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Decode the Technicalities of Medicare, the Federal Health Insurance Program Designed for Seniors

Medicare Insurance Plans

Medicare Plans – A Popular Health Insurance Plan Designed Especially for Seniors

Medicare is the federal government’s popular health insurance plan especially designed for senior citizens who are over 65 years of age or are turning 65 within three months. This plan also offers health coverage to people with permanent disability. Nearly 60 million Americans are covered under medicare and more are added everyday, with huge numbers of people retiring everyday. This social insurance program, is managed, administered and partially funded by the federal government and was designed to offer guaranteed health insurance benefits to senior citizens of the U.S. This plan was designed for retired seniors simply because they didn’t have a way to get employer-sponsored coverage and the health insurance for seniors was prohibitively expensive.

Medicare is immensely popular among the citizens not only because it covers a tremendous range of medical services but it also include pre-existing conditions. The Medicare plan is broken into four parts such as hospital insurance or Part A, medical insurance or Part B, Medicare Advantage Plan or Part C, and Prescription Drug Coverage or Part D. Each of this part covers different healthcare related costs. Medicare Part A plan includes hospital insurance, Part B include medical insurance, Part C include Medicare Advantage Plans and Plan D includes prescription drug coverage. Both Medicare Part A and Part B are administered by the Centers for Medicare and Medicaid Services. whereas Part C and Part D are managed by private insurance companies.

Eligibility for Medicare

All the citizens and permanent residents of the United States, who have continuously lived in the country for five or more years become eligible for original Medicare when they turn 65. Other individuals may also qualify for Medicare before 65, if they have received Social Security or certain Railroad Retirement Board disability benefits for at least two years, or if they have certain conditions such as end-stage renal disease or amyotrophic lateral sclerosis.

If you are receiving retirement benefits before you turn 65, then you will be automatically enrolled in Medicare Part A and Part B plan on the first day of the month in which you turn 65. However, if you are not receiving retirement benefits then on turning 65 you will need to manually enroll. You can sign for Medicare through Social Security or the Railroad Retirement Board during your Initial Enrollment Period. Different options available to apply for Medicare include:

  1. You can apply online through the social security website
  2. Visit Social Security office personally to apply
  3. You can call Social Security over the phone from Monday to Friday from 7AM to 7PM
  4. If you worked for a railroad you need to contact the Railroad Retirement Board to enroll in Medicare

After applying for Medicare through any of the above methods, you receive your red, white, and blue Medicare card through mail, if there are no issues with your application. If you are automatically enrolled in Medicare, your card arrive three months before your 65th birthday or after the 25th month of disability benefits.

Medicare Card

Medicare card is the most vital document you own, as it is the proof that you have Medicare Health coverage that you need to show to your health care provider while receiving the treatment. You generally get your Medicare card after you first apply for Medicare benefits. Americans usually qualify for this plan when they turn 65 while some individuals qualify at any age due to disability or certain health conditions like end-stage renal disease or amyotrophic lateral sclerosis. The application process varies depending on your specific situation and the manner in which you qualify for Medicare. This also affect the time when your card will arrive. If you are already receiving Social Security or Railroad Retirement Board retirement benefits when you turn 65 then you will be automatically enrolled in Medicare when you turn 65 and your card will be sent in the mail about three months before your 65th birthday. If you manually enroll in Medicare during your seven month initial enrollment period, your card will arrive depending on the month you signed up for Medicare. If you qualify for medicare because of disability then your card will arrive through mail three month before your 25th month of disability benefits.

Medicare Part A

Medicare is similar to the health insurance coverage that you have with an employer or you take individually. It covers doctor visits, inpatient and outpatient hospital care, prescription drugs, lab tests, and even dental and vision. Medicare plan is broken out a little different so find a brief overview on each part of the Medicare.

Medicare Part B

Medicare Part B is a part of original Medicare that covers medical services and supplies that are medically essential to treat your health condition. This plan is designed to help you pay for most of your non-hospital related medical coverage. Medicare Part B is designed to fill some of the gaps of Part A medical insurance coverage.

Medicare Part C

An alternative to original Medicare (Part A and Part B), medicare Advantage plans are health insurance plans that are offered by private health insurance companies and are approved by Medicare. Medicare Advantage health plans like HMOs and PPOs are legally enforced to offer …

Medicare Part D

Medicare Part D prescription drug coverage referred as Part D is provided and coordinated by Medicare approved private insurance companies. Any beneficiary eligible for Original Medicare Part A and Part B and who permanently resides in the service area of a Medicare Prescription Drug Plan, can sign-up for Medicare Part D.

