You care about the well being of your senior loved one, especially his or her health. However, you’re concerned that you cannot afford health care for him or her because of age, medical issues, or disabilities. You don’t have to be concerned any longer-Medicare can be a possible option for quality, affordable health care for your senior.
What is Medicare?
Medicare is health insurance for individuals that meet the following qualifications:
- Ages 65 or older
- Under 65 years of age with certain disabilities
- End-Stage Rental Disease (ESRD), permanent kidney failure that requires a kidney transplant or dialysis (at any age)
There are four parts of Medicare, which cover specific services:
- Part A (Hospital Insurance): This helps cover impatient care in hospitals, as well as hospice, skilled nursing facility, and home health care.
- Part B (Medical Insurance): This helps cover doctor’s (and other health care providers’) services, outpatient care, home health care, and durable medical equipment. It also provides some preventative services (flu shots, Pap tests, etc.) to help maintain your senior’s health and to prevent specific illnesses from getting worse.
- Part C (Medicare Advantage): This offers health plan options that run by private insurance companies that improve Medicare, a great way to obtain benefits from Parts A and B, and most programs include prescription drug coverage (Part D); some Advantage plans include additional benefits for an additional price.
- Part D (Prescription Drug Coverage): This helps cover the cost of prescription drugs, as well as possibly help lower the cost of prescription drugs and protect against increased prices in the future; programs are often run by Medicare-approved private insurance companies.
How Can My Senior Qualify for Each Medicare Program?
Each Medicare program has different eligibility requirements. Sometimes your senior automatically qualifies for some Medicare programs if he or she is signed up for other programs. Usually, he or she may need to to sign up for Medicare programs for various reasons.
Parts A & B
Most individuals get A and B automatically if one of the following applies to them:
- Receiving benefits from Social Security or the Railroad Retirement Board (RRB): He/she automatically receives Parts A and B starting on the 1st day of the month the person turns 65, or if the 1st day of the prior month if the birthday is on the 1st day of the month.
- Under 65 and disabled: Both parts are automatically received after the individual gets disability benefits from Social Security or certain disability benefits from the RRB for 24 months.
- Has Amyotrophic Lateral Sclerosis (ALS): He/she automatically gets both parts the month the disability benefits begin.
Most people receive Part A if they live in Puerto Rico and get Social Security and RRB benefits. They will need to sign up for Part B if they also want to participate in that program.
Your senior will receive a Medicare card 3 months before his/her 65th birthday or their 25th month of disability if he/she is automatically enrolled.
You may need to sign up for Parts A and B if your senior isn’t receiving Social Security nor RRB benefits and he/she qualifies for Medicare because he/she has ESRD. You can sign up for Parts A and B when:
- The person is first eligible. He/she will have a 7-month Initial Enrollment Period (begins 3 months before the month the person turns 65, includes the month he/she turns 65, and ends 3 months after the month he/she turns 65) to sign up for Part A and/or Part B
- The period between January 1 and March 1 of each year occurs
- The person is qualified for a special enrollment program
- The person has volunteered abroad
You can sign up for Parts A and B in one of the following ways:
- Apply online at the Social Security website
- Visit your local Social Security office
- Call Social Security at 1-800-772-1213
- Call the RRB at 1-877-772-5772 (if your senior worked for a railroad)
If your senior doesn’t want Part B, you should follow the instructions that come with the Medicare card, and then send the card back. If your senior keeps it, he/she will keep Part B and the premium costs will have to be paid.
What Are the Costs of Parts A & B?
Part A: There’s usually no monthly premium payment if your senior automatically qualifies for Part A. However, if he/she buys it, the cost can be up to $450 per month.
Part B: Most individuals pay $115.40 per month, but the amount may increase if your senior modified his/her adjusted gross income as reported on their federal tax return from 2 years ago is above a certain amount. Please be aware that if your senior doesn’t sign up for this program when he/she is first eligible, there will be a late enrollment penalty for the duration your senior has Medicare. The monthly premium may go up 10% for each entire 12-month period that he/she could have had Part B, but didn’t sign up for the program. If he/she met certain conditions that allowed them to sign up for Part B during a special enrollment period, the penalty usually doesn’t have to be paid.
Parts C & D
The times when you can sign up for Medicare Advantage (Part C) and/or Medicare prescription drug coverage (Part D) are based on your senior’s specific situation:
- He/she is newly eligible because he/she has turned 65: He/she can sign up for Part C and/or D during the 7-month initial enrollment period, which starts 3 months before the month he/she turns 65, includes the month he/she turns 65, and ends 3 months after the month he/she turns 65.
- He/she is newly eligible because he/she is disabled (under 65): He/she can sign up for Part C or D starting 21 months after he/she gets Social Security or RRB benefits. Your loved one’s chance to sign up lasts through the 27th month after he/she gets Social Security or RRB benefits. After signing up, his/her Medicare coverage will begin 24 months after he/she started to receive Social Security or RRB benefits.
- He/she is already eligible because he/she turned 65 and is disabled: He/she can do one of the following:
- Sign up for Part C and/or D
- Drop Part C or D completely
- Switch from current plan (C or D) to another plan.
One of these tasks can be done during the 7-month period. If he/she signs up for a Medicare Advantage Plan during this time, he/she can drop that plan at any time during the next 12 months and go back to original Medicare.
- He/she doesn’t have Medicare Part A coverage, and he/she enrolls in Part B during the Part B general enrollment period : He/she can sign up for Part D between April 1 and June 30.
- He/she has Part A coverage, and he/she enrolls in Part B during its general enrollment period: He/she can sign up for a Medicare Advantage Plan (with or without drug coverage) between April 1 and June 30.
These are just the basics of Medicare. Various exceptions and benefits apply if your senior is in other situations (he/she is a veteran, has other insurance, moves to a new location, loses current coverage, etc.). But if you want to be confident that your loved one is receiving the health care he or she needs at an affordable cost, Medicare may be an excellent option. If you can help your senior be healthy, happiness can follow.