The following article is designed to help you prepare yourself for life after retirement. Providing you with information about Original Medicare and some options that may be available to you.
Key Points:
Are you approaching the age of 65 and starting to consider your healthcare options? You’re in the right place to get the information you need to make an informed decision about your healthcare coverage. One of the first questions many people have when they’re nearing Medicare eligibility is: When will I be eligible for Medicare?
Generally, Americans are automatically enrolled in Medicare Part A (hospital insurance) three months before they turn 65. However, while this automatic enrollment ensures you have some coverage, it’s important to remember that Original Medicare only includes Part A and Part B (medical insurance). You may still need additional coverage, such as a prescription drug plan (Part D) or a Medicare Advantage plan (Part C), depending on your healthcare needs.
Understanding the different parts of Medicare and when to enroll can be overwhelming, and choosing the right plan for your situation requires careful consideration. Before picking a plan, it’s a great idea to speak with a professional who can help guide you through the options. A Medicare expert or advisor can help you navigate the complexities of the different coverage options, ensuring that you have the right plan to meet your health needs and budget. Taking the time to get expert advice can help you avoid unexpected costs and coverage gaps, and give you peace of mind knowing that your healthcare is properly covered.
As you approach the age of 65, one of the first questions that might come to mind is, "What exactly is Original Medicare?" On the surface, it seems like a straightforward question. But when you start considering how it impacts both your health and your finances, it quickly becomes clear that understanding the ins and outs of Medicare is anything but simple. The decisions you make now can have lasting effects on your coverage and your budget.
It’s easy to feel overwhelmed when navigating all the options and details on your own. The number of questions that pop up—about coverage, costs, enrollment periods, and what plans might work best for you—can leave anyone feeling unsure of where to turn for clear answers.
This is where working with a qualified, licensed health insurance broker can make all the difference. Rather than receiving generalized advice that may not apply to your specific situation, a broker can offer tailored guidance. They'll provide you with the personalized information you need to understand the full scope of your options. With their help, you can confidently make decisions that ensure your Medicare coverage fits your needs while safeguarding your retirement finances.
Now that we’ve set the stage, let’s dive in and explore what Original Medicare is, how it works, and why it’s crucial to get the right advice as you move forward.
What is Original Medicare? What's important?
Original Medicare is the federal health insurance program primarily designed for people aged 65 and older, as well as certain younger individuals with disabilities. It consists of two main parts: Part A (hospital insurance) and Part B (medical insurance). Part A covers inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health care. Part B helps cover outpatient care, doctor visits, preventive services, and some home health care.
Signing up for Medicare is generally simple, especially if you are already receiving benefits from Social Security or the Railroad Retirement Board (RRB). In most cases, if you are receiving these benefits, you will be automatically enrolled in Medicare Part A and Part B starting the first day of the month you turn 65. If your birthday falls on the first of the month, your coverage begins on the first day of the prior month.
However, if you aren’t automatically enrolled or if you want to ensure that your enrollment fits your specific situation, you have the option to enroll during your Initial Enrollment Period (IEP). The IEP spans seven months: three months before your 65th birthday, the month of your 65th birthday, and the three months after. This is your window to sign up for Medicare if you’re not automatically enrolled. Missing this window can lead to late enrollment penalties, which can increase your costs for Part B coverage.
It’s important to understand Original Medicare because it forms the foundation of your healthcare coverage once you turn 65. While it provides substantial coverage for hospital and medical services, there are some gaps—such as prescription drug coverage and certain types of care—that you might need to address separately with additional plans like Medicare Advantage (Part C) or Medicare Prescription Drug Plans (Part D).
Navigating these decisions on your own can be overwhelming, which is why working with a licensed health insurance broker is highly recommended. A professional can help you understand your options in greater detail, ensuring that you select the right Medicare plan based on your healthcare needs and financial situation.
If you live in Puerto Rico, you'll automatically get Part A the first day of the month you turn 65 or after you get disability benefits for 24 months. However, you must sign up for Part B (form CMS-40B) coverage this is not automatic. You can visit Medicare.gov/basics/forms-publications-mailings/forms/enrollment, to get Form CMS-40B in English or Spanish. |
If you automatically get Medicare, you'll get your red, white, and blue Medicare card in the mail three (3) months before your 65th birthday. You will get Original Medicare coverage, Part A ("premium-free Part A"), and Part B unless you choose not to keep the coverage due to current employer coverage. If you didn't automatically get Original Medicare because you're still working, and not getting Social Security or Railroad Retirement Board benefits, you can sign up for it within 90 days of leaving your employer-sponsored coverage. To apply visit ssa.gov/benefits/medicare to apply if you work for the railroad, contact the Railroad Retirement Board.
Important: If you choose not to keep Part B, but decide you want it later, you may have a delay in getting Medicare Part B coverage, and you may have to pay a late enrollment penalty for as long as you have Part B, if you don't have credible coverage as good as Medicare during this time of non-Part B coverage. There is also a penalty for not getting Medicare Part A (if you have to pay for it) when first eligible.
Special Enrollment Period
After your IEP is over, you may have a chance to sign up for Medicare without incurring a penalty.
