for Medicaid, you must have a low income and limited resources.

No, Medicare is not offered as a family or dependent benefit. People must qualify on an individual basis. For example, a person under age 65 does not receive Medicare automatically because their spouse turns 65 and enrolls in the Medicare program.

While there are several types of Medicare coverage, two of the most common are Medicare Advantage and Medicare Supplement – also known as Medigap – plans. While both pay for expenses not covered by Original (“Governmental”) Medicare, you cannot be enrolled in both Medicare Advantage and Medigap coverage simultaneously, as they each serve different functions. There are also several important distinctions between Medicare Advantage and Medigap that you should know if you are looking to enroll in Medicare.

While Medicare costs can add up fast depending on an individual’s needs and coverage selections, it is a myth that Medicare is unaffordable or that it is always more expensive than other forms of healthcare coverage. In fact, many people are surprised to discover that Medicare can lower their medical expenses. There are customizable options available for individuals considering Medicare, and these are worth exploring with the guidance of an experienced Licensed Insurance Agent to better understand all the Medicare available options and their associated costs.

Many people are surprised to learn that Medicare covers a wide range of medical services, as well as many durable goods and medical supplies. Your current doctor is likely to accept Medicare, and Medicare may cover equipment ranging from hearing aids to wheelchairs, depending on the coverage you select. Some Medicare plans also provide additional benefits such as dental, vision, hearing, and services like transportation to healthcare facilities, meal preparation, and gym memberships.

Most individuals will become eligible for Medicare at age 65, but not everyone is automatically enrolled in Medicare at that time. However, there are some circumstances in which you are automatically enrolled in Medicare. You will likely be automatically enrolled in Medicare Part A if you meet one of the following conditions at age 65:

• You have been entitled to Social Security Disability Insurance (SSDI) benefits for 24 months.
• You receive Railroad Retirement Board benefits.

If you’ve been automatically enrolled in a Medicare health plan, you will receive a Medicare card and welcome package in the mail three months before your 65th birthday. If you don’t receive anything prior to turning age 65 or are concerned about your Medicare enrollment status, contact Social Security directly. If you don’t qualify for automatic Medicare enrollment or have other questions about who qualifies and how to enroll, сall 844-378-5784.

While Medicare costs can add up fast depending on an individual’s needs and coverage selections, many people may find Medicare to be surprisingly affordable. In fact, many people are surprised to discover that Medicare can lower their medical expenses. If you are wondering how much Medicare costs, you should explore the many customizable Medicare plan options with the guidance of an experienced Licensed Insurance Agent so you can find coverage options that may fit your unique healthcare and financial needs.