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10 Facts You Need to Know about Medicare

By Sarah Foster

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(1) Am I covered?

Medicare is available to Americans 65 years of age and older who have worked at least 10 years in Medicare-covered employment (or have a spouse that has met that requirement). Additionally, people under the age of 65 who are receiving Social Security Disability Insurance benefits are eligible for Medicare after a two-year waiting period. Individuals with end stage renal disease (ESRD) or Lou Gehrig’s disease may also be eligible for Medicare coverage.

Unlike Medicaid, there is no financial eligibility criteria.

(2) What if I am still working?

Even if you are still working and even if you are not collecting Social Security retirement benefits, you are still eligible for full Medicare benefits at age 65.

People still working may be able to delay signing up without a penalty but need to be careful. If you plan to delay coverage due to work, contact your local Social Security office for details on how to avoid late enrollment penalties. Click here to find your local office.

(3) How much does it cost?

The programs includes two main parts: Part A covers inpatient hospital care, post-hospital care in skilled nursing facilities, and post-hospital care in the patient’s home. Part B covers medically necessary services and preventive services.

Sometimes called “premium-free Part A”, you usually do not pay a monthly premium for Part A if you are eligible for Social Security retirement benefits. However, most people pay a premium of $104.90 per month for Part B. You also pay $147 per year for your Part B deductible. However, if your income is more than $85,000 (single) or $170,000 (married), you will pay a higher premium, anywhere from $146.90 to $335.70, depending on your income.

Click here to see a Part B premiums chart by income.

(4) Can I opt out?

Because Part B has a monthly cost, you have the option to turn it down.

(5) Are my prescriptions covered?

You have two options for drug coverage, through a Medicare health plan or through election of Medicare Part D, the Medicare Prescription Drug Plan. The average Part D premium is $30 per month but you will also pay co-payments, deductibles and other out-of-pocket costs.

Click here for more information on Medicare Part D.

(6) What is a Medicare Health Plan?

Medicare health plan is a plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare. Medicare health plans may offer extra coverage like vision, hearing, dental and other health and wellness programs. Most also include Medicare prescription drug coverage. Click here more information on the different types of Medicare Health Plans available.

(7) What is Medigap insurance?

Medigap insurance is sold by private companies and covers deductibles, co-payments and others gaps in Medicare coverage. You must have Medicare Part A and Part B to be eligible for Medigap insurance. Medigap policies are identified by letters A through N and each policy that goes by the same letter must offer the same basic benefits; usually the only difference between same-letter policies is cost. Click here to find a Medigap policy.

(8) What if I already have private health insurance?

If you have Medicare and other health insurance, each type is called a “payer.” When there’s more than one payer, “coordination of benefits” rules decide which one pays first. The “primary payer” pays what it owes on your bills first, and then sends the rest to the “secondary payer”. Paying first means paying the whole bill up to limits of coverage. For example, if you have employer insurance that’s a secondary payer, they may require you to enroll in Medicare before your insurance will pay.

(9) How do I sign up?

If you already collecting Social Security benefits, you will automatically be enrolled in Parts A and B. If you have not started collecting Social Security benefits you will have to sign yourself up. You can sign up online or at your local Social Security office. Click here to find your local office.

(10) When do I need to enroll?

The seven-month enrollment period begins three months before the month you turn 65 and ends three months after your birthday month. To ensure coverage starts on time sign up as early as possible.

If you do not sign up for Medicare when you are first eligible, you can sign up during the general enrollment period between January 1st and March 31st of each year but may have to pay a higher premium due to late enrollment.

Also, if you decide not to join a Medicare Prescription Drug Plan when you’re first eligible for Medicare and do not have other creditable prescription drug coverage, you may end up having to pay a late enrollment penalty.

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