Anytime you are still covered under a group health plan
During the 8 months that begins the month after the employment ends or the coverage ends, whichever happens first.
This period does not apply if you are eligible for Medicare based on End Stage Renal Disease (ESRD), or if you still have your Initial Enrollment Period available.
Remember to always contact your current employer when you are considering Medicare and Medicare Insurance Plans to find out how your employer's coverage works with Medicare.
Original Medicare
Original Medicare is one of your Medicare health coverage choices, and you also have a choice of a Medicare Advantage Plan or other type of Medicare health plan.
With Original Medicare you can go to any Medicare-enrolled doctor, other healthcare provider, hospital, or other facility that accepts Medicare patients anywhere in the United States. However, it does not cover most drugs or drugs outside of what may be administered in a doctor's office. This means that you will need a prescription drug plan (PDP) if you take medications prescribed by your primary care physician.
Many diagnostic and treatment services are covered under Medicare by Medicare-participating hospitals. You generally pay 20% of the Medicare-approved amount for services. Original Medicare doesn't cover medical care outside the US unless certain exceptions are met.
What is Medicare Part A?
Original Medicare usually covers most medically necessary services and supplies in hospitals. Part A (Hospital Insurance) helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. It is possible to pay more for services you get in a hospital outpatient setting than you'll pay for the same care in a doctor's office, usually paying the hospital copayment for each service you get in a hospital outpatient setting.
Part A Penalty
If you are not entitled to Medicare Part A, and you don't buy it when you're first eligible, your monthly premium may go up 10%. You'll have to pay the higher premium for twice the number of years you could have had Part A but didn't sign up.
What is Part B?
Part B (medical insurance) helps cover services from doctors and other health care providers; as well as, outpatient care. Part B can also assist in giving recipients access to Durable medical equipment, like wheelchairs, walkers, hospital beds, and other equipment.
Part B has a monthly premium, and for covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible (often referred to as a coinsurance). It is also important to know that there is no year limit on what you pay out of pocket unless you have enrolled in Medicare Supplement Insurance or a Medicare Advantage plan. The Part B deductible applies, except for certain preventive services.
A good start to understand Medicare is to visit Medicare.gov or call 1-800-MEDICARE. You can also contact Social Security at 1-800-772-1213 for more information about your Medicare eligibility and to sign up for Part A and/or Part B. TTY users can call 1-800-325-0778. If you worked for a railroad or get RRB benefits call RRB at 1-877-772-5772 ( TTY users can call 1-312-751-4701. Get personalized health insurance counseling from your State Health Insurance Assistance Program (SHIP).
What Original Medicare doesn't cover
Prescription drug coverage is not covered under Original Medicare if you have to go to a pharmacy and pick up your medicines. You must understand that regardless of whether you take medications or not you need to enroll in a qualified prescription drug plan, or a plan that includes prescription drug coverage. Not enrolling into a plan when you are eligible holds a penalty. Therefore, look for a Medicare Advantage with Prescription Drugs (MAPD) plan or a stand-alone Prescription Drug Plan (PDP) plan to ensure that you are covered.
Looking for coverage from private insurance carriers talk to a local licensed broker to get detailed information about the plan(s) that you are interested in. Whether it is a Medicare Supplement plan, Medicare Advantage, or a stand-alone Prescription drug plan, a broker is an excellent resource to allow you to take care of your healthcare on your terms and that fits your lifestyle.
How to Qualify for Medicare Under 65: What You Need to Know About Disability Benefits and Enrollment
While most people qualify for Medicare once they turn 65, individuals under 65 can also qualify for Medicare if they have certain disabilities. If you are under 65 and have been receiving disability benefits from Social Security or the Railroad Retirement Board (RRB) for at least 24 months, you will automatically be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) starting the 25th month of receiving your disability benefits.
You will receive your red, white, and blue Medicare card shortly before the start of the 25th month, signaling the official start of your Medicare coverage. The good news is that you won't have to pay a premium for Part A, since you’re automatically enrolled due to your disability.
In some cases, individuals with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, will receive automatic enrollment in Medicare Part A and Part B the month their Social Security benefits begin, regardless of the 24-month waiting period.
It’s important to note that people under 65 who are eligible for Medicare due to disability can still choose to enroll in other Medicare options, like a Medicare Advantage plan (Part C) or a Medicare Prescription Drug plan (Part D), to help cover additional needs like prescriptions or outpatient services.
If you have a disability but are not receiving Social Security or RRB disability benefits, you can still apply for Medicare through your local Social Security office. Contacting a Medicare representative will help guide you through the process and ensure you get the appropriate coverage. In any case, whether you’re automatically enrolled or need to apply, it’s crucial to understand the process and your options to make sure you get the right coverage for your health needs.
Conclude
As you approach the age of 65 or navigate the complexities of Medicare eligibility, it's important to have the right guidance to make informed decisions about your healthcare coverage. At Arnett Evans and Company, we specialize in helping residents of Mississippi and Tennessee explore their Medicare options, ensuring that they choose the plan that best fits their health needs and budget. With the vast array of coverage choices available, working with a local, licensed professional can help you avoid confusion and potential pitfalls. Reach out to us today to get personalized advice and find the right Medicare plan for you—your health and peace of mind are our top priorities.
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