How Do I Get Full Medicare Benefits
Youâre entitled to full Medicare Part A and Part B benefits as soon as youâre eligible for Medicare.
If youâre interested in benefits beyond Original Medicare, you may want to consider:
- Medicare Advantage: Also known as Medicare Part C, these plans give you another way to get your Medicare Part A and Part B coverage. Plus, they often include extra benefits, like prescription drug coverage.
- Medicare Supplement Insurance: This private insurance plan works alongside your Medicare Part A and Part B coverage. Itâs also called Medigap.
- Medicare Part D: This stand-alone prescription drug plan helps you cover the cost of prescription medications.
Finding the Medicare plan thatâs right for your needs doesnât have to be overwhelming â eHealth is here to help. Get started now.
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What Is A Quarter Of Coverage
To calculate a persons eligibility for premium-free Medicare Part A insurance, Medicare counts the number of employment quarters the individual worked.
A quarter of coverage is a 3-month calendar quarter in which a person worked in a job and paid Medicare taxes. Every quarter of coverage earned counts as one credit toward qualifying for free Medicare Part A.
During a quarter of coverage, an employee pays Federal Insurance Contributions Act taxes, which combine withheld taxes for Medicare and Social Security.
On a paycheck, Medicare withholding tax appears as Fed Med/EE. Each year has four quarters. Roughly, 40 quarters equals 10 years of work.
The 40-quarters rule only applies to premium-free Medicare Part A. Other parts of Medicare, including Medicare Part B, involve a monthly premium regardless of how long a person has worked in their lifetime.
Reaching Age 62 Can Affect Your Spouse’s Medicare Premiums
Although reaching age 62 does not qualify you for Medicare, it can carry some significance for your spouse if they receive Medicare benefits.
When one spouse in a couple turns 62 years old, the other spouse who is at least 65 years old may now qualify for premium-free Medicare Part A if they havent yet qualified based on their own work history.
- For example, Gerald is 65 years old, but he doesnt qualify for premium-free Part A because he did not work the minimum number of years required for eligibility. He can still receive Medicare Part A, but he will have to pay a monthly premium for it. In 2023, the Medicare Part A premium can be as high as $499 per month.
- Lets say Geralds wife, Jessica, reaches age 62 and has worked for the required number of years to qualify for premium-free Part A once she turns 65. Because Jessica is now 62 years old and has met the working requirement, Gerald may now receive premium-free Part A.
In the above example, Jessica has not become eligible for Medicare by turning 62. Her husband Gerald, however, is now eligible to receive his Medicare Part A benefits without paying a monthly premium any longer.
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Can I Sign Up For Medicare Plans Online
Enrolling in Medicare coverage options online is generally easy and quick. More and more people are signing up online, according to an eHealth study. During 2018, about 16% of people in the study enrolled in Medicare coverage options online. Thatâs up from only 10% in 2017. In other words, about 60% more people in the study used eHealthâs online enrollment tool to sign up in 2018 than in 2017.
Itâs interesting to note that online enrollment was even higher during âQ4.â Q4 means the 4th quarter of the year, October through December. Thatâs when Medicareâs Fall Open Enrollment happens for Medicare Advantage and Medicare prescription drug plans. Fall Open Enrollment goes from October 15 â December 7 every year.
Can You Get A Medicare Supplement Plan On Disability
At the present time, there is no federal legislation that guarantees enrollment in Medigap for beneficiaries under age 65. It is left to the states to enact legislation that makes Medigap coverage a guaranteed issue.
Only 11 states require insurers to offer at least one Medigap plan to those under age 65 with an equal number making all plans guaranteed-issue, but under-65 premiums can be much higher. Twelve states make all plans guaranteed-issue and include restrictions on premiums. Also, 12 states and Washington, D.C., have no coverage requirement for insurers. Four states have not even addressed the issue of Medicare for those under 65.
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Does Medicare Work With Health Savings Accounts
When enrolled in any Medicare parts, you CANNOT contribute to a Health Savings Account . Your employer also cant contribute to your HSA once your Medicare is active. If you continue to add to your HSA, you could face tax penalties.
If your spouse has coverage on your group insurance, they can still contribute as long as their Medicare is not active. The good news is, you can use the funds in your HSA to pay for any medical expenses.
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What Are Employment Quarters For Social Security
The Social Security Administration calls employment quarters by several names, such as quarter of coverage and Social Security credits or simply credits.
How credits for Social Security retirement benefits have been calculated has changed over the years. Today, Social Security credits are based on your total income during the year, and the year is divided into four employment quarters.
The dollar amount needed to earn credits may go up slightly each year, according to the Social Security Administration, as average earnings increase. For more information on the current earnings needed to earn Social Security or Medicare work credit, visit the Social Security website.
