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Medicare Part B covers outpatient medical services when an overnight hospital stay is not required
Part B requires payment of a monthly premium for most people
Enrollment for Part B can only happen at certain times and you must meet certain eligibility requirements based on your age, work history, and citizenship status
People who receive Social Security benefits for four months before turning 65 may be automatically enrolled in Medicare Part B. You have the right to keep or refuse this coverage.
People with certain disabilities may also be automatically enrolled in Medicare
If you do not enroll in Part B when you are first eligible, but then you choose to enroll later, you will most likely be responsible for a permanent late enrollment penalty
Medicare Part A is hospital insurance. It covers most hospital visits that are deemed medically necessary, as well as nursing facility care, home health visits, and hospice.
Medicare Part A will be premium-free for people who have worked long enough to earn 40 working credits. This measurement is roughly equivalent to 10 years of working and paying taxes.
The Social Security Administration tracks work credits to measure individuals’ eligibility both for retirement income benefits and for Medicare coverage.
If you haven’t worked long enough to qualify for this benefit, you can still enroll in Medicare Part A. In that case, you will be responsible for paying a monthly premium.
Medicare Part B provides coverage for medically necessary services that don’t require an overnight hospital stay.
This includes medical office visits, medical equipment, outpatient services, lab tests, X-rays, as well as mental health, ambulatory services, and certain medications administered by physicians.
Most people pay a monthly premium to have Medicare Part B coverage.
Medicare Part D is prescription drug coverage.
Part D differs from Parts A and B because the government does not provide it directly.
Instead private insurance companies that have contracts with the federal government offer Part D coverage.
If you already have parts A and B, you can choose a stand alone part D plan. Alternatively, you could get your prescription drug coverage built into a Part C plan.
“Medicare Part C”, known better as Medicare Advantage, is an assortment of health plans through private insurance companies to provide benefits equal to Medicare Parts A and B. Many plans also build in Part D prescription drug coverage.
Medicare Advantage plans often include additional benefits that Medicare does not normally cover, like transportation, dental, vision and hearing.
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Entitlement to premium-free Part A means eligibility to enroll in Medicare Part B at the same time.
If a person is required to pay a premium for Medicare Part A, they must be enrolled and pay for Part A in order to enroll in Medicare Part B.
You must be at least 65 or older and a United States resident and citizen.
Alternatively, legal residents who live in the United States for at least five continuous years before filing for Medicare are eligible.
Receiving Social Security or Railroad Retirement Board (RRB) benefits for at least four months before becoming eligible for Medicare Part B are automatically enrolled in both Part A and Part B.
Whether Part A is premium-free depends on work and payroll tax history.
If you live in Puerto Rico and are eligible for automatic enrollment, you will only be automatically enrolled in Part A.
Part B will require a separate enrollment procedure.
Entitlement to monthly Social Security or RRB benefits based on disability, or diagnosis with either Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), entitles a person to premium-free Medicare Part A.
Most are still responsible for paying the monthly premium for Medicare Part B.
Sign up for Medicare Part B using one of several ways.
You can apply online at the Social Security website using the application for enrollment in Part B, apply in person at your local Social Security office, or call the Social Security office number.
If you worked for a railroad, the RRB can assist you with your application.
A seven month Initial Enrollment Period (IEP) starts three full months before you turn 65, includes the full month of your birthday, and ends three full months after you turn 65.
If you are eligible for Medicare before you turn 65 due to disability, your initial enrollment period will start on your 25th month of receiving disability benefits.
The starting date of your coverage varies depending on when you enroll during the initial enrollment period.
If you enroll during the first three months, then coverage will start the first day of one’s 65th birthday month.
For those whose date of birth lies on the first day of the month, they can start coverage as early as the first day of the month that comes before their 65th birthday month.
Delaying enrollment until the latter months of the IEP delays your start date, but no penalty applies.
If you do not enroll in Medicare Part B when you are first eligible, you will be responsible for paying the late enrollment penalty for as long as you have Medicare Part B.
The late penalty adds 10% to the monthly premium, multiplied by the number of full 12-month periods that they did not enroll in Part B, but were eligible.
Group health insurance coverage through an employer that has more than twenty employees can be an acceptable substitute for Medicare coverage.
No late enrollment penalty would apply unless the person loses that group coverage and goes more than eight months without enrolling in Part B.
During the eight months, Part B coverage will begin on the first day of the next month following the application.
A general enrollment period takes place between January 1 and March 31 of every year.
If the GEP lies outside of their Initial Enrollment Period (IEP), then Original Medicare coverage for both parts A and B will begin in July 1 of that year.
You still must meet the eligibility requirements to enroll during the general enrollment period.
If you didn’t sign up for Medicare right away because you had employer coverage, but that employer coverage ends, you get eight months to sign up for Medicare.
If you delay Part B enrollment until after the eight month enrollment period following loss of employer coverage, the next possible time to sign up would be the General Enrollment Period between January 1 and March 31, but Medicare coverage would start July 1 of that year.
Depending on what time of year you lost your employer coverage, this could put you beyond 12 months without coverage, leaving you with the permanent penalty.
Special Enrollment Periods (SEPs) allow those still working, those with disabilities and international volunteers to enroll.
Other life events can also give special enrollment opportunities.
If a person did not enroll when they were first eligible because they volunteered outside the United States with a tax-exempt organization that provided health insurance coverage, that person will get a Special Enrollment Period of 12 months to enroll in Part B upon returning to the United States.
Several other situations may qualify someone for a Special Enrollment Period. These include change of address to another area, discharge from a nursing home or rehabilitation facility, or natural disasters.
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