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How and when do I apply for Medicare?
Just the essentials...
New applicants can apply for Medicare online as well as by traditional methods
New applicants can apply three months before their 65th birthday
New applicants have financial advantages for selections during the Initial Enrollment Period
Online application is quick and easy usually requires only a few minutes
New applicants can apply for Medicare in the three months before and after their 65th birth month. They can apply online or by regular methods of paper, telephone, and in-person application.
Comparison shopping is a great way to move out of Original Medicare and into the private insurance plans approved by Medicare for prescription benefits, comprehensive care, and Medigap Insurance.
Essential Health Benefits
Applying for Medicare can do two important things for older Americans. First, it avoids the penalty for no insurance.
Second, it opens the door to a comprehensive healthcare system. The Affordable Care Act added a significant amount of prevention and wellness services to Medicare that comes without additional costs.
Methods for Applying for Medicare
Applicants can quickly and easily sign up for Medicare online at the Social Security Web page or with Medicare.gov. These involve little more than filling out forms with personal information to identify the applicant, prove citizenship or lawful status, and eligibility by birth date. The available methods for sign-up include the below-listed steps.
Telephone with Social Security or Medicare representatives
In-person at social security local offices
Complying with the Individual Mandate
One reason that older Americans need to apply for Medicare is the Affordable Care Act of 2010. Known as Obamacare, the reform health law requires every resident to have qualified health insurance coverage.
American senior citizens can use Medicare enrollment to meet the requirements of the Affordable Care Act.
Minimum Value and the Mandate
Medicare Part A satisfies the requirement for qualified health insurance coverage because it exceeds the minimum value and it provides essential health benefits. Part B alone does not meet the requirements of the mandate. The private plans approved for Medicare Advantage satisfy the mandate. Medicare Supplement goes with Original Medicare.
Late Fee for Part B
Applicants that do not choose Part B when selecting during the Initial Enrollment Period must pay a late fee penalty. Part B is medical insurance, and unless one has a special enrollment, the late application will cause a penalty.
The penalty equals 10 percent of the premium for each 12 months of lateness. The penalty continues with the Part B insurance for the life of the coverage
Choosing Original Medicare or Medicare Advantage
Original Medicare consists of Medicare Part A – Hospital Insurance and Medicare Part B – Medical Insurance. Together they provide a broad insurance coverage for medical services and hospital care. These include the treatments and equipment deemed medically necessary to treat an illness, medical condition, or disease.
Prices and Selection Can Vary
Original Medicare is a one-size fits all approach. Participants can choose any doctor or hospital that participates in the Medicare payment system. They do not need referrals to see specialists or to use any particular resource.
Medicare Advantage has private insurance plans that use HMO, PPO, EPO, HMOPOS, and other forms of managed care networks. These plans make a distinction between resources inside the plan and those outside the plan.
Variety Adds to Consumer Choices
Medicare Advantage can offer greater value for higher prices, and similar value for lower prices. They can provide benefits not found in Original Medicare. Consumers pay higher costs when going outside of the network.
The Congressional purpose of Medicare Part C was to add private sector creativity and approaches to the mix available for American seniors and their healthcare needs.
Managed Care Inside Medicare Advantage
Medicare Advantage plans come from private insurance companies and the Centers for Medicare and Medicaid must approve them.
Managed care methods differ, and consumers can choose which method is best for them. The leading choices include the HMO, PPO, EPO, HMOPOS, and PFFS.
HMO is the phrase for the Health Management Organization. This type of managed care emphasizes prevention and early detection of severe illness.
These were pioneers in introducing extending wellness visits, low -cost annual checkups, and promoting screenings and vaccines.
The HMO uses a primary care physician to deliver care and make referrals to network resources. Except for emergencies, the HMO does not cover use of outside resources.
PPO stands for Preferred Provider Network. It gives users more flexibility than HMO. It does not require the primary care physician, nor does it require referrals.
People with PPO healthcare plans can use any network resource without a referral. The PPO allows the use of outside resources. It covers them at a higher rate of consumer payment than with network resources.
The Point of Sale option for the HMO type of organization uses a primary care physician to treat the patients and direct them to use in-network resources. The primary care physician can issue referrals to network resources. He or she can also refer patients to outside specialists and additional medical resources.
EPO stands for “‘Exclusive Provider Organization.” These are usually small networks that offer consistently low prices. Participants cannot use outside resources; the exclusive provider model does not pay for resources outside of the network.
This is the private fixed-fee-for-services type of private insurance plan. These networks consist of doctors and medical care providers that accept offered terms of engagement. The plan details the insurance and consumer shares of the service costs.
General Enrollment Period
Those that do not sign up for Medicare during their initial enrollment period can add Part A and Part B during the General Enrollment Period.
This open signup period runs from January 1 through March 31 each calendar year. Coverage purchased during this period will begin on the following first day of July.
There may be a penalty for late enrollment in Part A.
Special Enrollment Periods
The other method for sign-up after the Initial Enrollment Period is the special enrollment period. On limited circumstances, one can qualify for a special enrollment when a job ends or job-sponsored insurance coverage ends.
The below-listed categories of applicant qualify for a special enrollment period.
Applicants covered by a job-sponsored plan
Eight-month window for applicants whose job-sponsored plan ends
Eight-month window for applicants after job ends
Applying for Medicare is Fast and Easy
Older persons must have health insurance coverage that meets or exceeds the standards of the Affordable Care Act. The insurance must have a minimum value, and it must contain the essential health benefits.
Original Medicare meets the requirements of the Obamacare reform law and avoids the penalty for no insurance.
Easy Compliance with Mandate
Medicare Advantage satisfies the individual mandate and offers many choices including prescription drug benefits. Comparison shopping is an excellent tool for deciding which Medicare Advantage plan works best for the individual’s needs and preferences.
This technique will help decide which Medicare Supplement and Prescription Drug benefit can have the greatest value to complete coverage in Original Medicare.
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