Medicare Advantage Plans

How do I enroll in Medicare?

Medicare is a health insurance program run by the federal government of the United States that has had much success in providing quality health insurance at an affordable price. Available for qualifying individuals 65 years of age or older and those with disabilities, Medicare is widely accepted by most doctors and hospitals in the United States. Enrolling in Medicare can be an extensive process and being prepared for this process is vital to avoid potential mistakes that can cost an individual valuable time and money.

Sign-up and Sign-up Information

Individuals can sign up for Medicare by visiting the Social Security website or by scheduling a meeting at their local Social Security office. Those that receive disability through Social Security or the Railroad Retirement Board are automatically enrolled after receiving benefits for 24 months and will not have to sign up. Below are several important pieces of information that an individual should have when applying:

• Birth Certificate

• Proof of US citizenship or legal residency

• Social Security card

• Health insurance information - In certain circumstances, Medicare can be used with other forms of insurance. Medicaid, for example, is commonly used by many lower-income individuals to help pay for medical costs not covered by Medicare.

• Tax information (W-2)

• Military documents (if applicable)

 

Individuals who are unsure of what documents apply to them for use in the application process should either visit the Social Security website or contact them by phone at 1-800-772-1213. Individuals who were employed by a railroad company should visit the Railroad Retirement Board website or contact them by phone at 887-772-5772.

 

Enrollment Periods

Medicare has different enrollment periods depending on an individual's situation. Failure to sign up during the appropriate enrollment period could potentially result in penalties that can significantly increase premiums.

 

Initial Enrollment Period

The initial enrollment period for most Medicare recipients is 7 months centering around the time they turn 65. Potential Medicare customers can enroll during the 3 months before they turn 65, the month of their 65th birthday, and the 3 months after their birthday month. Individuals can choose between Parts A and Part B of Medicare, also known as Standard Medicare or Original Medicare, or Medicare Part C, also known as a Medicare Advantage plan. If a customer opts for Original Medicare, they can also sign up for Medicare Part D, an optional prescription drug plan.

 

General Enrollment Period

For individuals who miss the initial enrollment period for Medicare, a general enrollment period is available from January 1 to March 31 for them to enroll. Coverage will begin for customers who enroll during this period on July 1 of the same year, albeit with increased rates due to the penalties applied for missing the initial enrollment period.

 

Special Enrollment Period

Special Enrollment Periods allow individuals to sign up for Medicare after the initial enrollment period without having to pay any penalties. One of the most common reasons for qualifying for a Special Enrollment Period includes current coverage by an employer group health plan. Individuals have 8 months to sign up for Medicare after their employment ends or the health plan based on their employment ends. Special Enrollment Periods may also be used by those who are volunteering or serving in a foreign country.

Who is eligible for Medicare coverage?

The rapid increase in healthcare costs in the United States has amplified the importance of finding quality health insurance at an affordable price. Medicare, a government healthcare program for older American citizens established in 1966 by the Social Security Administration, is a great health insurance option to help balance out massive medical bills. Most people view Medicare as an option only for Americans who are 65 and older, but eligibility is much more comprehensive.

 

Age Qualifications

Most Americans qualify for Medicare when they turn 65 years old if they have been an American citizen or legal resident for at least 5 years. If an individual was employed in a job for 10 years where Medicare taxes were withheld, they will receive coverage without any premiums for Part A of Medicare. It is important to note that an individual needs to have worked 10 full years or 40 quarters to qualify for premium-free coverage for Medicare Part A, not just parts of 10 years. Any individuals who have not worked for at least 40 quarters have the option to purchase Medicare coverage for a monthly premium.

 

Disability Benefit Qualifications

Individuals also qualify for Medicare coverage before the age of 65 if they receive disability benefits from the Social Security administration for at least 24 months. While the initial enrollment period for most Medicare recipients lasts 7 months, individuals are automatically enrolled in Medicare after 24 consecutive months of receiving disability benefits. Railroad Retirement Board disability beneficiaries are also automatically enrolled in Medicare once they have received benefits for 24 months. Both Social Security and Railroad Retirement Board disability beneficiaries can get Part A of Medicare with no premiums.

