MEDICARE MATTERS: A VIDEO TIMELINE ABOUT MEDICARE
( Kaiser Family Foundation, www.KFF.org )
Medicare is the national health indemnity program to which all Social Security recipients who are either over 65 years of long time or permanently disabled are eligible. In addition, individuals receiving railway retirement benefits and individuals living with end stage nephritic disease are eligible to receive Medicare benefits .
Medicare is not a wellbeing program, and should not be confused with Medicaid. The income and assets of a Medicare benefactive role are not a retainer in determining eligibility or benefit payment. Medicare is a home broadcast and procedures should not vary significantly from state to state of matter .
coverage under Medicare is similar to that provided by individual insurance companies : it pays a assign of the price of medical care. Often, deductibles and co-insurance ( overtone payment of initial and subsequent costs ) are required of the beneficiary .
Medicare has two meaty coverage components, Part A and Part B. Part A covers inpatient hospital care, hospice care, inpatient wish in a skilled nursing facility, and home health care services. Part B covers aesculapian care and services provided by doctors and early medical practitioners, home health caution, durable medical equipment, and some outpatient concern and base health services .
Part A of the program is financed largely through union payroll taxes paid into Social Security by employers and employees. Part B is financed by monthly premiums paid by Medicare beneficiaries and by general revenues from the federal politics. In addition, Medicare beneficiaries themselves share the cost of the program through copayments and deductibles that are required for many of the services covered under both Parts A and B .
An increasing number of beneficiaries are financing their health services through managed care plans. The Medicare managed care profit is different from the traditional Medicare “ fee-for-services ” system but coverage should generally be the lapp. Generally, a Medicare managed wish plan administers the health care treatment of an enrollee by the manipulation of a doctor ( known as a “ gatekeeper ” ) who must approve the patient ’ s referral to specialized care. ( Some Medicare managed care plans permit beneficiaries to go directly to a specialized care supplier, without the gatekeeper ’ sulfur approval, in return for requital of an extra premium. ) A beneficiary may choose to receive Medicare coverage and wish through a managed wish plan by filing an registration form. Once the choice is made, the benefactive role by and large must receive all of his or her wish through the design in order to receive Medicare coverage. Beneficiaries can change their minds, disenroll from their managed care plan, and restitution to “ original ” Medicare .
These plans are presently referred to by the presidency as “ Medicare Advantage ” plans. They are intended to offer options for the financing of Medicare covered health services. The options will include “ coordinated wish plans, ” which include managed manage plans, vitamin a well as aesculapian savings accounts, private fee-for-service plans, and early options. Beneficiaries should enroll in such plans only after careful study and thought.
MEDICARE ELIGIBILITY AND ENROLLMENT
For data on enrolling in Medicare even if you are not eligible for Social Security, chink HERE .
Individuals entitled to Social Security retirement insurance who are 65 years of old age and older, and individuals entitled to Social Security disability benefits for not less than 24 months are eligible to participate in Medicare. Individuals entitled to Railroad Retirement benefits or Railroad Retirement disability benefits and individuals suffering from end stagecoach nephritic disease or ALS are besides eligible to participate. Certain federal, submit and local government employees who are not eligible for Social Security retirement or disability benefits may be eligible for Medicare benefits if they worked and paid the Medicare Part A “ hospital policy ” fortune of their FICA taxes for a sufficient period of time. federal employees became national to the hospital insurance fortune of FICA in January 1983. Most newly hired state and local employees, not differently covered under Social Security, started paying the hospital indemnity part as of April 1986. Individuals who are not otherwise eligible for Medicare, but who are over long time 65, may besides purchase coverage by paying a monthly premium .
Medicare eligibility for Social Security and Railroad Retirement beneficiaries begins on the first day of the first month in which the individual attains historic period 65. This is besides the date upon which individuals not otherwise eligible for Medicare are entitled and may purchase coverage .
Individuals receiving Social Security or Railroad Retirement disability benefits become eligible for Medicare coverage in the twenty-fifth month of receiving those benefits. Individuals who have end stage nephritic disease normally become eligible on the first day of the third calendar month of a run of nephritic dialysis treatments. Individuals with ALS ( Lou Gehrig ’ south disease ) become eligible when they are eligible for Social Security disability benefits, without a twenty-four month waiting period .
An lotion for Social Security or Railroad Retirement benefits will trigger automatic registration in both Medicare Part A and Part B. however, since engagement in Part B is voluntary and requires the requital of a monthly premium, individuals are offered an opportunity to decline registration in this part of the course of study .
