Reviewed By: Pramod Kerkar, MD, FFARCSI

What is Medicare?

The government of the United States of America has many schemes in place to ensure the wellbeing and welfare of its citizens. Amongst these; Medicare is a health insurance scheme, which serves an outstanding number of beneficiaries by providing nationalized insurance against a wide range of expenses incurred as a result of illness and disabilities. Medicare mostly caters to individuals who are 65 years of age and older and is funded by payroll taxes, premiums and surtaxes from beneficiaries. Additionally; Medicare does cover the medical expenses of people younger than 65 years of age with disabilities or health conditions, such as end stage renal disease and amyotrophic lateral sclerosis.

What is the Eligibility for Medicare?

Medicare is sub-divided into 4 parts; Medicare-A, B, C and D.

  • Medicare-A covers inpatient hospital care expenses, inpatient medical care expenses at skilled nursing establishments and hospice and home care in limited circumstances. Medicare-B covers doctor’s fees, diagnostics charges at clinical labs for various health tests, outpatient care, home care, disease screenings, surgery costs and medical supplies, occupational and physiotherapy.
  • Medicare –C; also known as Medicare Advantage, is one package that includes the benefits of both; Medicare-A and B. Additionally; one can get more out of Medicare-C by combining it with Medicare-D; that covers the costs of prescription drugs.
  • Similar to Medicare-A and B; Medicare D is a standalone health benefits plan that covers the cost of prescriptions drugs however it can combined with Medicare Advantage to cover all healthcare related costs.

Who is Entitled to the Benefits of Medicare?

Understanding the various facets of Medicare and the terms and conditions governing who is entitled to what benefits; is the first step to applying for Medicare. Premium free Medicare-A is mostly limited to US citizens over the age of 65 who have worked and paid Medicare taxes for 10 years at the very least. Being married to an individual who has paid Medicare taxes for a minimum of 10 years makes you entitled to the same benefits under Medicare-A.

Premium free Medicare A is also extended to any US citizen receiving Social Security Benefits or those covered by the Railroad Retirement Board. Medicare-B is not premium-free under any circumstances. Medicare-C and D are covered by private health insurance agencies and are only available to those availing of Medicare-A and B. Anyone above the age of 65 can pay premiums and avail of Medicare-A, B, C and D benefits.

Automatic Enrollment for Medicare

In many cases, Medicare-A & B enrollment is automatic. For US citizens of ages 65 and older; automatic Medicare-A & B enrollment comes into effect on the first day of the 65th year of your life. Hypothetically; if you turn or turned 65 on the 15th of this month; your Medicare benefits came into effect on the 1st of this month. Additionally; your Medicare card should be in the mail 3 months prior to your 65th birthday. It must be noted that automatic Medicare enrollment is only available to those covered by Social Security or the Railway Retirement Board. If you are covered by the Railway Retirement Board or Social Security and you do not receive your Medicare card 3 months prior to your 65th birthday; reach out to the Social Security Administration at 800-772-1213.

Medicare Enrollment for Those Not Covered By Social Security or the Railway Retirement Board

While Medicare-A enrollment is automatic for some citizens of the United States; those not covered by Social Security or the Railway Retirement Board need to proactively register for Medicare benefits. There is a time period during which enrollment for Medicare is advised. The IEP or Initial Enrollment Period for Medicare starts 3 months prior to the month of your 65th birthday and ends three months after the month of your 65th birthday. This is the 7 month window to proactively enroll for Medicare benefits. There are multiple ways to enroll for Medicare benefits. The 3 primary ways to get started in Medicare are as listed below:

  1. Enroll online at www.SocialSecurity.gov
  2. Call the Social Security helpline at 1-800-772-1213, Monday to Friday, from 9AM to 3.30PM.
  3. Enroll for Medicare benefits at your nearest Social Security Office.

Bear in mind that if you fail to enroll during the IEP; you will be required to pay a late enrollment penalty for Medicare Plan B; as such you need to make full use of the 7 month enrollment period to enroll for Medicare benefits at the right time. While Medicare is mostly beneficial to retired senior citizens, certain disabilities and ailments may make it necessary to take advantage of health insurance through Medicare even when you are younger than 65. In these cases; enrollment is often automatic. If you are below 65 and yet receive disability benefits from the office of Social Security; you are entitled to automatic Medicare A and B. Availing of Medicare Plan C and D requires careful calculation of the costs involved and the extent of your medical needs.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: September 8, 2018

This article does not provide medical advice. See disclaimer

Sign Up for Our Newsletter

We'll help you live each day to the healthiest