Medicare is the U.S. health care program that offers essential coverage with limited out-of-pocket costs, but it’s not available to everyone. To enroll in Medicare, criteria like age, work history, and current health must be met.
For example, the age for Medicare eligibility is 65. Any person younger than 65 who has a qualifying disability or meets other special conditions can join Medicare earlier.
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How Medicare Works
Like other health insurance plans, Medicare comes with a range of deductibles, copayments, and coinsurance you’re responsible for paying.
Before Medicare begins to cover its portion of your medical expenses, you often have to pay a fixed amount (deductible). Then, Medicare pays its portion for covered services and goods, and you pay your portion (coinsurance or copayment).
For Part B, you typically pay a monthly premium. Typically, you are not required to submit Medicare claims. The law compels suppliers and providers to submit claims for the supplies and services they get that are covered.
Doctors, hospitals, skilled nursing facilities, and home health companies are examples of providers.
The amount you can spend personally each year is unlimited for Original Medicare. There is no out-of-pocket maximum for Original Medicare.
What Are The Different Parts Of Medicare
Medicare’s several components assist in covering particular services:
- Part A of Medicare (Hospital Insurance): Part A includes coverage for some home health care and inpatient hospital stays, care in skilled nursing facilities, and hospice care.
- Part B of Medicare (Medical Insurance): Outpatient care, medical supplies, and preventative services are all covered by Part B.
- Prescription medicine coverage provided by Medicare Part D helps with cost coverage (including many recommended shots or vaccines).
Original Medicare doesn’t cover prescription drugs. You can buy drug coverage through Medicare Part D, but it’s not provided by Part A or Part B.
How coverage begins
If you have Medicare based on age, your coverage will begin the first day of the month following your 65th birthday. Suppose you have Medicare based on a disability. In that case, it starts on the first day of the month after your 35th birthday (if you or your spouse has already been receiving Social Security disability benefits for 24 months).
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If you don’t enroll in Part A or Part B when you’re eligible, Medicare is automatically registered for you at a later date.
when you Can sign up for Medicare
There are several scenarios that determine when you can sign up for Medicare.
When You Are Almost 65 Years Old
You can generally enroll in Part A and Part B beginning three months before turning 65 and ending three months after that month. If you get disability benefits from Social Security or the Railroad Retirement Board, you can be eligible for Medicare sooner.
If You Are Retired Before Age 65
If you want to enroll in Medicare before you retire from your job, you can choose to do so at any time up until the month before you turn 65.
The only exception is if you are enrolled in an employer-sponsored retirement plan that provides retirement benefits for a less expensive benefit amount than would otherwise be available under Medicare (such as Social Security).
If You Have Low-Income
If your family’s annual income is below the above-listed limits, you are referred to as “Medicare eligible.” You can enroll if you are a U.S. citizen or national, reside in the United States, and meet your state’s health insurance eligibility requirements.
If You Are a Federal Employee
If you work for the federal government and want to enroll in Medicare, you must be an employee when applying. You also must have at least 24 months of Medicare-covered federal employment after your first month of registration (the exception is if you are a Congressional employee).
You can enroll in Part A and Part B any time after your 31st birthday (your current employer must have been with the same employer for at least 12 consecutive months). The only exception for military personnel is if they work in certain overseas positions designated by law.
If You Are Eligible for Social Security Disability Benefits
If you receive Social Security Disability payments because of illness or injury, you are automatically eligible for Medicare coverage under the same condition.
In addition, once your disability has been approved, Medicare covers you even if your disability ends and your Social Security Disability payments stop. If you have received Social Security Disability payments for 24 months, you can apply for Part A anytime. There is no required enrollment period.
If You Are the Spouse of a Covered Worker
If your spouse works for a federal agency or is active with the military and qualifies under Medicare, you can enroll (in most circumstances) as soon as you and your spouse have been married for 24 months.
In addition, if your spouse has worked for a federal agency or the military for at least 12 consecutive months, you cannot be turned down because of your age or sex.
To get Medicare benefits, you must know if you are eligible for it, how it works, and how to sign up. You should also know when and how to enroll in Medicare as well. Review the points above as often as needed until you feel comfortable with the information.
Greg is a Chartered Financial Analyst (CFA) with 22+ years experience in Financial Services. He has held numerous FINRA Securities licenses (series 7, 63, 65, and 66), and is an expert on Investment Products and Financial Planning. Greg has 22+ years experience as a real estate investor and degrees in Psychology and Philosophy.
Greg has been quoted/interviewed in Yahoo Money, Yahoo Finance, USA Today, Authority Magazine, Realtor.com, Business Insider, and others.
Greg is an avid runner, and the father to identical twin girls and their awesome brother. His love of budgeting and his kids led him to join The Great Resignation in 2021.
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