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What Benefits Do You Get With Medicare

When Do I Use My Medicare Cards

How Medicare Advantage Plans Can Help You Live Your Best And Healthiest Life

Everyone who enrolls in Medicare receives a red, white, and blue Medicare card. This card lists your name and the dates that your Original Medicare hospital insurance and medical insurance began. It will also show your Medicare number, which serves as an identification number in the Medicare system.

If you have Original Medicare, make sure you always bring this card with you when you visit doctors and hospitals so that they can submit bills to Medicare for payment. If you have a supplemental insurance plan, like a Medicare Supplement Plan, retiree, or union plan, make sure to show that plans card to your doctor or hospital, too, so that they can bill the plan for your out-of-pocket costs.

Note: Medicare has finished mailing new Medicare cards to all beneficiaries. You can still use your old card to get your care covered until January 1, 2020. However, if you have not received your new card, you should call 1-800-MEDICARE and speak to a representative.

If you are enrolled in a Part D plan , you will use the Part D plans card at the pharmacy.

Remember: Do not give your Medicare or Social Security numbers or personal data to strangers. Medicare will never ask for this information over the phone. If you believe you have been the target of Medicare marketing or billing fraud, contact your local Senior Medicare Patrol.

How Do You Qualify For Social Security Disability Benefits

Qualifying for SSDI is a complicated process and many people find the need to consult an attorney to expedite the process. SSA has instructions and offers an online application.

Qualification for SSDI has only two criteria, which are not entirely straightforward.

  • You must have worked in jobs covered by SSA and worked enough quarters to qualify. Generally, the qualification is the same as Medicare 40 quarters of qualifying work with 20 earned in the last 10 years ending with the year your disability begins. Younger workers may qualify with fewer credits. Learn how you can earn credits.
  • Your medical condition must meet SSAs strict definition of disability. This can be a tricky area to discern and is often the reason for seeking counsel. However, an article on the SSA website Disability Evaluation Under Social Security educates on this subject. Medicare Eligibility For People With Disabilities is also helpful in understanding SSDI qualifications.
  • Option : Original Medicare

    • Medicare is primary and Medi-Cal is secondary. In Original Medicare, also known as fee-for-service, it is important to present providers with both Medicare and Medi-Cal cards. With Original Medicare you can choose any medical provider that accepts Medicare and Medi-Cal, no referrals to a specialist is needed.
    • In addition to the Medicare and Medi-Cal card, beneficiaries also have a CalOptima Member Identification card and a Part D Prescription Drug Plan card.
    • Medi-Medi beneficiaries that do not enroll in a Part D Plan or a Medicare Advantage Plan will automatically be enrolled in a Part D benchmark plan. Medi-Medi beneficiaries are automatically eligible for , the program that helps pay for prescription drug plan co-payments.

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    How Old Do You Have To Be To Get Medicare

    Home / FAQs / General Medicare / How Old Do You Have To Be To Get Medicare

    When you think about Medicare, the first thing that comes to mind is typically retirement. Those who have Medicare are often of an age old enough for retirement. However, this is not always the case. Medicare not only covers those who have retired from the workforce, but also those disabled or who meet other specific criteria.

    Find Medicare Plans in 3 Easy Steps

    We can help find the right Medicare plans for you today

    So, how old do you have to be to get Medicare?

    Below, we review the age for you to get Medicare and how you may qualify for coverage and not even know yet.

    Can I Get Medicare Early If I Retire Early

    Medicare Advantage vs Medicare Supplement

    If you retire earlier than age 65, you will not be eligible for Medicare. Although Medicare is often thought of as insurance for retired people, the Medicare age requirement is still 65. Some people continue to work past age 65 and have insurance coverage through their employer. Many people retire before they turn 65 and must purchase health insurance or are covered on their spouses insurance plan. Although you may be eligible for social security retirement benefits if you retire early, it does not change your age requirement for Medicare health insurance coverage.

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    What Is Medicare Part A Hospital Insurance

    Medicare Part A covers the following services:

    • Inpatient hospital care: This is care received after you are formally admitted into a hospital by a physician. You are covered for up to 90 days each benefit period in a general hospital, plus 60 lifetime reserve days. Medicare also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital.
    • Skilled nursing facility care: Medicare covers room, board, and a range of services provided in a SNF, including administration of medications, tube feedings, and wound care. You are covered for up to 100 days each benefit period if you qualify for coverage. To qualify, you must have spent at least three consecutive days as a hospital inpatient within 30 days of admission to the SNF, and need skilled nursing or therapy services.
    • Home health care: Medicare covers services in your home if you are homebound and need skilled care. You are covered for up to 100 days of daily care or an unlimited amount of intermittent care. To qualify for Part A coverage, you must have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home health care.
    • Hospice care: This is care you may elect to receive if a provider determines you are terminally ill. You are covered for as long as your provider certifies you need care.

