Medicare is an essential health insurance program that is overseen by the federal government, administered by the Social Security Administration (SSA) and available to senior citizens who are 65 years of age or older.
Also for disabled individuals who meet additional eligibility requirements and individuals who meet special enrollment criteria. In order to apply for Medicare, it is important to first understand Medicare eligibility, as well as the coverage and benefits provided by the Medicare program.
If you want to maintain your health as a senior, it is equally important to familiarize yourself with the costs of Medicare since depending on the parts of Medicare that you enroll in, you will likely have monthly premiums, deductibles and copayments. Once you are ready to apply, you can submit a Medicare application either online, in person or over the phone. Knowing what to expect on the application as well as the documentation that you may be asked to provide can often times expedite the application process. To learn more about the Medicare program, review the information below.
What is Medicare?
Medicare was originally designed to provide health coverage to senior citizens who were 65 years of age or older. The program was later extended in 1972 to include disabled individuals who meet a certain set of criteria.
Medicare is partially funded by taxes and accounts for about 15 percent of the federal budget in recent years. Administered by the Social Security Administration (SSA), it is estimated that there are 59 million American citizens who receive health coverage through Medicare. Of that 59 million, about 13 percent of Medicare beneficiaries are 85 years of age or older and 17 percent of Medicare beneficiaries are disabled individuals who are younger than 65.
Medicare is unique in that it allows eligible recipients to build their own health care plan based upon their own individual needs and the cost that they are willing to pay. Therefore, Medicare is made up of four parts. These include Original Medicare, also known as Medicare Part A and Part B. Beyond Original Medicare, eligible applicants may also choose Part C coverage, which offers hybrid plans with an array of benefits, and Part D, which only provides prescription drug coverage.
Learn About Requirements for Medicare
It is important to be aware of the Medicare requirements, as this can help you to better prepare yourself for the Medicare application process. You can qualify for Medicare if you are at least 65 years old and you either receive or are eligible to receive Social Security or Railroad Retirement Board (RRB) benefits.
Alternatively, you can be deemed eligible for Medicare based upon a disability, so long as you are eligible to receive Social Security or Railroad Retirement Board (RRB) benefits for a minimum of 24 months.
There are exceptions to this rule, however, as individuals who have been diagnosed with Lou Gehrig’s disease, also referred to as Amyotrophic Lateral Sclerosis (ALS), can receive Medicare health coverage the first month that they become entitled to Railroad Retirement Board (RRB) or Social Security benefits.
You may also be eligible to receive Medicare right away if you are receiving regular dialysis treatment for End-Stage Renal Disease (ESRD) or if you are a kidney transplant patient.
It is worth knowing that there are additional reasons that you may be deemed eligible for Medicare other than for age or disability, including:
- If you are a disabled widow or widower that has not yet applied for disability benefits due to already receiving a different Social Security benefit.
- You must be at least 50 years of age in order for this scenario to apply to you.
- You are a government employee who became disabled before the age of 65.
- In this case, you would not need wait the 24-month period.
- You, your spouse or dependent child has permanent kidney failure.
No matter what type of Medicare eligibility would be required of your situation, it is important to know that you must be a resident of the United States in order to qualify. Additionally, you must also be a United States citizen or have remained as a lawful, qualifying alien for a minimum of five years within the United States.
About Medicare Costs and Coverage
As stated previously, Medicare provides beneficiaries with the unique ability to create a health insurance plan that fits the level of coverage needed. The program is split into four different parts, each with its own level of Medicare costs and coverage.
Medicare Part A is commonly referred to as hospital insurance, as it provides inpatient hospital coverage, hospice care and care received within a skilled nursing facility for a limited period of time. Unlike other parts of Medicare, Part A does not impose a monthly premium fee on most beneficiaries.
Medicare Part B provides a greater range of covered medical services with physician visits, laboratory services, X-ray services, mental health services and preventive services include within Medicare Part B plans. Unlike Medicare Part A, Part B does involve a monthly premium that is based off of income, with an average payment of $134 a month.
Additionally, a deductible of $134 must be met before Medicare will begin to provide coverage, paying for 80 percent of all approved medical services. The remaining 20 percent are out of pocket fees that Medicare beneficiaries will incur. It is also worth knowing that if you fail to enroll during your initial or special enrollment periods, you will receive a higher monthly premium for every 12 months that you were eligible for Medicare Part B but did not enroll.
Medicare Part C is considered a “hybrid plan,” as it offers many of the coverage benefits that are provided with Medicare Part A and Part B. In some cases, additional coverage such as prescription drugs, vision services, hearing services and dental care may also be included within a plan. The plans that are available to you, the level of coverage that is offered and the cost of the plan will vary depending on the area you live in.
Medicare Part D provides only prescription drug coverage and can be added to any Medicare plan that does not provide drug coverage. Similarly to Medicare Part C, the cost and coverage of Medicare Part D will depend on the plans that are available within your local area.
How to Apply for Medicare
By knowing how and when to apply for Medicare, you can save yourself a lot time and hassle. It is recommended that, if applying for Medicare based upon age eligibility, that you apply during your initial enrollment period. Your initial enrollment period begins three months prior to your birthday, includes your birthday month and also includes the three months following your birthday month. If you miss your initial enrollment period, you will then have to wait for the annual general enrollment period for Medicare, unless you are eligible for a special enrollment period.
You will only be eligible for a special enrollment period if you currently have medical insurance through a group health plan that is provided through either your or your spouse’s current employment. If this is the case, your special enrollment period will be any month in which you remained covered by the group health plan (and employment continues) or the eight-month period following the end of the health plan or the employment, whichever occurs first.
It is worth knowing that for every year that you remain eligible for Medicare but choose not to enroll, your premiums may increase for certain parts of Medicare, such as Medicare Part B and Part D.
Once you are ready to submit your Medicare application, you will need to provide a variety of information about yourself and any recent employment, including:
- Your legal name, date of birth, place of birth and Social Security Number (SSN).
- Your citizenship status.
- The names of all former and current spouses as well as the dates and places of marriages, deaths or divorces.
- The names and addresses of any employers that you have worked for in the current or previous year.
- The amount of money that you earned through employment in the current or previous year.
You can apply for Medicare health coverage either online or by contacting the Social Security Administration (SSA) by phone or at your local office. In most cases, you may be asked to provide additional documentation such as your birth certificate, proof of income or proof of citizenship (or lawful status) once your application has been completed. If you are not able to gather all of these documents, the SSA may be able to aid you in obtaining them.