A person not entitled to Medicare by virtue of Social Security or Railroad Retirement benefits must make a divide application for Medicare and agree to pay monthly premiums. See the cost-sharing chart below for details on premiums. A person may elect not to apply for Social Security or Railroad Retirement benefits at long time 65 and still be entitled to Medicare coverage. In this case a separate application for Medicare benefits is required. application for benefits can be made at any Social Security office. Railroad Retirement beneficiaries should contact the Railroad Retirement Board to enroll .
Enrollment and Coverage
If you ’ ra not already getting retirement or disability benefits, you may contact Social Security to sign up on-line for Medicare during your “ initial Enrollment Period, ” the three months before your sixty-fifth birthday, your give birth month, and the three months after. You can sign up for Medicare evening if you don ’ triiodothyronine plan to retire at age 65 .
A person not entitled to Medicare by merit of Social Security or Railroad Retirement benefits must make a separate application for Medicare and agree to pay monthly premiums. See the cost-sharing graph below for details on premiums. A person may elect not to apply for Social Security or Railroad Retirement benefits at senesce 65 and still be entitled to Medicare coverage. In this case a offprint lotion for Medicare benefits is required. application for benefits can be made at any Social Security office. Railroad Retirement beneficiaries should contact the Railroad Retirement Board to enroll .
An individual may make application to enroll in Medicare three months prior to the beginning calendar month in which they would be eligible for benefits and for three months after their first calendar month of eligibility. This period is referred to as the “ initial registration period. ”
registration in the first base three months of the initial registration period will result in coverage begin on the first day of the first gear month in which the individual attains old age 65. registration in the month in which the individual attains historic period 65 will result in coverage beginning in the stick to month. registration during the month following will result in coverage beginning on the first day of the second month following the calendar month in which the individual enrolls. registration in one of final two months of the initial registration period will result in coverage begin on the first day of the third month following the calendar month in which the person enrolls .
An individual turns 65 in May. Her initial registration time period will be February 1, through August 31. Depending upon the month in which she enrolls her coverage period would be as follows :
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There is besides a “ general registration period ” which occurs in the first three months of each year. An person who fails to enroll during his initial menstruation of eligibility can only enroll in Part B of Medicare during this general period ( and may be required to pay a premium overload for late registration ), unless he falls under the provisions of the working aged discussed below. registration in Part A can take place at any time and coverage can be retroactive up to six months unless the individual must purchase Part A coverage. If an individual must purchase coverage, registration in Part A can only occur during the initial or general registration period and coverage will begin on July 1 of that year. Similarly, for beneficiaries enrolling in the general registration period Part B coverage will not begin until July 1 of that year .
registration is broadly handled by the Social Security Administration through their local offices. Railroad Retirement beneficiaries should contact the Railroad Retirement Board to enroll .
ENROLL ONLINE : As of 2010, you may besides enroll on-line at www.socialsecurity.gov ( locate visited September 23, 2015 ). Click “ Online Services ” and then “ Apply for Benefits. ” The application serve can take less than 10 minutes .
At the time that the Medicare course of study was established in 1965 most people retired at 65, and automatically began their engagement in the course of study at that old age. however, as people began to work past the age of 65, and as Medicare began to try to contain costs, Medicare coverage and registration policy changed .
In the early 1980 ’ s several pieces of legislation were passed which made Medicare benefits secondary to benefits account payable under an employer group health plan ( EGHP ) for employees and their spouses old age 65 and older. Further, employers are now prohibited from offering a different health plan to Medicare eligible employees and their spouses than that which is offered to other employees. Employers with less than 20 employees are nontaxable from these new laws but may participate voluntarily .
These changes led to the establishment of an extra “ special registration period ” for the working aged. Individuals, over the age of 65, who are covered by an EGHP by virtue of their own, or a spouses ’ employment, have the choice to enroll in Medicare past long time 65 without incurring a bounty surcharge. Since their EGHP is the elementary payer many workers may not want to pay for Medicare coverage which might be duplicative. failure to enroll during this “ special registration menstruation ” may result in a agio overcharge and the individual may not be allowed to enroll until the following general registration period .
primitively, the special registration period ( SEP ) began on the first day of the first month in which the employee was nobelium long covered by the EGHP, and ended seven months late. however, effective March 1, 1995, individuals covered under an EGHP can enroll in Medicare while still covered by the EGHP. additionally, the menstruation during which registration may occur, after EGHP coverage ends, was extended from seven to eight months. *
Under these new provisions, an individual can enroll in Medicare while inactive covered by an EGHP, and elect to have coverage begin in that month or any of the be three months .
