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The In-Depth Comprehensive Guide to Qualifying and Applying for Medicare Coverage

Medicare is the federally-funded health-insurance program for Americans 65 or older. Younger people with certain disabilities are also eligible for Medicare benefits.

Medicare benefits are available through either original Medicare or a supplemental Medicare Advantage Plan. In this in-depth comprehensive guide to qualifying and applying for Medicare coverage, we’ll cover some of the most-asked questions about the program, how you can qualify and how to apply.

Understanding The Four Parts of Medicare

Before jumping into the application process, it’s important that you understand the various types of Medicare options available. Medicare consists of four parts: Part A; Part B; Part C; and Part D. Medicare Part A is typically offered at no charge, whereas Parts B, C, and D require a premium be paid. Typically, if you are eligible for Part A you are also eligible for Parts B, C, and D.

What Is Medicaid Part A and Who Is Eligible

Medicare Part A is hospitalization insurance designed to cover inpatient hospital care as well as care in other healthcare facilities, such as a nursing home. Medicare Part A is available at no cost if you:

  • Are 65 or older and are eligible to receive Social Security benefits.
  • Are eligible to receive railroad retirement benefits.
  • Your spouse receives or is eligible to receive Social Security or railroad retirement benefits.
  • Have a spouse who worked in a government sector job that had Medicare taxes withheld.
  • Are a dependent parent of a child who is fully insured.

You are eligible for Medicare coverage before the age of 65 if:

  • You receive disability payments for 24 months from either the Social Security Administration or the Railroad Retirement Board.
  • You are receiving disability benefits due to having ALS, or Amyotrophic Lateral Sclerosis, or end-stage renal disease requiring dialysis or a kidney transplant.

Understanding Medicare Part B

Medicare Part B covers certain types of services, including some doctor visits, durable medical equipment, such as wheelchairs, outpatient services, ambulance services, and lab tests. People who are eligible for Medicare Part A at no cost are eligible for Part B coverage. Part B premiums are on a sliding scale based income level. Even if you aren’t eligible for no-cost Part A, you can still qualify for Part B if:

  • You are 65 or older.
  • You are a U.S citizen or lawfully-admitted alien who has permanently resided in the U.S. continuously for at least five years immediately before applying for Part B.

Medicare Part C Defined

Medicare Part C, commonly referred to as Medicare Advantage, is a Medicare-approved health care plan offered by private insurance companies to provide both Part A and Part B benefits in one plan. This includes Health Maintenance Organizations, or HMOs, Medicare Medical Savings Account Plans, Preferred Provider Organizations, and Special Needs Plans. All Advantage plans are required to provide the same levels of coverage as individual Parts A and B plans. Typically, Medicare Advantage plans offer coverage for prescription drugs and may also offer additional benefits including routine dental and vision services

Medicare Part D – Medication

Medicare Part D, also known as Prescription Drug Plans, is a stand-alone policy to cover the cost of prescription medications. Like Parts B and C, Part D is offered through Medicare-sanctioned private insurance companies.

Applying for Medicare

The first Medicare Coverage Election Period runs for seven months, starting four months before your 65th birthday and ends three months after you turn 65. You are eligible for Medicare coverage even if you don’t retire at 65. The annual open enrollment period for Medicare is from October 15 to December 7 of each year. People who are already receiving Social Security or railroad retirement benefits will be contacted three months before their 65th birthday. If you live in the U.S, or one of its territories, like the U.S Virgin Islands, you will be enrolled in Medicare Parts A and B automatically. However, because Part B requires a premium, you will also be given the choice of opting out of Part B coverage.

You can also apply for Medicare before 65 if:

  • You are disabled and a widow or widower over 50.
  • You were a government employee and became disabled before your 65th birthday.
  • You or an immediate family member has an end-stage renal disease.
  • You previously had Medicare Part B but discontinued coverage.
  • You opted out of Medicare Part B when first applying for Medicare Part A.
  • You or your spouse was employed in the railroad industry.

Enrollment Periods

You can still sign up for Medicare even if you miss the initial enrollment period, but you may get dinged with a late-enrollment penalty. Coverage will begin on the following July 1st after you enroll. If you have a Part C plan and wish to switch to a standard Part A and Part B plan you can change plans from January 1st to February 14th. For Part D plans, the same January-to-February enrollment dates apply and coverage will begin on the first day of the month after your Part D enrollment form is received.

Applying for Medicare Coverage

Applying for Medicare Coverage can be very simple and there are 3 different ways to enroll into both Medicare Part A and B. The first way to apply for Medicare Coverage is by going to the website www.socialsecurity.gov where an application can be found to enroll into the program or programs. Next, the following way to apply to Medicare is by calling the Social Security phone number can be found on the Social Security website or by calling the following number 1-800-772-1213. The office hours for the Social Security phone number is from 7 am to 7 pm during the week excluding Saturday and Sundays.

Visit Your Local SS OfficeImage result for social security office illustration

Moreover, the next way to apply for Medicare Coverage is by looking up a local Social Security Office and applying in person. This way of applying for Medicare Coverage can be the best due to being able to get assistance from employees in the office to make sure the application is properly filled out without any mistakes that could cause a delay in the process. A very important thing to remember is the Medicare Initial Enrollment Period. This period takes place between three months before an individual’s 65th birthday and 3 months after their 65th birthday.

Understanding How To Qualify For Medicare

There are 3 important things to remember when truly understanding how to qualify for Medicare which is understanding the costs of Medicare, understanding what is actually covered through Medicare, and understanding what supplemental coverage options are available to individuals enrolled into Medicare. Medicare does indeed have some costs for two of the 3 parts of the program. Medicare Part A is free and covers hospital bills like room and board. Now, Medicare Part B which is for outpatient coverage does indeed have costs for things like doctor visits, surgeries, etc. The average starting rate for Medicare Part B is around $134 per month.

The Average Starting Rate

Moreover, this average starting rate can be more depending on how much income an individual makes, if their current income is higher than usual then their Medicare Part B Coverage will also be more. Medicare Part D varies due to the different amount of plans that are offered to individuals. Individuals must make sure they research which plan to choose for their specific prescriptions they may need. Finishing up on the cost of Medicare, the average price for Medicare Part D is $34 per month. Medicare Part A covers the first 60 days of the hospital room and board with a deductible of $1,340. Medicare Part B covers 80% of medical bills with the other 20% is for the individual to pay. Furthermore, Medicare Part D covers prescription drugs with just simple co-pays to protect individuals from high prescription drug costs. Understanding how to qualify for Medicare means understanding Medigap insurance plans and Medicare Advantage Supplemental Insurance Plans. Medigap covers the gap in Medicare Part B that is not covered by the other 80% of medical bills. Medicare Advantage Plans are plans that pay for medical bills instead of Medicare.

Understanding How to Apply for Medicare Coverage

Understanding How to Apply for Medicare Coverage is very important but is very simple once all the information is understood. For example, when applying online a simple 10-minute application is all it takes to apply for Medicare Coverage and then the individual’s application process is complete. If there is anything missing like a specific document that is needed for approval the Social Security Office will let individuals know the required documents that are missing. After this process is complete the Social Security Office will review the application and then they will mail the decision of approval or denial to the individual after the review is complete. This information will help individuals for understanding how to apply for Medicare Coverage.