    Keep in mind that Medicare does not usually pay the full cost of your care, and you will likely be responsible for some portion of the cost-sharing for Medicare-covered services.

    How To Apply Online For Just Medicare

    Are you 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 .

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    Benefit Gaps And Supplemental Coverage

    Medicare provides protection against the costs of many health care services, but traditional Medicare has relatively high deductibles and cost-sharing requirements and places no limit on beneficiariesâ out-of-pocket spending for services covered under Parts A and B. Moreover, traditional Medicare does not pay for some services that are important for older people and people with disabilities, including long-term services and supports, dental services, eyeglasses, and hearing aids. In light of Medicareâs benefit gaps, cost-sharing requirements, and lack of an annual out-of-pocket spending limit, most beneficiaries covered under traditional Medicare have some type of supplemental coverage that helps to cover beneficiariesâ costs and fill the benefit gaps .

    Figure 4: Distribution of Types of Supplemental Coverage Among Beneficiaries in Traditional Medicare in 2016

    Medicare Advantage

    In 2018, one-third of all beneficiaries were enrolled in Medicare Advantage plans rather than traditional Medicare, some of whom also have coverage from a former employer/union or Medicaid. Medicare Advantage plans are required to limit beneficiariesâ out-of-pocket spending for in-network services covered under Medicare Parts A and B to no more than $6,700, and may also cover supplemental benefits not covered by Medicare, such as eyeglasses, dental services, and hearing aids.

    Exceptions To The 24 Months Norm

    Medicare Supplement Plans / Benefits & Hidden Risks

    Generally, you have to wait for a period of 24 months on SSDI benefits before you get enrolled in Medicare. However, there are two exceptions to this norm. If you suffer from amyotrophic lateral sclerosis , or Lou Gehrigs Disease, you will get Medicare coverage in the first month of receiving SSDI benefits itself.

    Similarly, if you have end-stage renal disease , your Medicare coverage begins after receiving 3 months of dialysis treatment.

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    How Do I Apply For Medicare Benefits

    If you are already receiving Social Security retirement or disability benefits or railroad retirement checks, Social Security will contact you a few months before you become eligible for Medicare and give you the information you need to register. You should sign up for Medicare even if you dont plan to retire at age 65, or you may be penalized a 10% premium surcharge for each year past age 65 that you do not have Medicare. However, if you are age 65 or older and are covered under a group health plan either from your own employment or you are covered from your spouses employment, you may delay enrolling in Medicare medical insurance without having to wait for a general enrollment period or pay the 10% premium surcharge for late employment. The rules allow you to:

    • Enroll in Part B any time you are covered under the group health plan, or
    • Enroll in Part B during an eight-month special enrollment period that begins with the month your group health coverage ends or the month your employment ends, whichever comes first

    I disagree with the SSAs decision on my claim. How can I appeal? Please visit www.ssa.gov/pubs/10041.html or call 1-800-772-1213 to file an appeal. All appeals should be sent to your local office to find your local office, please visit www.ssa.gov/locator.

    Who Is Eligible For Social Security Retirement Benefits

    As mentioned, youll need to meet a few requirements to be eligible for Social Security retirement benefits. Just like with Medicare, youll need to be a United States citizen or permanent resident. You might also need to have worked and earned credits. The amount of credits you need depends on your circumstances and the type of benefit youre applying for.

    Youll need at least 40 credits in order to apply for retirement benefits. Since you can earn up to four credits a year, youll earn 40 credits after 10 years of work. This rule applies to anyone born after 1929.

    The amount youll receive per month will depend on your income throughout your working life. You can use the calculator on the Social Security website to estimate your retirement benefits.

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    Do You Automatically Get Medicare With Social Security Disability Benefits

    Social Security Disability Insurance is a gateway to Medicare for disabled individuals under age 65.

    Recipients of SSDI are automatically enrolled in Original Medicare Parts A and B beginning the 25th month of coverage. Find out when SSDI beneficiaries qualify for Medicare Supplement, Medicare Advantage, and Medicare drug coverage.

    Texas Medicaid Wellness Program

    About Medicare and Medicare Advantage

    The Texas Medicaid Wellness Program is a special health program for people who get Medicaid and have long-lasting or serious health conditions. These conditions can include asthma, diabetes, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease , and others.

    People in this program can get help any time of day or night with:

    • Getting an answer to a health question.
    • Finding a main doctor.
    • Managing their health between doctor visits.
    • Learning more about their health conditions.
    • Knowing how to take their medicines.
    • Picking the best medical care for their health.

