The 4 Parts of Medicare

Medicare is health insurance for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

4 Parts to Medicare

People often confuse “Medicare Supplements” with “Medicare Advantage”. It’s very important not to confuse the two.  As you can see Medicare Advantage represents Part C of Medicare whereas Medicare Supplements, as it’s name suggests supplements Original Medicare.

Another big mistake people make is they think that when they are in a Medicare Advantage plan, they are no longer in Medicare.  That is incorrect.  Your are in Part C of Medicare.

New to Medicare? Initial Enrollment Period

When you turn 65, you will automatically be enrolled in Medicare Part A and Medicare Part B if you are receiving benefits from Social Security or the Railroad Retirement Board.

If you are 65, working, and not yet receiving Social Security benefits,Medicare enrollment may work differently. If you aren’t already getting retirement benefits when your turn 65, you won’t be automatically enrolled in Medicare Part B and will need to sign up during your Initial Enrollment Period.

If you have coverage through your employer and choose to delay enrollment in Medicare Part B, you will be given a Special Enrollment Period that starts when you stop working or your employer-sponsored health insurance ends. If you don’t sign up during this time, you can do so during the General Enrollment Period, but may owe a late-enrollment penalty.

On the other hand, Medicare Part A enrollment if you’re still working at 65 will depend on if you have enough work history to get Part A without a premium. If you’ve worked at least 10 years (40 quarters) and qualify for premium-free Medicare Part A, you’ll be automatically enrolled in Part A when you turn 65 even if you’re still working at the time. However, if you don’t have enough work quarters to get Medicare Part A without a premium, you’ll also need to manually enroll in Part A.

If you need to sign up for Part A and/or Part B, you can sign up during the following times:

  • Initial Enrollment Period— When you are first eligible for Medicare, you have a seven-month period to sign up. This seven-month period begins three months before your 65th birthday, includes the month you turn 65, and ends three months after you turn 65.
  • General Enrollment Period— If you miss your Initial Enrollment Period, you can sign up between January 1 through March 31 each year. Your coverage will begin July 1. You may have to pay a higher premium for late enrollment.
  • Special Enrollment Period — If you or your spouse (or family member if you are disabled) is currently working and you are covered by a health insurance through an employer or union, you will have a Special Enrollment Period when your coverage ends. There is also a Special Enrollment Period for international volunteers if you are serving as a volunteer in a foreign country.

For example: If your 65th birthday is October 20, 2014 and you automatically qualify for Medicare, your Medicare effective date would be October 1, 2014. If your birthday is on the first day of the month, Medicare Part A and Part B will be effective on the first day of the prior month. So then, if your 65th birthday is October 1, 2014, your Medicare effective date would be September 1, 2014.

If you are under age 65 and receiving Social Security or Railroad Retirement Board disability benefits, you automatically get Part A and Part B after you get disability benefits from Social Security or certain benefits from the RRB for more than 24 months. You will get your Medicare card in the mail three months before your 65th birthday or your 25th month of disability.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease), you automatically get Part A and Part B the month your disability benefits begin.

If you have end-stage renal disease (ESRD), different rules apply. You can contact the Social Security Administration to learn more about Medicare eligibility because of end-stage renal disease by calling 1-800-772-1213, Monday through Friday, from 7AM to 7PM (TTY users can call 1-800-325-0778).

2017 Dual Eligible Guidelines

2017 MSP LIS Income Asset Limits

DUAL Eligibles:  The chart above describes the various categories of individuals who, collectively, are known as dual eligibles. Medicare has two basic coverages: Part A which pays for hospitalization costs, and Part B, which pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services.  Dual eligibles are individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit.

QMB:  Qualified Medicare Beneficiaries. Full Dual.  These individuals are entitled to Medicare Part A, have income of 100% FPL (Federal Poverty Level) or less and resources that do not exceed twice the limit for SSI eligibility, and are eligible for full Medicaid benefits. Medicaid pays their Medicare Part A premiums, if any, Medicare Part B premiums, and, to the extent consistent with the Medicaid State plan, Medicare deductibles and coinsurance, and provides full Medicaid benefits.

SLMB: Specified Low-Income Medicare Beneficiaries. These individuals are entitled to Medicare Part A, have income of greater than 100% FPL, but less than 120% FPL and resources that do not exceed twice the limit for SSI eligibility, and are eligible for full Medicaid benefits. Medicaid pays their Medicare Part B premiums and provides full Medicaid benefits.

QI-1: Qualifying Individuals.  These individuals are entitled to Medicare Part A, have income of at least 120% FPL, but less than 135% FPL, resources that do not exceed twice the limit for SSI eligibility, and are not otherwise eligible for Medicaid. Medicaid pays their Medicare Part B premiums only.

QDWI: Qualified Disabled and Working Individuals. These individuals lost their Medicare Part A benefits due to their return to work. They are eligible to purchase Medicare Part A benefits, have income of 200% FPL or less and resources that do not exceed twice the limit for SSI eligibility, and are not otherwise eligible for Medicaid. Medicaid pays the Medicare Part A premiums only.

LIS: Low Income Subsidy. Also referred to as Extra Help. Provides financial assistance to people for Part D prescription drug plans.

 

Medicare Out-of-Pocket Costs You Should Expect to Pay in 2016

Medicare 1

Medicare provides valuable health insurance to most older Americans. But it also comes with a complicated set of rules and sometimes significant out-of-pocket costs. Click here or on the picture above to learn about some of the expenses you are likely to incur with your Medicare Plan in 2016.

For help in managing your Medicare costs and selecting the plan that is right for you, contact Steve McDaniel at 972-768-3895 or Lonnie Hall at 214-924-3120.