Medicare Coverage

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When you understand your Medicare coverage, you have more control in your healthcare benefits. Medicare is a federal health insurance coverage formed in 1965.

It covers people 65 and over; but, people with disabilities may qualify before 65. With so many U.S. citizens utilizing Medicare, we wanted to take a closer look at who has Medicare and how they use it.

Explanation of Medicare Coverage & Benefits for 2020

Medicare Part A Coverage

More than likely, you or your spouse paid into Medicare through payroll taxes, so Part A is free. Part A covers inpatient care, but not long-term care or custodial care. It does help cover the cost of hospice care and come home health care.

Medicare Part B Coverage

Part B will cover doctor and outpatient services. It’ll include services that Part A doesn’t cover. Also, services for therapists are included.

Any Durable Medical Equipment you need has coverage. Part B does come with a monthly premium. The premium may increase depending on what income bracket you fall under.

Medicare Part D Coverage

Part D is drug coverage. Part A & B don’t cover prescriptions.

Medicare Coverage Age

Turning 65 means you’re eligible for Medicare coverage. If you’ve been collecting Social Security Disability Insurance for over 24 months, you may be Medicare-eligible before 65.

At the beginning of the 25th month, you’re automatically enrolled in Medicare.

When Does Medicare Coverage Start

Your coverage will start at age 65 or after disability for 24 months. There are many different enrollment periods to understand. The Initial Enrollment Period will include the three months prior, the month of your birthday, and the three months following.

You’ll have another opportunity to sign up during the General Enrollment Period. That takes place yearly from January 1st through March 31st. Coverage begins July 1st of the same year you enroll.

The Annual Election Period runs from October 15th-December 7th of every year. That is only for those currently enrolled in Medicare. This period allows current recipients to change their Advantage or Part D for the upcoming year.

Also, this period allows you to return to Medicare & pick up a Medicare Supplement plan. January 1st is when new coverage will start.

If you find yourself stuck with Part C, you can use the Medicare Advantage Open Enrollment Period, which also runs between January 1st and March 31st, to return to Medicare.

If you delayed coverage or your circumstances change, you may also be eligible for a Special Enrollment Period.

What are the Requirements for Medicare Coverage

Specific requirements for Medicare coverage must be met before coverage will begin.

Requirements include if you or your spouse: 

  • Are a U.S. citizen or permanent legal resident of the United States for a minimum of 5 years
  • Worked long enough (40 credits or about ten years) to get Social Security or Railroad Retirement benefits
  • Are an employee of the government
  • Or retiree who’s not paid into Social Security but paid Medicare payroll taxes while working

Medicare coverage requirements for those under 65 include:

  • Entitled to Social Security benefits for a total of 24 months
  • Currently receiving a disability pension from the Railroad Retirement Board
  • Diagnosed with Lou Gehrig’s disease (which would qualify you immediately)
  • Permanent kidney failure that requires regular dialysis treatment (or had a kidney transplant)
  • Or your spouse paid Social Security taxes for a specified period (depending on your age)

Having a terminal illness is one of the only reasons a person wouldn’t be eligible to receive Medicare benefits.

If you have a Health Savings Account, you may no longer add to your HSA once Medicare begins.

When you contribute to your HSA after your Medicare coverage begins, you might receive a tax penalty.

Losing Coverage

You can lose coverage if you don’t make your payments. You can lose coverage if you were disabled, and no longer have a disability.

Should you find yourself unable to make your monthly payments, you’ll get warning letters in the mail. If you don’t make this payment, your coverage will be terminated.

Applying for Coverage

You can apply online here. Applications take less than 10 minutes to complete online, and there will be no further forms required.

When applying for Medicare, you may sign up for Part A and B. Part B requires a premium. Although, if you later decide to register, you could face a Part B late-enrollment penalty if you didn’t have creditable coverage.

You’ll want to apply for Part D when you’re first eligible; it has a penalty for not signing up when first eligible.

Who’s Covered By Medicare

57 Million Beneficiaries on Medicare

Medicare Coverage

There are more than 57 million people enrolled in Medicare.

A vast majority of individuals on Medicare deal with a multitude of health issues, some even including multiple chronic conditions.

Many beneficiaries live on very modest monthly incomes.

Many see an annual income of less than $26,200 per year.

With the sky-high costs related to healthcare, Medicare can offer a breath of fresh air.

Women on Medicare

For the most part, women on Medicare tend to have more health needs and face more chronic conditions than men. A few of these conditions include hypertension, osteoporosis, and arthritis.

Women on Medicare tend to have more physical limitations with daily living than men. Since women usually live longer than men do, women make up about three-quarters of Medicare beneficiaries in long-term care facilities, such as nursing homes.

Medicare Coverage Under 65

Many may be surprised to discover that they can utilize Medicare coverages if they’re under 65 years old. If you’re under the age of 65 years old, you may be eligible to begin collecting Medicare benefits.

In fact, according to Medicare’s break down of demographics who currently are on Medicare, 16% of beneficiaries are under 65.

If you receive Social Security Disability and have been getting these benefits for 24 months, you could begin Medicare.

There may be exceptions on a case by case situation where recipients aren’t required to wait the entirety of the 24 months.

ESRD before Turning 65

Another possible situation a patient may find themselves in is facing End-Stage Renal Disease. If diagnosed with ESRD, you may also be eligible to receive Medicare before turning 65. If you’ve had any dialysis treatments or a kidney transplant, you could qualify for Medicare.

Medicare Coverage between 65 and 74

Patients between the ages of 65 and 74 make up a whopping number of 43% of the recipients on Medicare.

Studies found black and Hispanic patients were more likely to be under 65 years old with poorer health conditions and more limited financial states.

Medicare Coverage between 75 and 84

Over 20% of Medicare beneficiaries are between the ages of 75 and 84 years old.

Medicare Coverage for those 85 and Older

Medicare patients who are 85 years old and older make up 8% of current Medicare beneficiaries.

What Medicare Benefits are Most Utilized

Part A and Part B services make up most benefits. Inpatient services make up about 21%. Part D services make up roughly 14% of the benefits used. Doctors’ payments make up 10%. Outpatient services through a hospital facility equate to about 7%. Skilled nursing facilities are at about 4%. Home health care services comprise 3% of the benefits used, and other miscellaneous services make up about 11%.

The information above comes from the Kaiser Family Foundation.

Where Can Qualified Medicare Beneficiaries Sign up for Medicare

Patients can sign up for benefits through several avenues. Patients can reach out to their local Social Security office.If an individual chooses to apply online, they can do so at www.ssa.gov. But, they won’t be able to apply online if they already carry Part A and are enrolling in Part B.

If you have questions about Medicare, give us a call at the number listed above! You can also compare rates in your area by filling out our online rate form.