Medicare Coverage

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

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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.

What Does Medicare Cover in 2023?

Medicare includes coverage for inpatient and outpatient services. Including hospital visits, doctor visits, preventive services, medical equipment, lab tests, and more.

You need to buy a separate policy for medications. Further, many people buy a Medicare Supplement (Medigap) plan or a Medicare Advantage plan (Medicare Part C) to lower costs.

Medicare Part A Coverage

Medicare Part A Coverage

More than likely, you or your spouse paid into Medicare through payroll taxes, so Part A is free.

Medicare 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

Medicare Part B Coverage

Medicare 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 your income bracket.

Medicare Part D Coverage

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

What is Not Covered By Medicare

What is Not Covered by Medicare

Some of the benefits many people think are covered that aren’t include long-term care, acupuncture, and routine foot careDental, including dentures, doesn’t have coverage through Medicare. Further, eye exams, hearing aids, hearing exams, and cosmetic surgery won’t be covered through Medicare.

Services Medicare doesn’t cover; you’ll pay for yourself.

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.

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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.

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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 Medicare Covers

62.7 Million Beneficiaries on Medicare

Medicare Coverage

There are more than 62.7 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.

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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 in 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

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

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

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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 beneficiaries 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%, and other miscellaneous services make up about 11%.

The information above comes from the Kaiser Family Foundation.

How to Sign Up for Supplemental Medicare Coverage

Once you enroll in Part B you can also enroll in supplemental Medicare coverage. Of course, you should have a general sense of Medicare in 2022 before you sign up for anything. That's where we can help! Give us a call or complete our online rates form to see rates in your area now.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

6 thoughts on “Medicare Coverage

  1. I hope you can answer this question. I had a stroke in 2017 and am now on warfarin I am paralyzed on my left side of my body and am in a wheelchair. I have Medicare part a and b, also GEHA dental Insurance. I have 8 teeth that need to be removed in the hospital for an overnight stay due to my health issues. Mass General informed me that Medicare does not cover this, as it is oral surgery. Can you explain, what do I need to do as other oral surgeons will not do this and I am very uncomfortable. I am on social security with limited funds with a 12year old daughter that I support, before this I was a mailman for 14 years. I am hoping you can advise me of options.

    1. Ronald, your best option may be to enroll in a dental insurance plan that will cover the cost of the surgery. However, many plans do have a waiting period for major services, so you may not be able to receive coverage right away.

  2. I am having surgery on my face to remove several tumors in front of my left ear. If the results distort my face can I have cosmetic surgery for correction?

  3. This question is not for me but Does medicare cover botox injections for migraines every 10wks if the provider finds it necessary

    1. Hi Sam! Yes, if the doctors say it’s medically necessary to treat migraines then Medicare will cover Botox treatments.


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