When Do You Become Eligible For Medicare?

When Do You Become Eligible For Medicare?

There are four eligibility tests that determine when you become eligible for Medicare Part A coverage.

1. You are eligible for Social Security Benefits.

(Open enrollment for 2012: Oct. 15, 2011 – Dec. 7, 2011)

If you are eligible for Social Security benefits, you are automatically eligible for Medicare.

2. You are at least 65 years of age and are a citizen or resident of the United States.

3. You worked for at least 10 years and paid Medicare taxes.

4. You have been receiving Social Security Disability benefits for 24 months.

When you pass one of the four eligibility tests, you are eligible for Medicare Part A coverage.

If you believe you are eligible for Medicare, contact your Social Security office for more information.

Please visit the Social Security website for more information on Medicare coverage.

Medigap

A Medigap plan is a supplemental insurance policy sold by private insurance companies. Medicare does not cover all of your healthcare expenses.

The purpose of a Medigap plan is to help pay some of the costs not covered by Medicare.

Medigap benefits are standardized by law, which means that all Medigap policies sold must cover the same benefits.

If you are considering a Medigap plan, you should understand what benefits are included in the plan.

Please visit the Department of Insurance website for more information.

Medicare Cost-Sharing

Medicare does not pay for all of your healthcare costs. You are responsible for paying for some of your healthcare costs. These costs are known as “cost-sharing.”

When you receive care, you will be expected to pay for a portion of the cost for services that are not covered by Medicare. Examples of cost-sharing include deductibles, coinsurance and copayments.

Medicare Part A

Medicare Part A covers inpatient hospital care, skilled nursing facility care and some home health services.

In 2014, you will pay a deductible for Medicare Part A hospital and skilled nursing facility care. Your Medicare Part A deductible is $1,260.

In 2014, you will pay coinsurance for Medicare Part A hospital services. For hospital stays less than 60 days, you will pay $162 per day for nursing facility care. You will pay $335 per day for hospital care for days 61 through 90.

You will pay 20 percent of the Medicare approved amount for medical supplies, durable medical equipment, and outpatient physical therapy.

Medicare Part B

You will pay a deductible for Medicare Part B coverage. In 2014, you will pay a deductible of $147.00.

You will pay 20 percent of Medicare approved amounts for medical services covered by Medicare Part B.

Medigap Plan

If you are enrolled in a Medigap plan, you will pay 20 percent of the Medicare approved amount for medical services covered by Medicare Part B.

Medicare Part D

Medicare Part D is a prescription drug program administered by private insurance companies.

The Medicare Part D deductible is $405.00 for 2014.

You will pay 25 percent of the approved amount for each prescription drug.

Prescription drug coverage may differ depending on the type of plan you choose.

Please visit the Department of Health and Human Services website for more information.

Prescription Drug Coverage

You may enroll in a Medicare Part D prescription drug plan at any time during the year. The Part D premium for 2014 is $104.90.

You will pay a premium for Medicare Part D coverage depending on your drug coverage and the plan you choose.

You may enroll in a Medicare Part D prescription drug plan during Open Enrollment. If you enroll in a Medicare Part D prescription drug plan during Open Enrollment, coverage will begin January 1, 2014.

When to Enroll in a Medicare Part D Prescription Drug Plan

You will be automatically enrolled in a Medicare Part D prescription drug plan after you enroll in Medicare Part A and/or Medicare Part B.

You may delay enrolling in a prescription drug plan if you have other drug coverage.

If you do not delay enrolling in a Medicare Part D prescription drug plan, you will pay a penalty of 1 percent of the national base beneficiary premium for each month you could have had prescription drug coverage.

You may enroll in a Medicare Part D prescription drug plan during Open Enrollment or at any other time during the year. If you enroll in a Medicare Part D prescription drug plan during Open Enrollment, coverage begins January 1, 2014.

If you are not enrolled in a Medicare Part D prescription drug plan, you must pay for your prescription drugs. You may pay for your prescription drugs by purchasing a Medicare drug card or using a prescription drug discount card. Information about prescription drug discount cards is available at www.medicare.gov.

If you are on a low income, you may be eligible for Medicare Extra Help. Medicare Extra Help is a low-income subsidy for prescription drug coverage. Information about Medicare Extra Help is available at www.medicare.gov.

If you are not on a low income and you do not have other drug coverage, you may enroll in a Medicare Part D prescription drug plan at any time during the year. You can enroll in a Medicare Part D prescription drug plan during Open Enrollment or at any other time during the year. You may enroll in a Medicare Part D prescription drug plan during Open Enrollment if you do not have other drug coverage.

If you enroll in a prescription drug plan during Open Enrollment, coverage begins January 1, 2014.

If you enroll in a prescription drug plan during Open Enrollment, you will pay the premium for the calendar year. If you enroll in a prescription drug plan during Open Enrollment, you are eligible for Extra Help if you are on a low income.

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