Medicare Eligibility

TPMO DISCLAIMER:

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

Medicare Plan Eligibility 

Medicare is the United States’ Federal Health Insurance Program for people who are 65 or older. It is also available for certain people younger than 65 with disabilities or people with End-Stage Renal Disease. There are several parts to Medicare that contain different coverage.

Enjoy this short video to understand the basics of Medicare plan eligibility:

Part A

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most of the time Part A does not cost a dime.

Part B

Medicare Part B is outpatient medical coverage. Part B helps pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treat a medical condition. Surgeries, lab work, and preventative services are all covered under Part B.

Part C

Medicare Part C is also called Medicare Advantage (MA). It’s an alternative benefit form to Original Medicare. Medicare Advantage may include prescription drug coverage, along with other extra benefits. It is offered through private insurance companies, so you don’t enroll in it at the Social Security office or website.

Part D

Medicare Part D is also known as prescription drug coverage. Part D coverage is available as a Stand Alone Option (PDP) or as part of a Medicare Advantage plan (Part C). Part D plans are offered by private insurance companies contracted and approved by Medicare.

Medicare Supplements

Medicare Supplement plans, also called Medigap, are designed to work with Original Medicare Parts A and B. Medigap policies help pay for some health care costs not covered by Original Medicare, such as deductibles, coinsurance and foreign travel emergency. These plans are offered by private insurance companies and are available to people with Medicare Part A and B. People with Original Medicare and a Medicare supplement can choose any stand-alone Part D prescription plans to pay for their drugs. People who are enrolled in Medicare Advantage plans (Part C) are not eligible for a Medicare Supplement insurance policy.

Are you eligible for Medicare?

You can qualify for Medicare coverage at 65 if you are a US citizen or a permanent resident and you’ve lived here continuously for at least five years.

If you are under 65, you can also qualify if you:
~Are permanently disabled and have been receiving Social Security disability income benefits for 24 months.
~Have end-stage renal disease.
~Have Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease).

Medicare eligibility for Part A

You are eligible for Medicare Part A coverage at no cost at age 65 as long as you or your spouse has worked for at least 10 years in the United States. If you haven’t worked for 10 years, you can still purchase Part A coverage. As long as you have already enrolled in Social Security, you will be automatically enrolled in Part A. If not, you will have to contact the Social Security office to enroll. Your Medicare card will arrive around one month before you turn 65.

Medicare eligibility for Part B

The same eligibility requirements for Part A apply for Part B. However, there is a monthly premium for Medicare Part B. This premium is determined by Medicare and could be higher based on income.

Medicare eligibility for Part C

To be eligible for Medicare Part C, or Medicare Advantage, you must first be enrolled in Medicare Part A and B. Once your Medicare Part A and Part B start dates are determined you can begin to enroll in a Medicare Advantage Plan.

Medicare eligibility for Part D

You are eligible for Part D as long as you are enrolled in either Part A or B. You can enroll in a Part D with only Part A. You can also enroll in a Part D plan with only Part B.

When can you enroll in Medicare?

Your initial enrollment period begins three months before the month of your 65th birthday and ends three months after your 65th birthday month. This happens with one exception: if your birthday is on the first of the month. This will cause your enrollment period to begin one month early. For example: if your birthday is October 1, your enrollment period will begin June 1 and your Medicare will begin one month early as well — September 1. During your initial enrollment period, you can enroll in Original Medicare (Part A and B), Medicare Advantage plan, or Medicare Part D.

If you have questions or need more information about Medicare enrollment in the Durham area, please reach out to ClearBenefits Group LLC’s experts today!

When can you enroll in Medigap?

Once you are enrolled in Medicare Part A and B, there is a six-month open enrollment period for Medigap (Medicare Supplement) plans. This window begins with your Part B effective date and is a one-time election period.

What if you have employer coverage?

Many people work beyond age 65 and would like to continue their employer coverage instead of signing up for Medicare. This is fine and you will not be penalized. When you do retire, you will be able to sign up for Medicare during a Special Enrollment Period. This enrollment period is eight months long that begins either the month you or your spouse quits working or the month your group coverage ends, whichever comes first.

How to receive help paying for your Medicare Coverage

Many people qualify for Extra Help with their Medicare Coverage Costs. This help can range from full expense coverage through a combination of Medicaid and Medicare or partial expense coverage with Part D Prescription Premiums and Co-Pays.

To determine if you qualify for any assistance, the process starts with a simple application for Extra Help through the Social Security Administration.

ClearBenefits Group LLC is happy to assist you with completing this on-line application via the website while we do a conference call. Or you may visit the link here to complete the application:

https://secure.ssa.gov/i1020/start

You should allow for 30 days of processing time after completing the application to receive your Beneficiary Award Letter which will indicate exactly which level of assistance you may qualify for.

With this information in hand we can proceed with accurately forecasting your overall costs for Medicare, Medicare Advantage, Medicare Supplements, and Part D Prescription Drug Plans

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