There are special rules for certain types of jobs, such as domestic work, farm work, and work for a church or similar organization that does not collect Social Security and Medicare taxes. Employment of this sort may count towards your employment quarters for retirement and Medicare benefits, but you should contact the Social Security Administration to confirm. Conversely, some people may not qualify for Social Security retirement credits, such as federal employees hired before 1984, railroad employees with more than 10 years of service, and employees of some state and local governments. Other factors may be used to determine their eligibility for premium-free Medicare Part A.
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How Do People Under Age 65 With Disabilities Qualify For Medicare
People under age 65 become eligible for Medicare if they have received SSDI payments for 24 months. Because people are required to wait five months before receiving disability benefits, SSDI recipients must wait a total of 29 months before their Medicare coverage begins. People under age 65 who are diagnosed with end-stage renal disease or amyotrophic lateral sclerosis automatically qualify for Medicare upon diagnosis without a waiting period.5 Of those who were receiving SSDI in 2014, 34% qualified due to mental disorders, 28% due to diseases of the musculoskeletal system and connective tissue, 4% due to injuries, 3% due to cancer, and 30% due to other diseases and conditions.6
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Do Husband And Wife Pay Separate Medicare Premiums
You and your spouse pay separate premiums for Medicare benefits under Medicare Part B, and Medicare Part D if you sign up for it. If one or both of you choose to enroll in a Medicare Advantage plan, you will continue to pay separately the Medicare Part B premium and possibly a separate plan premium.
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How To Enroll Kids In Medicare
The path to enrolling a child in Medicare depends on the reason theyre eligible. Kids between ages 20 and 22 who are eligible through disability will be automatically enrolled in Medicare after receiving 24 months of SSDI payments. Theyll receive enrollment information and their Medicare card in the mail. At this time, they can also enroll in Medicare Advantage, Medicare Part D, or Medigap.
Children eligible through an ESRD diagnosis will need to enroll through Social Security. You can enroll a child by visiting a local Social Security office or by contacting Social Security online. Medicare coverage for kids with ESRD begins their fourth month of dialysis treatment. Depending on when you apply, coverage might backdate and cover treatments a child has already received.
How Are Disabled Widows Benefits Calculated
Your survivors benefit amount is based on the earnings of the person who died. The more they paid into Social Security, the higher your benefits would be. The monthly amount you would get is a percentage of the deceaseds basic Social Security benefit . Two surviving parents 75 percent to each parent.
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Can You Pass Along Benefits Upon Death
Some traditional insurance products offer the ability to continue benefits for family members listed on the policy following the policy holders death. Medicare insurance does not provide an option for this. Because each plan applies only to the individual to whom the plan was issued, benefits cant be passed on to others upon death or for any other reason.
Signing Up Late: General Enrollment Period
Part A. If you didnt sign up for Medicare Part A when you were first eligible, you can sign up for Part A anytime, without penalty.
When coverage begins. Your Part A coverage will go back to six months before the date you signed up .
Part B, C and D. If you didnt sign up for Medicare Part B when you were first eligible, you can sign up for Part B during a General Enrollment Period, which happens between January 1 through March 31 each year. You will also have from April 1 through June 30 of that year to add a Medicare Advantage plan or Medicare Part D plan.
When coverage begins. When you sign up for Part B, C, or D during a General Enrollment Period, your coverage will start July 1.
Late sign-up penalty. Individuals who did not sign up for Medicare Part B when they turned 65 might face a penalty of higher lifetime premiums when they do sign up. However, most individuals who were covered by a group health plan through an employer are not subject to the penalty. If you didnt sign up for Part B because you had group health benefits through work, you should be able to sign up during your Special Enrollment Period.
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Medicare Eligibility By Disability
Most Medicare recipients under the age of 65 reach eligibility during their 25th month receiving Social Security disability benefits. If you qualify for Medicare because of a disability, your Initial Enrollment Period will begin during the 22nd month you receive these benefitsthree months before youre eligible for coverage.
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How Could Lowering The Medicare Age Affect People Eligible For Full Medicaid Benefits
What is current policy? Today, some people are eligible for both Medicare and full Medicaid benefits, while others may lose Medicaid eligibility once they become eligible for Medicare. A persons status as a Medicare beneficiary does not qualify them for full Medicaid benefits. Instead, a person must independently qualify for Medicaid through an eligibility pathway based on low income or disability. Individuals in the 60-64 age range may qualify for Medicaid through various pathways that may have different eligibility criteria and benefit packages. For example:
What are the key policy choices and implications? Lowering the age for Medicare would require policy choices about whether to allow individuals in the new age range to continue to receive full Medicaid benefits, if eligible under the ACA expansion or other poverty- or disability-related pathways, or whether these individuals would move from Medicaid to Medicare as their sole or primary source of coverage. How these eligibility issues are resolved has important implications for enrollee benefits and cost-sharing as well as state and federal costs . Additionally, Medicare enrollment is limited to specific periods, while Medicaid enrollment is open year-round. However, Medicaid eligibility must be periodically renewed, while Medicare eligibility currently continues without the need to renew eligibility once a person turns 65.
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Before You Make Your Decision
There are advantages and disadvantages to taking your benefit before your full retirement age. The advantage is that you collect benefits for a longer period of time. The disadvantage is your benefit will be reduced. Each person’s situation is different. It is important to remember:
- If you delay your benefits until after full retirement age, you will be eligible for delayed retirement credits that would increase your monthly benefit.
- That there are other things to consider when making the decision about when to begin receiving your retirement benefits.
What Are My Rights As A Medicare Beneficiary
As a Medicare beneficiary, you have certain guaranteed rights. These rights protect you when you get health care, they assure you access to needed health care services, and protect you against unethical practices.
You have these rights whether you are in Original Medicare or another Medicare health plan.
Your rights include, but are not limited to:
The Right to Receive Emergency Care
If you have severe pain, an injury, or a sudden illness that you believe may cause your health serious danger without immediate care, you have the right to receive emergency care. You never need prior approval for emergency care, and you may receive emergency care anywhere in the United States.
The Right to Appeal Decisions About Payments or Services for Medical Care
If you are enrolled in Original Medicare, you have the right to appeal denial of a payment for a service you have been provided. If you are enrolled in another Medicare health plan, you have the right to appeal the planâs denial for a service to be provided.
The Right to Information About All Treatment Options
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Medicare Part Bit Depends On The Size Of Your Employer
Medicare Part B covers doctors’ services, outpatient care, medical supplies and preventive services. The primary consideration in deciding if you need Part B is how many employees work at your company.
- If your company has 20 or more employees, your company would remain your primary insurer and you can delay enrolling in Part B without worrying about a late-enrollment penalty or lapse of coverage. When you leave your job, you then have eight months to sign up for Part B under a Special Enrollment Period.
- If your company has fewer than 20 employees, Medicare is considered your primary insurer, whether you’ve enrolled in Medicare or not. Your company plan is the secondary, which means that your employer plan won’t pay for anything that’s assumed to be covered by Medicare. If you don’t sign up for Part B as soon as you’re eligible, you may have to pay a penalty, and there could be a delay in coverage.
Other Ways To Get Medicare Coverage
If you do not qualify on your own or through your spouses work record but are a U.S. citizen or have been a legal resident for at least five years, you can get full Medicare benefits at age 65 or older. You just have to buy into them by:
- Paying premiums for Part A, the hospital insurance. How much you would have to pay for Part A depends on how long youve worked. The longer you work, the more work credits you will earn. Work credits are earned based on your income the amount of income it takes to earn a credit changes each year. In 2022 you earn one work credit for every $1,510 in earnings, up to a maximum of four credits per year. If you have accrued fewer than 30 work credits, you pay the maximum premium $499 in 2022. If you have 30 to 39 credits, you pay less $274 a month in 2022. If you continue working until you gain 40 credits, you will no longer pay these premiums.
- Paying the same monthly premiums for Part B, which covers doctor visits and other outpatient services, as other enrollees pay. In 2022 the amount is $170.10 for individuals with a yearly income of $91,000 or less or those filing a joint tax return with $182,000 in income or less. Rates are higher for people with higher incomes.
- Paying the same monthly premium for Part D prescription drug coverage as others enrolled in the drug plan you choose.
You can enroll in Part B without buying Part A. But if you buy Part A, you also must enroll in Part B.
You can get Part D if youre enrolled in either A or B.
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Medicare Requirements Impacting Your Calpers Health Coverage
If youre Medicare eligible and you lose your Part A and/or Part B, youll be disenrolled from the CalPERS Medicare health plan. Your disenrollment from Part A and/or Part B may result in cancellation of your CalPERS health coverage.
CMS requires members to live in the approved plan service area and list a residential address. Post Offices Boxes are not permitted. If CalPERS is unable to verify your permanent residential address, your enrollment may be subject to cancellation, or you may be administratively enrolled in a Medicare Supplement plan to continue your CalPERS health coverage.
CMS must approve your enrollment in a Medicare Advantage plan and Medicare Part D plan. CalPERS and/or your CalPERS Medicare health plan may contact you to obtain additional information required by CMS to complete your enrollment. If youre contacted for additional information, respond immediately to protect your health coverage.
You may be enrolled in only one Medicare Advantage plan at one time, as well as one Medicare Part D plan at one time. If youre enrolled in a CalPERS Medicare health plan and later enroll in another Medicare health plan, youll be disenrolled from the previous Medicare health plan.