How Do I Get Full Medicare Benefits
If youve worked at least 10 years while paying Medicare taxes, there is no monthly premium for your Medicare Part A benefits. But if you havent worked, or worked less than 10 years, you may qualify for premium-free Part A when your spouse turns 62, if she or he has worked at least 10 years while paying Medicare taxes. However, to be eligible for Medicare, you need to be 65 years old. You also need to be an American citizen or legal permanent resident of at least five continuous years.
So, to summarize with an example:
- Bob is 65 years old. Hes on Medicare, but he pays a monthly premium for his Medicare Part A benefits. He only worked for seven years and no longer works.
- His wife, Mary, has worked for over 30 years.
To Qualify For Medicare You Need To Get Disability Benefits From:
- Social Security
- Railroad Retirement Board
If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
If you live in Puerto Rico or outside the U.S.
How Much Does Medicare Cost
Original Medicare is divided into Part A and Part B .
- Part A helps pay for inpatient hospital care, some skilled nursing care, home health care and hospice care.
- Part B helps pay for doctor services, outpatient hospital care, durable medical equipment, home health care not covered by Part A, and other services. Medicare was never intended to pay 100% of medical bills. Its purpose is to help pay a portion of medical expenses. Medicare beneficiaries also pay a portion of their medical expenses, which includes deductibles, copayments, and services not covered by Medicare. The amounts of deductibles and copayments change at the beginning of each year.
Part A – Monthly Premium
If you are eligible, Part A is free because you or your spouse paid Medicare taxes while you were working. You earn Social Security “credits” as you work and pay taxes. For each year that you work, you earn 4 credits.
You are 65 or older, and you receive or are eligible to receive full benefits fr om Social Security or the Railroad Retirement Board
You are under 65, and you have received Social Security disability benefits for 24 months You are under 65, and you have received Railroad Retirement disability benefits and you meet Social Security disability requirements You or your spouse had Medicare-covered government employment You are under 65 and have End-Stage Renal Disease
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What Happens After I Register For Medicare
After your application is received and processed, a letter will be mailed to you with the decision. If you encounter any questions or problems during the process, you can always contact Social Security for assistance.
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In most circumstances, youll get a Medicare I.D. card several weeks after your initial application is approved. Unfortunately, waiting times can be as long as 90 days in some cases.
However, if you automatically enroll in Medicare because you already get Social Security benefits, you will receive your I.D. card two months before turning 65.
You Automatically Get Medicare
- You should already have Part A and Part B , because you have ALS and youre already getting disability benefits.
- We mailed you a welcome package with your Medicare card.
Sign up for Part B if you live in Puerto Rico or outside the U.S.
- Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.
Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months after your Part A starts, you might have to wait to sign up and pay a monthly late enrollment penalty.
- Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.
Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.
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Signing Up For Medicare
Many different factors determine when you can sign up for Medicare. For most, the first time they can sign up is when they turn 65. However, there are instances where you can become eligible for Medicare before age 65.
Signing up for Medicare is simple. Three months before the month of your 65th birthday, your initial enrollment window will open. This period lasts through your birthday month and ends on the last day of the third month following.
In total, your initial enrollment period lasts seven full months. This is a once-in-a-lifetime enrollment window that you do not want to miss.
If for any reason, you happen to miss it, there are other opportunities to enroll. Keep in mind that no part of Medicare is mandatory. However, if you dont sign up when youre first eligible, you could incur penalties when you eventually sign up. The only way around the late penalties that result from delaying Medicare enrollment is to have .
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Signing Up For Premium
You can sign up for Part A any time after you turn 65. Your Part A coverage starts 6 months back from when you sign up or when you apply for benefits from Social Security . Coverage cant start earlier than the month you turned 65.
After your Initial Enrollment Period ends, you can only sign up for Part B and Premium-Part A during one of the other enrollment periods.
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Can I Continue To Work After Full Retirement Age
Yes, and you can earn as much as you want without facing any penalties or negatively affecting the amount youll receive in Social Security benefits when you do decide to take them.
Since your benefits are based on your 35 highest-earning years, working after full retirement age could actually increase your benefits if you are a high-earner. Even if you begin collecting benefits, the Social Security Administration will recalculate your average wage to account for any new income.
Those who began collecting Social Security benefits prior to full retirement age but then decided to continue working will be subject to the retirement earnings test . This test checks to see if your earnings exceed a limit. If your earnings exceed the current limit, you will temporarily lose some or all of your Social Security benefits. At the time you reach full retirement age, those benefits are recalculated, and youll receive most of that money back.
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 plan’s denial for a service to be provided.
The Right to Information About All Treatment Options
You have the right to know about all your health care treatment options from your health care provider. Medicare forbids its health plans from making any rules that would stop a doctor from telling you everything you need to know about your health care. If you think your Medicare health plan may have kept a provider from telling you everything you need to know about your health care options, then you have the right to appeal.
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Who Is Eligible To Receive Medicare Benefits
Two groups of people are eligible for Medicare benefits: adults aged 65 and older, and people under age 65 with certain disabilities. The program was created in the 1960s to provide health insurance for senior citizens. Older Americans had trouble finding affordable coverage, which spurred the government to create a program specifically for this portion of the population. Its an entitlement program in that the federal government finances it to some degree, but its also supported and financed directly by the very people who use it. Youre eligible for Medicare because you pay for it, in one way or another.