Ms. M attained old age 65 in 2007, but continued to work and be covered by an EGHP. In April 2009 she filed an application for monthly Social Security benefits and Medicare because she planned to retire on June 30, 2009. She can elect to have Medicare coverage begin either in April of 2009, or in any of the three following months. She elects to have coverage begin in July of 2009, since she has coverage under her EGHP until that clock time .
Mary could besides have chosen to delay her application for Medicare until July 2009, the first full month she was not covered by an EGHP. This would besides result in Medicare coverage becoming effective on July 1, 2009, the beginning day of the month that she was no long covered by the EGHP. however, should Ms. M have delayed application for Medicare until August 2009, her coverage would not have been effective until September of 2009. This is because registration in Medicare during the seven months following the first broad month in which an person is no long covered by an EGHP will result in coverage beginning the foremost day of the calendar month after the month of registration. therefore, to avoid any gaps in coverage it is advisable to enroll either in the three months before, or in the actual calendar month your employment ends. It is crucial to remember that the changes in the jurisprudence did not alter the fact that the SEP is only available to people covered by an EGHP by merit or their own or a spouse ’ sulfur use .
Failure to Enroll
There can be serious significance for individuals who fail to enroll in Medicare during their proper registration period. There is the surcharge of 10 % per class assessed on the Part B premium for each year that an individual fails to enroll. What can be more unplayful, is that failure to enroll during the initial or especial registration period will result in the individual not being allowed to enroll in Medicare Part B until the general registration time period during the first three months of each year. coverage for Part B benefits then would not begin until July of that year. As a solution, there may be several months when an individual, having no Part B Medicare coverage, may be vulnerable to costly out-of-pocket medical expenses. It is authoritative to note that an person entitled to Social Security or Railroad Retirement benefits may enroll in Part A at any time and receive astir to 6 months ex post facto coverage without punishment. It is merely Part B coverage which is subject to enrollment period restrictions and to a surcharge. An exception to this is those individuals not entitled to Part A coverage but who elect to pay the premium and participate voluntarily. They will be topic to the registration restrictions and the surcharge .
A decision to deny Medicare eligibility or coverage, for whatever cause, can be appealed to the Social Security Administration or Railroad Retirement Board. When a person ’ s registration rights have been prejudiced because of the carry through, inaction, misrepresentation or error on the separate of the federal politics she can not be penalized or caused hardship. If an individual can demonstrate this to be the case, the decision to deny Medicare eligibility or coverage, or the imposition of a punishment surcharge, may be reversed. Appeals are handled by the local Social Security function. It is significant if you feel you are being unfairly denied Medicare coverage that you insist on your properly to an appeal .
HOW TO ENROLL IN MEDICARE IF NOT ELIGIBLE FOR SOCIAL SECURITY
The old age of eligibility for full Social Security benefits is gradually increasing from 65 to 67, thus an increasing act of people will need to enroll in Medicare at historic period 65 without besides registering for Social Security benefits. here ’ s how to do it :
1. Apply securely on-line at hypertext transfer protocol : //secure.ssa.gov/iCLM/rib .
- Fill out the simple questions on applying for self or other and visual impairment on the right under “to start the application process”
- Cick the “apply for benefits” button
- Fill out the electronic forms on the following pages.
The sections are divided indeed as to keep them short and clear. just be certain to be accurate and complete .
2. Call the Social Security 800 telephone phone number
- Call 1-800-772-1213, choose prompt 1 for English, 3 for other additional services or to speak with a representative, and finally 0 to speak with a claims representative;
- Once you are talking to a claims representative, explain that you want to enroll in Medicare but NOT Social Security. They will fill out an application for you and instruct you how to submit your birth certificate;
- Your application will then be submitted by the claims representative;
- Four to six weeks after the receipt of your documentation, you will receive your Medicare card and handbook in the mail.
3. Visit your local Social Security office
- Visit your local Social Security office. (You can find it online, or by calling 1-800-772-1213);
- Once you are talking to a claims representative, explain that you want to enroll in Medicare but NOT Social Security. They will fill out an application for you and make a copy of your birth certificate;
- Your application will then be submitted by the claims representative;
- Four to six weeks later, you will receive your Medicare card and handbook in the mail.