What is Medicare?
What is Medicare?
Medicare is a health insurance program provided by the federal government for qualifying individuals, including people over the age of 65, those with certain disabilities, and individuals with end-stage kidney disease.
Some people may confuse Medicaid and Medicare programs — the primary difference between the two is that Medicaid is a needs-based insurance program, while Medicare is not. Your income is not a determining factor for Medicare qualification.
Although Medicare is a federal insurance program, there are monthly premiums for certain parts of Medicare. Additionally, Medicare does have some limitations and regulations on what it will cover for healthcare-associated costs. Read on to learn more about what Medicare covers and information on enrollment.
Medicare Parts
When you become eligible for Medicare you have choices to make. First, you must decide whether you will enroll in Part A and B or Part A only and defer Part B. Most people choose Part A because it is premium-free. However, if you are enrolled in a Health Savings Account (HSA) you will not be able to continue contributing to it if you enroll in Part A. Once your A and B choices are made you will move on to which Advantage, Supplement, and/or Part D plans to choose from.
Learn more about what each part of Medicare covers here.
What isn’t covered by Medicare?
Original Medicare does not cover certain health services and costs, including:
Long-term care
Dental care (with some exceptions)
Vision exams needed to prescribe glasses
Dentures
Cosmetic surgery
Acupuncture
Hearing aids and related exams
Routine foot care
How do I enroll in Medicare?
There are a few different ways to enroll in Medicare. Some people are automatically enrolled in Medicare and others will have to sign up on their own. However, everyone should check with Social Security three months before their expected start date to make sure everything is in order.
You will be enrolled automatically in Medicare if you:
Are already receiving Social Security benefits (at least four months prior to start)
Receive Railroad Retirement Board benefits (at least four months prior to start)
Are under the age of 65, but have a social security disability for 24 months
Have Amyotrophic Lateral Sclerosis (ALS) or end stage renal disease
You will have to enroll in Medicare on your own if you:
Are about to turn 65
Are already 65, but not receiving Social Security benefits
There are also some individual circumstances that may change when you enroll. For instance, if you have employer insurance, you may be able to wait to apply for Medicare Part B instead of being required to apply when you turn 65.
Medicare Enrollment Periods
The Initial Enrollment Period (IEP) for Medicare is a 7-month period beginning 3 months before you turn 65, the month in which you turn 65, and 3 months after you turn 65. For example, if you turn 65 on June 14, your IEP is from March 1st through September 30.
It’s important to know that if you do not sign up during your initial enrollment period, and you are not covered by an employer health plan or are volunteering overseas for at least 12 months, you’ll begin accruing Part B late enrollment penalties, and will only be able to enroll during the General Enrollment Period (GEP). The GEP runs from January 1st through March 31st each year with coverage starting July 1st.
Medicare Advantage plans cannot start before your Part B start date, so if you do not enroll in Part B by the end of your IEP, you’ll have to wait until the GEP for Medicare Advantage enrollment also. This is also true for Medicare Supplement and Part D plans as well.
When does Medicare coverage start?
What month your Medicare coverage begins depends on what month you enroll in Medicare in relation to your 65th birthday. Remember during the IEP, you can enroll three months before you turn 65, the month you turn 65, and three months after you turn 65.
Depending on which of those three time frames you enroll in Medicare, will change the date your coverage starts. For example:
If you enroll in Medicare during the three months before you turn 65, Medicare coverage begins the first day of the month you turn 65.
If you enroll in Medicare the month you turn 65, your Medicare coverage will start the first day of the month after you turn 65.
If you enroll during the month after you become 65, your Medicare coverage will begin two months after you sign up.
If you enroll two or three months after you turn 65, your coverage starts three months after you sign up.
Let’s run through the scenarios above, by saying for example, you turn 65 on May 10.
If you enroll in February, March, or April, three months before your birthday, your coverage will begin on May 1.
If you enroll in May, the month you turn 65, your coverage will start June 1.
If you enroll in June, the month after you turn 65, your coverage will begin August 1.
If you enroll in July, two months after you turn 65, your coverage will start on October 1.
If you enroll in August, three months after you turn 65, your coverage will begin November 1.
You can coordinate your ancillary coverage — supplemental plans, Medicare Advantage plans, and Medicare Part D — to start the same day as your Medicare Part A and B coverage.
When you are ready to apply for Medicare, you can fill out an online application through the Social Security website, or in-person at your local Social Security office.
Attribution for this blog post written by Ron Elledge and Caren Lampitoc,
provided by:
