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How Do You Qualify For Medicare Benefits

How Do You Receive The Part B Giveback

How Do You Apply for Medicare?

For most Medicare beneficiaries, the cost of Part B is deducted from their Social Security checks. Beneficiaries who dont receive Social Security retirement benefits are invoiced directly for their Part B premiums. The giveback rebate can be used by people in either scenario: If youre receiving Social Security retirement benefits and you enroll in an Advantage plan with a giveback rebate, the amount thats deducted from your check to cover the cost of Part B will be lower. And if you pay your premiums directly to Medicare, youll be invoiced a smaller amount.

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What Is Part B Giveback

Medicare Part B Premium Giveback, also known as Part B Premium Reduction, is a program offered through Medicare Advantage plans that gives back a portion or all of your Medicare Part B premium.

Medicare Advantage plans are offered by private insurance companies approved by Medicare that include Original Medicare benefits plus additional benefits like dental, vision, hearing, and more. Since Medicare Advantage plans include Original Medicare benefits, you still have to pay your Part B premium in addition to a Medicare Advantage premium if any. For 2021, the standard monthly Part B premium cost is $148.50. If you enroll in a Medicare Advantage plan with Part B Premium Giveback the plan will give you back a portion or all of your monthly Part B premium.

I Am Receiving Social Security Retirement Or Railroad Retirement Board Benefits

You will be enrolled in Original Medicare automatically when you turn 65. Youll get your Medicare card in the mail. Coverage usually starts the first day of your 65th birthday month.

If you have other you can delay Part B and postpone paying the premium. You can sign up later without penalty, as long as you do it within eight months after your other coverage ends. If you dont qualify to delay Part B, youll need to enroll during your Initial Enrollment Period to avoid paying the penalty. You may refuse Part B without penalty if you have creditable coverage, but you have to do it before your coverage start date. Follow the directions on the back of your Medicare card if you want to refuse Part B.

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What Is The Takeaway

Both SSDI and Medicare are complicated programs that can be life-changing when combined in the lives of disabled individuals. While this article answers many of the common questions asked, it is recommended that counsel be enlisted for those with difficult circumstances.

Representatives at SSA field offices are available to help you apply for SSDI benefits and establish your qualification. You can make an appointment by calling 1 772-1213 or stopping by your local office.

Ron Elledge is an accomplished Medicare agent, planner, and author. Elledge earned a bachelors degree in Bible theology from International Seminary and spent 30 years in pastoral ministry. He began his current career in insurance with a specialty in Medicare in 2008 and has since authored Medicare Made Easy: What Expats, Frequent Travelers and You Need to Know and is often a featured speaker at the International Living conferences. Elledge is a contributor to International Living, supporting Medicare beneficiaries with articles, podcasts, and Q& As.

By obtaining dependable details on how to read their Medicare options, recipients can plan for it correctly and make the best choices, says Elledge. These choices often make a huge financial and emotional difference in their futures. When Medicare is correctly utilized, it becomes a powerful financial and medical tool for all who qualify.

Is It Possible To Be Eligible For Medicare And Medicaid

Using A Medigap Plan Comparison Chart

Yes. Medicaid is a joint federal-state health insurance program that states run to help those with limited income and resources pay medical bills. Enrollment in both Medicare and Medicaid is called having dual eligibility. Coverage varies by state.

Individuals with full Medicaid can get help paying for services that Medicare doesnt cover or only partially covers, such as nursing home care and long-term supports and services. In most cases, Medicaid will pay your Medicare Part B premium and may help with deductibles and other costs. This may be through a Medicare Savings Program, a state-based program that can help you pay for out-of-pocket Medicare expenses. Contact your state Medicaid program or ask your SHIP counselor if you qualify.

With Medicare and full Medicaid, youll automatically qualify for Extra Help, financial assistance for Medicare Part D drug coverage costs.

Most dually eligible beneficiaries qualify for full Medicaid benefits, according to the Kaiser Family Foundation. You may be eligible for Medicaid if you have a limited income and:

  • Are 65 or older

  • Are caring for a child

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Medicare Eligibility If You Are Under 65

People younger than 65 may qualify for Medicare if they have certain costly medical conditions or disabilities.

If you are under 65, you can qualify for full Medicare benefits if:

  • You have been receiving Social Security disability benefits for at least 24 months. These do not need to be consecutive months.
  • You have end-stage renal disease requiring dialysis or a kidney transplant. You qualify if you or your spouse has paid Social Security taxes for a specified period of time, based on your age.
  • You have amyotrophic lateral sclerosis, also known as Lou Gehrigs disease. You qualify for Medicare immediately upon diagnosis.
  • You receive a disability pension from the Railroad Retirement Board and meet certain other criteria.

What If Ive Worked But Not Long Enough

You can still get Medicare Part A coverage, even if you dont fully meet the work requirement of 40 credits. Heres what youll pay in 2022:

  • If you have 30 to 39 credits, your Part A premium will cost $274 per month.
  • If you have fewer than 30 credits, your Part A premium will cost $499 per month.
  • If youre able to continue working and you accumulate 40 work credits, you wont have to pay the monthly premium for Part A coverage.

Part A is the only part of Medicare that requires a specific amount of work history. You can enroll in Medicare parts B, C, and D without a work history.

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How Do Sources Of Supplemental Coverage And Prescription Drug Coverage Differ For Medicare Beneficiaries Under Age 65 With Disabilities And Older Beneficiaries

Supplemental coverage

Most Medicare beneficiaries, including those under age 65 with disabilities, have public or private supplemental insurance to help cover Medicares cost-sharing requirements.9 A much larger share of beneficiaries under age 65 with disabilities than older beneficiaries rely on Medicaid to supplement Medicare because of their relatively low incomes .10 Medicaid helps with Medicare premiums and cost-sharing requirements, and covers services needed by many people with disabilities that are not covered by Medicare, particularly long-term services and supports.

Figure 3: Supplemental Coverage Among Medicare Beneficiaries Under Age 65 Compared to Those Age 65 or Older in 2012

Just over 1 in 5 beneficiaries under age 65 has no supplemental coverage, compared with 12% of those age 65 or older. Lack of supplemental coverage among Medicare beneficiaries is associated with higher rates of access problems, but rates of access problems are higher among younger beneficiaries with disabilities who lack supplemental coverage than among older beneficiaries, including not seeing a doctor for a health problem when they think they should and having trouble getting needed health care .12 Regardless of whether or not they have supplemental coverage, however, a larger share of younger beneficiaries with disabilities than older beneficiaries experience access and cost-related burdens .

Prescription drug coverage

What Factors Other Than Premium Should I Consider When Choosing A Medicare Advantage Plan

Who Qualifies for Medicare?

The total monthly premium is just one aspect of your coverage, and there are numerous other features that youre going to want to take into consideration when youre making a plan selection. For example:

  • How will the plan cover your specific prescription drugs, and what pharmacies are in-network?
  • Which doctors and hospitals are in the plans provider network?
  • What are the total out-of-pocket costs that youre likely to have under the plan?
  • What additional benefits does the plan provide, and how much value will you get from them? This can include coverage for things like over-the-counter drugs, in-home support, dental services , hearing aids, gym memberships, and more. Particularly for people with certain chronic medical conditions, Medicare Advantage plans are increasingly offering additional supplemental benefits, but you have to qualify for these based on your medical needs.
  • What star rating does the plan have?

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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How Do You Receive Your Medicare Benefits When You Meet Medicare Eligibility Requirements For People Younger Than Age 65

  • If you receive Social Security benefits for 24 months, usually you will automatically be enrolled in Medicare Part A and Part B at the beginning of the 25th month.
  • If you have Lou Gehrigs disease, usually you will automatically be enrolled in Medicare Part A and Part B as soon as you receive the first month of Social Security disability benefits.
  • If you have ESRD, you might be eligible for Medicare but you must apply for Medicare benefits by visiting your local Social Security office or contacting Social Security from 7AM 7PM Monday Friday, all U.S. time zones. Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments.

Are you unsure whether you meet Medicare eligibility requirements? Contact me. I will be happy to help you.

  • You can use the links below to reach me or have me send you customized information through an email.

If you wish to learn more about some of the Medicare plans where you live, use the Compare Plans button on this page.

New To Medicare?

Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.

How Do Medicare Spending And Use Of Services Differ For Beneficiaries Under Age 65 With Disabilities And Older Beneficiaries

Medicare per capita spending

Average total Medicare spending is higher for traditional Medicare beneficiaries under age 65, mainly due to higher Part D prescription drug spending.13 Medicare per capita spending for beneficiaries younger than age 65 averaged $13,098 in 2014, nearly one third more than average per capita spending for beneficiaries over age 65 .14 Excluding Part D drug spending, the difference narrows considerably to $9,281 for beneficiaries under age 65 and $8,814 for those over age 65, on average. On average, beneficiaries under age 65 have higher per capita spending for drugs covered under Part D and for inpatient and outpatient services, but lower spending on post-acute and hospice care than beneficiaries over age 65 .

Figure 5: Average Medicare Per Capita Spending for Beneficiaries Under Age 65 With Disabilities and Over Age 65, by Type of Service, 2014

Use of medical services

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How Do You Receive Your Medicare Benefits When You Meet Medicare Eligibility Requirements At Age 65

If you meet Medicare eligibility requirements and you have received Social Security benefits for at least four months prior to turning age 65, you will typically get Medicare Part A and Part B automatically the first day of the month you turn age 65.

If youre not enrolled in Original Medicare automatically, you may need to file an application with the Social Security Administration. You can enroll in Medicare Part A and Part B during the period that begins three months before your 65th birthday month, includes your birthday month and ends three months after your birthday month.

Note: You have a choice if you want to keep or refuse enrollment in Medicare Part B. If you refuse it, you dont lose your Medicare Part B eligibility. However, you may have to wait for a valid enrollment period before you can enroll. You may also have to pay a late enrollment penalty for as long as you have Medicare Part B coverage.

Medicare Coverage And Eligibility

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It is good to know as much as you can about Medicare eligibility, so that you can be prepared when the time comes to enroll. The following criteria are necessary for Medicare eligibility:

  • Be age 65 or older and eligible for Social Security: You may be automatically enrolled in Medicare Part A when you reach age 65 and become eligible for Social Security. But, if youâre not receiving retirement benefits from Social Security or the Railroad Retirement Board , you must sign up for Medicare Part B when you meet the age requirement, as your enrollment isnât automatic.
  • Be permanently disabled and receive disability benefits for at least two years: You automatically get Part A and Part B after you get disability benefits from Social Security for 24 months or certain disability benefits from the Railroad Retirement Board for 24 months.
  • Have end-stage renal disease : You need to sign up for Medicare, as your enrollment isnât automatic.
  • Have Lou Gehrigâs disease : You automatically get Part A and Part B the month your disability benefits begin.

Most Medicare members donât have to pay a premium for Medicare Part A if they or their spouse paid Medicare taxes while working for at least 10 years . If youâre not eligible for premium-free Part A, you will have to pay a monthly premium of up to $499 in 2022.

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What If Im Not Automatically Enrolled At 65

If your Medicare enrollment at 65 is not automatic, but you want to enroll, here are some more magic numbers.

3 and 7.

To start taking advantage of Medicare at 65, you need to sign up during the three months before the birthday month you turn 65. Those are the first three months of your seven-month Initial Enrollment Period.

Unless your birthday is on the first day of the month, your Initial Enrollment Period includes the three full months before turning 65, the month you turn 65, and the three months after you turn 65. If you were born on the first day of the month, IEP is the four months before your birth month, along with your birthday month and the two months after.

If you sign up during one of the months before your 65th birthday, your coverage will begin on the first day of the month you turn 65 .

Are you eligible for cost-saving Medicare subsidies?

How Do You Enroll In The Medicare Qmb Program

To enroll in the QMB program, you first need to be enrolled in Medicare Part A.

The next step is to review your income and assets to see if you fall below the limits set by Medicare. But remember there are exceptions to those limits, and youre encouraged to apply even if your income or assets exceed them.

To apply for the QMB program, youll need to contact your state Medicaid office. You can check online to find your states office locations, or call Medicare at 800-MEDICARE. The documentation youll need varies by state, but your application process will likely include submissions of identification, proof of Medicare coverage, and financial information.

Once you submit your application, you should receive a confirmation or denial within about 45 days. If youre denied, you can request an appeal. Enrollment in any of the MSPs must be renewed each year.

Even when your QMB is active, you may at times be wrongfully billed for items or services that it covers. Contact Medicare for any billing problems. Be sure to carry documentation of your participation in the QMB program and show it to your providers.

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Other Ways To Get Medicare Coverage At Age 65

If you dont qualify for premium-free Medicare Part A coverage, you may be eligible to buy coverage. However, you must still be a U.S. citizen or a permanent resident for at least five years to qualify.

Other Medicare Eligibility Options

  • You can pay premiums for Medicare Part A hospital insurance. Premium costs vary based on how long you have worked and paid into Medicare.
  • You can pay monthly premiums for Medicare Part B medical services insurance. Youll pay the same premiums as anyone else enrolled in Part B.
  • You can pay monthly premiums for Medicare Part D prescription drug coverage. Your premium will be the standard rate and would depend upon the plan you choose.

You will not be able to purchase a Medicare Advantage plan or Medigap supplemental insurance unless you are enrolled in Original Medicare Medicare Parts A and B.

Should I Take Medicare Part B

Who Is Eligible for Medicare?

You should take Medicare Part A when you are eligible. However, some people may not want to apply for Medicare Part B when they become eligible.

You can delay enrollment in Medicare Part B without penalty if you fit one of the following categories.

Employer group health plans may cover items normally not covered by Medicare Part B. If so, and you meet one of the categories above or below, then you may not need to enroll in Medicare Part B and pay the monthly premium.

If you are:

  • a spouse of an active worker
  • a disabled, active worker
  • a disabled spouse of an active worker

and choose coverage under the employer group health plan, you can refuse Medicare Part B during the automatic or initial enrollment period. You wait to sign up for Medicare Part B during the special enrollment period, an eight month period that begins the month the group health coverage ends or the month employment ends, whichever comes first.

You will not be enrolling late, so you will not have any penalty.

If you choose coverage under the employer group health plan and are still working, Medicare will be the “secondary payer,” which means the employer plan pays first.

If the employer group health plan does not pay all the patient’s expenses, Medicare may pay the entire balance, a portion, or nothing. An employer group health plan must be primary or nothing.

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