Specific Medical Condition Qualifications

Specific medical conditions also allow a person to qualify for Medicare before they reach 65. If an individual has end-stage renal disease, requiring regular dialysis treatments or a kidney transplant, they will automatically qualify for Medicare. ALS patients also automatically qualify for Medicare as soon as they begin receiving their Social Security or Railroad Retirement Board disability benefits. Both these conditions also allow individuals to avoid paying any premiums for Medicare Part A coverage.

Special Needs Plan

A Medicare Special Needs Plan (SPN), also known as Medicare part C, is also available to people with certain diseases or financial situations. A Special Needs Plan combines Medicare parts A and B into a single customized health insurance plan sold by a private insurance company. For individuals to qualify for a Special Needs Plan, they must already be enrolled in Medicare and live in the area serviced by their desired plan. Also, depending on their condition, they must have a doctor's note confirming they have the specified condition serviced by the plan, reside at least 90 days in a long-term care facility covered by the plan, or meet the state's guidelines for nursing home care at home for at least 90 days. Individuals must also have verification of their Medicare and Medicaid enrollment information.

All Medicare qualifications are subject to changes in laws and regulations implemented by the federal government. If an individual is unsure whether or not they will qualify for Medicare, they should schedule a meeting with their local social security administration field office.

What are the benefits of standard Medicare coverage?

The burgeoning costs of medical care in the United States have increased the importance of government healthcare programs. Medicare, a government healthcare program for both those who are 65 years of age and older and those with disabilities, has done a great job providing quality healthcare at an affordable price. Medicare is divided into 4 parts that serve different purposes. The two standard portions of Medicare that most recipients have are Medicare Part A, which deals with hospital stays and expenses, and Medicare Part B, which deals with doctor's visits. These two parts of Medicare possess many benefits to their customers.

 

Free Premiums - Part A

Perhaps the top benefit of standard Medicare coverage is that there are no premiums for Part A for qualifying individuals that have worked 10 full years or 40 quarters at a job where Medicare taxes were withheld. However, it is important to note that if a person worked between 30-39 quarters they will have to pay a monthly premium of $252. Individuals who worked less than 30 quarters will have to pay a monthly premium of $458.

 

Low Coinsurance Rates - Part A

Extended hospital stays can be very extensive, potentially bankrupting otherwise financially stable individuals. Part A of Medicare mitigates this expense by allowing hospital patients to pay $0 for coinsurance after meeting their $1,408 deductible for the first 60 days of the 90 day Medicare benefit period. If a patient has to spend more time in the hospital, the last 30 days of the period will require a $352 coinsurance payment per day, a small fraction of the total medical expenses incurred.

 

Lifetime Reserve Days - Part A

Lifetime Reserve Days are a part of the coinsurance portion of Medicare Part A and provide an individual an additional 60 days of a particular benefit period. During this 60 day grace period, the coinsurance portion of Medicare Part A will continue to cover some of the medical expenses of a hospital stay. The $704 per day coinsurance payment required during this period is still a small fraction of the total medical expenses of an extended hospital stay.

 

Low Premiums and Deductibles - Part B

While premiums vary for Medicare Part B, the standard coverage for most individuals, those with taxable income of $87,000 or less, or $174,000 or less if they file taxes jointly, is $144.60. The deductible for this same group is only $198, a fraction of the cost that many private health insurance plans currently offer.

 

High Acceptance Rates

Another significant benefit of Medicare is the number of doctors who accept this insurance, far outpacing most private insurance plans. With over 90% of doctors in the United States accepting Medicare, recipients can almost always see a doctor of their choice. This is in stark contrast to Medicaid, the other major government healthcare program in the United States, where under 70% of doctors currently see patients with this plan.

 

Broad Coverage

Some individuals may fear that standard Medicare coverage may have to sacrifice some coverage options to be able to provide low rates and premiums. However, Medicare covers virtually every medical condition or illness in existence, all while offering reasonable rates that vary based on income, not health status.