Medicare Coverage

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When you understand your Medicare coverage, you have more control, more power, and more confidence in your healthcare benefits.

Medicare is a federal health insurance coverage formed in 1965. While it typically covers people over 65 years old, however, given certain circumstances, people who deal with specific disabilities may qualify well before 65. This program is designated to help people, regardless of income, current health conditions, and medical histories.

With so many U.S. citizens utilizing Medicare, we wanted to go ahead and take a closer look at just who exactly is covered by Medicare.

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 physician and outpatient services. It will also include some home health services that Part A doesn’t cover. Services for physical and occupational therapists are also included. Any Durable Medical Equipment is also included if found medically necessary.

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 prescription drug coverage. Part A & B do not cover prescription drugs give outside the doctor or hospital.

Medicare Coverage Age

Turning 65 means you’re eligible for Medicare coverage. If you’ve been receiving 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 Medicare coverage will start when you age in at 65 or have been on 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.

If you don’t enroll in Part B during your Initial Enrollment Period, it’s okay. However, entering outside this period will result in having to answer medical questions.

You’ll have another opportunity to sign up during the General Enrollment Period. GEP 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. AEP is only for beneficiaries currently enrolled in Original Medicare coverage.

This period allows current beneficiaries to change their Medicare Advantage and/or Part D coverage for the upcoming year.

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

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

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

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 who’s lived in the United States for a minimum of 5 years
  • Worked long enough (40 credits from about ten years of working) to receive 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 Medicare coverage if you don’t make your premium payments. You can also lose your Medicare coverage if you were previously disabled, and now you no longer have a medical disability.

Should you find yourself unable to make your monthly premium payments, you’ll get warning letters in the mail. If you don’t make this payment, your Medicare 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 also want to apply for Part D coverage when you’re first eligible; it also has a penalty for not signing up when first eligible for Medicare coverage.

Who’s Covered By Medicare

Medicare Coverage

Patients on Medicare

A vast majority of individuals who are 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 for so many.

Approximately 32% of Medicare beneficiaries deal with impairments.

25% of recipients are reported to have either fair or poor self-reported health, 22% of patients suffer from five or more chronic conditions, and roughly 3% of patients reside in long-term care facilities.

Women on Medicare

For the most part, women who are on Medicare tend to have more significant health needs and face more chronic health conditions than men do. A few of these health conditions may include hypertension, osteoporosis, and arthritis. Women on Medicare also tend to have more physical limitations with daily living than men on Medicare do.

Since women usually live longer than men do, women make up about three-quarters of Medicare beneficiaries who reside within long-term health care facilities, such as skilled nursing facilities or 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 receiving 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 currently receive Social Security Disability benefits and have been receiving these benefits for a minimum of 24 months, you could potentially begin Medicare coverage.

At the beginning of your 25th month of getting Social Security benefits, you’ll automatically gain enrollment into the Medicare program.

There may be exceptions on a case by case situation where beneficiaries 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 who are between the ages of 65 and 74 years old make up a whopping number of 48% of the beneficiaries who are 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

Approximately 25% 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 12% of current Medicare beneficiaries. Two out of every three of these older Medicare beneficiaries are women.

What Medicare Benefits are Most Utilized

Part A and Part B services make up most benefits utilized at about 30%. Inpatient services (such as hospital stays) make up about 21%. Part D services make up roughly 14% of the benefits used.

Physicians’ 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%.

Where Can Patients Sign up for Medicare

Patients can quickly sign up for Medicare benefits through several different avenues. They can contact RRB to find out if they qualify to receive Railroad Retirement Benefits

Patients can reach out to their local Social Security office (this can include calling the local office, going into the office to complete an application, or they can mail in a letter to the local office).

If an individual chooses to apply online, they can do so at www.ssa.gov. However, they will not be able to apply online if they already carry Part A and are attempting to enroll in Part B coverage.

If you have any questions about Medicare coverage, give us a call at the number listed above or complete an online rate form today! We’re here to help you! Once you know your Part B effective date, you can then begin the process of enrolling in a Medigap plan to complete your coverage. Medigap plans help cover out-of-pocket costs like deductibles, co-pays, and coinsurance.

For more information on Medigap Plans, you can reach a Medicare expert at the number above. You can also compare rates in your area by filling out our online rate form.