To receive Medicare benefits, you must first:
- Be a U.S. citizen or legal resident of at least five continuous years, and
- Be entitled to receive Social Security benefits.
That means that every U.S. citizen can enroll in Medicare starting at age 65 . When we say Medicare, were referring to original Medicare. This comprises Parts A and B. Part A covers hospital care while Part B covers medical care. There are four parts to the program Part C is a private portion known as Medicare Advantage, and Part D is drug coverage. Please note that throughout this article, we use Medicare as shorthand to refer to Parts A and B specifically.
To qualify for Medicare based on ESRD, you first need to meet the following qualifications:
What Can I Do Next
Generally, youre first eligible to sign up for Part A and Part B starting 3 months before you turn 65 and ending 3 months after the month you turn 65.
Because the company has less than 20 employees, your job-based coverage might not pay for health services if you dont have both Part A and Part B.
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How To Apply Online For Just Medicare
If you are within three months of turning age 65 or older and not ready to start your monthly Social Security benefits yet, you can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses benefits later. It takes less than 10 minutes, and there are no forms to sign and usually no documentation is required.
To find out what documents and information you need to apply, go to the .
Tips For Getting Retirement Ready
- A financial advisor can be a big help in figuring out how medical expenses will affect your retirement. Finding the right financial advisor that fits your needs doesnt have to be hard. SmartAssets free financial advisor matching tool matches you with financial advisors in your area in 5 minutes. If youre ready to be matched with local advisors that will help you achieve your financial goals, get started now.
- Medical costs arent the only expenses youll need to grapple with in retirement. Think about where youll want to retire to see how cost of living could impact your lifestyle. SmartAssets cost of living calculator can help you figure out your costs so youll know how much youll need to save. And our retirement calculator can help you see if youre on track with those savings.
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When Is My Medicare Initial Enrollment Period
For most people, enrolling in Medicare Part A is automatic. However, there are several instances where you may have to manually enroll in Medicare Part A and/or Part B during your Initial Enrollment Period , the seven-month period that begins three months before you turn 65, includes the month of your 65th birthday, and ends three months later.
Some situations where you would enroll in Medicare during your initial enrollment include:
Who Is Eligible For Medicare
Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease . Medicare has two parts, Part A and Part B . You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:
- You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
- You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
- You or your spouse had Medicare-covered government employment.
To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.
If you did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:
- You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
- You are a kidney dialysis or kidney transplant patient.
While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.
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Medicare Eligibility Age Chart
Most older adults are familiar with Medicare and its eligibility age of 65. Medicare Part A and Medicare Part B are available based on age or, in some cases, health conditions, including:
- Age 65 or older
- End-Stage Renal Disease
Individuals under 65 and already receiving Social Security or Railroad Retirement Board benefits for 24 months are eligible for Medicare. Still, most beneficiaries enroll at 65 when they become eligible for Medicare.
Medicare: A Social Program For All
If Medicare is considered a public necessity and you pay into the system through your employment taxes, then you probably want to know how Medicare benefits you as an individual. Weve discussed how this comprehensive social insurance program impacts and affects the United States as a whole. In this section, well discuss the specific portions of Medicare and how each benefits and affects individuals. After all, social programs work best when more people benefit from their services. As a unique enterprise, Medicare functions as both a social project and an individual one. Primarily, it helps to offset the cost of your medical care by giving you back a portion of the funds you paid into the system while you worked.
Medicare Parts A and B go hand-in-hand, but only Part A is premium-free for most people. Part A covers hospital care and services relevant to hospital care on a limited basis. Part B covers medical care, such as doctors visits and routine treatments. Unless you earn an income thats higher than the standard threshold, you get Part A for free once you qualify for Medicare. The standard monthly premium for Part B in 2022 is $170.10 a month. This rate applies to new enrollees.
You most likely get Part A for free, and Part B doesnt cost much to keep. Before deciding against Medicare, talk to your plan administrator for a breakdown of your actual costs. This will allow you to make a more informed decision.
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If You Disagree With Our Decision
If you disagree with the decision we made about your income-related monthly adjustment amounts, you have the right to appeal. The fastest and easiest way to file an appeal of your decision is online. You can file online and provide documents electronically to support your appeal. You can file an appeal online even if you live outside of the United States.
You may also request an appeal in writing by completing a Request for Reconsideration , or contact your local Social Security office. You can use the appeal form online, or request a copy through our toll-free number at 1-800-772-1213 . You dont need to file an appeal if youre requesting a new decision because you experienced one of the events listed and, it made your income go down, or if youve shown us the information we used is wrong.
If you disagree with the MAGI amount we received from the IRS, you must correct the information with the IRS. If we determine you must pay a higher amount for Medicare prescription drug coverage, and you dont have this coverage, you must call the Centers for Medicare & Medicaid Services to make a correction at 1-800-MEDICARE . We receive the information about your prescription drug coverage from CMS.
Sign Up: Within 8 Months After Your Family Member Stops Working
- If you have Medicare due to a disability or ALS , youll already have Part A .
- Youll pay a monthly premium for Part B , so you may want to wait to sign up for Part B.
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty until you turn 65. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
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