FAQ on Medicare

If you sign up for the Social Security benefits before turning 65 years of age, then you will be automatically enrolled in Original Medicare. You will receive your medicare card three months prior to your 65 birthday. Everyone else need to enroll in Medicare or face lifetime late enrollment penalty that is imposed on all baring seniors who are still working and have proper employer coverage. Seniors who are still working for a firm with 20 or more employees, their employer’s insurance is their primary coverage and they can obtain Medicare to fill any gaps in the coverage. Such seniors do not require to sign up for Medicare at 65 and they will not be imposed with late enrollment penalty as long as they sign up within eight months of leaving job or losing work-based coverage.

Online applying for Medicare is an easy and simple process that hardly take few minutes to complete. If you are looking to enroll in Medicare plan you can enroll during your initial enrollment window that spans for seven months, beginning three months prior your 65th birthday month and ending three months after that month. This will be your initial enrollment window during which you can sign up for Medicare online. Though, you also have the option to do over the phone or in person but if you wish to save time then applying online is the best way. The first thing you need to do is to create an account on the Social Security Administration’s web site. You will be asked that whether you wish to sign up for only Social Security or for both Social Security and Medicare at the same time.

In next step you will be required to provide your basic information like your name, address, telephone number along with your Social Security number to complete your application. Beside these, you will also need to provide some of your documents like birth certificate, driver’s license, or proof of U.S. citizenship if you were not born in the U.S. and in case if you are not U.S. citizen then your permanent resident card number.

Now you will need to decide that whether you should enroll in Medicare Part A only or Part A and Part B both. Part A covers hospital care and Part B covers things like office visits, preventive care, and lab work and also covers services like chemotherapy, radiation, and kidney dialysis. There is no premium for Part A but you will have to pay a premium to enroll in Part B. Therefore, if you are working and are covered by your employer then you it is best you to sign up for Part A alone, which doesn’t charge a premium. However, you will need to provide your start date of your employment and the date on which your group healthcare coverage began. If your covered through your spouse employer then also you should sign up for Part A only. It is always best to enroll on time because if you are eligible for coverage and you don’t apply then you will risk a 10% surcharge on your Part B premiums. In case if you are working during your initial enrollment period and have group health coverage you will get a special enrollment period to sign up for Medicare later on without having to pay any penalty. Otherwise enrolling on time is certainly the best option.

In the normal scenario, once you are enrolled in Medicare, you don’t need to renew your coverage every year. This applies for every medicare plan, Original Medicare, Medicare Advantage plan, or a Medicare prescription drug plan. You just need to pay the necessary premiums and your coverage is automatically renewed every year. Though, there are some exceptions where you will require to take necessary action in order to continue your coverage. Some of the scenarios in which your Medicare Advantage or stand-alone Medicare Part D prescription drug plan won’t be automatically renewed are:

  1. Medicare terminates its contract with your Insurance Company.
  2. Insurance carrier of your plan reduces its service area and now you live outside its coverage area.
  3. Your insurance company suddenly leave the Medicare program in the mid of the year.
  4. Insurance carrier does not renew its contract with Medicare for the upcoming year.

There is also might be a case when your Medicare Advantage Plan might not renew its contract with Medicare for the coming year. In such a case you will have Special Enrollment Period that run from December 8 to the last day of February of the following year, during which you can enroll in a new plan and if you don’t enroll be the date your current plan ends contract with Medicare, then you will be automatically returned to original Medicare. Your new coverage will starts from the first day of the month after you submit your enrollment application.

If you are enrolled in a Medicare Advantage or Medicare Part D Prescription Drug Plan and your plan terminates its contract with Medicare then you get a three month Special Election Period that starts two months before the contract ends and continue an additional month after the contract ends. And in case if Medicare terminates your plan’s contract then you have a Special Election Period that starts prior one month the termination effective date and ends two months after the effective date of the termination. In this case you will need to renew your coverage.

If you are enrolled in Original Medicare then your coverage will remain in the new state also but Medicare Advantage, Medicare Part D and some Supplemental insurance plans (Medigap) are state-specific. You should check with your insurance carrier before moving to ensure that your plan is transferable and will be accepted by hospitals and doctors in your new state. If your plan doesn’t cover you in the new state then you will have access to a special enrollment period when you will have the option to select a new coverage. If you have Original Medicare along with a Medigap plan then you will be able to keep the Medigap plan in new state as most of the Medigap plans do not have nay specific provider networks and they simply cover extra costs incurred under Original Medicare which has provider everywhere in the country. Though, in case if you have Medigap coverage with Medicare SELECT plan then it has a localized provider network that you are suppose to use and so if you are moving out of the state you will not be able to use it. In such case, you can either choose to buy a regular Medigap plan from your current insurance carrier or you can use your special enrollment period to purchase any Medigap plan in your new state.

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