    Learn more about the Wellness Program.

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    Option : Medicare Advantage Plans

    • Medicare Advantage Plans are a type of Medicare health plan offered by private companies that contract with Medicare to provide Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage.
    • In Orange County, Medicare Advantage are either an HMO or PPO. Plan members are assigned a medical group and referrals are required prior to seeing a specialist. MA plans pay first, and Medi-Cal pays any remaining cost sharing amounts. Beneficiaries need only present their MA Plan card when obtaining medical services.

    Do I Automatically Get Medicare When I Turn 65

    Yes. If you are receiving benefits, the Social Security Administration will automatically sign you up at age 65 for parts A and B of Medicare.

    What insurance do you need when you turn 65?

    MedicareMedicare: When you turn 65, you are eligible for Medicare, an insurance program operated by the federal government.

    Can you collect Social Security at 65 and still work full time?

    When you reach your full retirement age, you can work and earn as much as you want and still get your full Social Security benefit payment.

    How much Social Security will I get at the age of 65?

    How Your Social Security Benefit Is Reduced

    If you start getting benefits at age* And you are the: Wage Earner, the benefit amount you will receive is reduced to And you are the: Spouse, the benefit amount you will receive is reduced to
    65
    46.9

    How soon before my 65th birthday should I apply for Social Security?

    You can apply up to four months before you want your retirement benefits to start. For example, if you turn 62 on December 2, you can start your benefits as early as December, and apply in August. Even if you are not ready to retire, you still should sign up for Medicare three months before your 65th birthday.

    Does Medicare automatically send you a card?

    You should automatically receive your Medicare card three months before your 65th birthday. You will automatically be enrolled in Medicare after 24 months and should receive your Medicare card in the 25th month.

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    Medicare For Ssi Recipients

    Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions.Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an uninsured Medicare claim, which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down.

    For people with limited income and assets, Medicare offers Extra Help for prescription drug costs. This Extra Help covers the costs of a Medicare prescription drug plan including monthly premiums and prescription co-pays. The application is online at www.socialsecurity.gov/prescriptionhelp. For more information, see Nolos article on the Extra Help subsidy.

    Is It Worth To Get Married

    Medicare & You: Understanding Your Medicare Choices

    Research has shown that the marriage benefitsthe increases in health, wealth, and happiness that are often associated with the statusgo disproportionately to men. Married men are better off than single men. Moreover, women in marriages, but not in other relationships, reported lower levels of satisfaction.

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    Medicare Enrollment For Social Security Beneficiaries

    Whether or not you are automatically enrolled in Medicare depends on the timing of your Social Security benefits. Remember that you can start your Social Security retirement benefits at age 62 . So, when are you eligible for Medicare? You do not becomeeligible for Medicare until age 65. So, if you are already receiving your Social Security benefits or Railroad Retirement Board benefits when you get Medicare eligibility, you will be automatically enrolled in Original Medicare. This means that you will receive both Medicare Part A and Medicare Part B. If you live in Puerto Rico, you will only be automatically enrolled in Part A coverage.

    Most people receive premium-free Part A coverage, although there is a monthly premium associated with Part B coverage. Remember thatMedicare is funded with taxes you pay while working. As long as you have sufficient work history, you wont need to pay a monthly premium for Part A coverage. For this reason, some people choose to opt out of their Part B benefits. Others choose to opt out because they are still working and are covered by a health plan through their employer. We will discuss this situation in more detail later in this article.

    Medicaid Is Structured As A Federal

    Subject to federal standards, states administer Medicaid programs and have flexibility to determine covered populations, covered services, health care delivery models, and methods for paying physicians and hospitals. States can also obtain Section 1115 waivers to test and implement approaches that differ from what is required by federal statute but that the Secretary of HHS determines advance program objectives. Because of this flexibility, there is significant variation across state Medicaid programs.

    The Medicaid entitlement is based on two guarantees: first, all Americans who meet Medicaid eligibility requirements are guaranteed coverage, and second, states are guaranteed federal matching dollars without a cap for qualified services provided to eligible enrollees. The match rate for most Medicaid enrollees is determined by a formula in the law that provides a match of at least 50% and provides a higher federal match rate for poorer states .

    Figure 2: The basic foundations of Medicaid are related to the entitlement and the federal-state partnership.

    • In part by the Medicare payroll tax
    • In part by Medicare recipients premiums
    • In part by general federal taxes

    The Medicare payroll taxes and premiums go into the Medicare Trust Fund. Bills for healthcare services to Medicare recipients are paid from that fund.

    Medicaid is:

    • Partially funded by the federal government
    • Partially funded by each state

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