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Medicare: Eligibility and Enrollment

Sign-up for Benefits Not Necessarily Automatic
By: CaregiverZone

Who is eligible for Medicare?

Seniors age 65 and older are eligible for Medicare if they or their spouse worked for at least 10 years in Medicare-covered employment and if they are a citizen or permanent resident of the United States. Younger people with certain disabilities sometimes also qualify for coverage.

Medicare, the nation's largest health insurance program, covers 39 million Americans. It includes two components. Part A helps pay for stays in hospitals and skilled nursing facilities; Part B covers outpatient hospital services, diagnostic tests, physicians' fees and a variety of other medical expenditures.

Employees in most workplaces have Medicare taxes withheld from their paychecks. However, some exceptions exist; if you need more information about whether the senior you care for is eligible, call the Social Security Administration at (800) 772-1213.

Do Medicare recipients have to pay premiums?

Here are some simple guidelines. At age 65, seniors can get Medicare Part A without having to pay premiums if they:

  • Are already receiving retirement benefits from Social Security or the Railroad Retirement Board.

  • Are eligible to receive Social Security or Railroad benefits but have not yet filed for them.

  • Had - either directly or through a spouse - Medicare-covered government employment.

Individuals under 65 can get Part A without having to pay premiums if they:

  • Have received Social Security or Railroad Retirement Board disability benefits for 24 months.

  • Are a kidney dialysis or kidney transplant patient.

Seniors who do not qualify to receive Medicare Part A without paying premiums may still be able to purchase coverage; you can find out more by calling the Social Security Administration.

Even if the senior does not have to a pay a premium for Part A, Part B is available only by paying a monthly premium. The Part B monthly premium in 2000 is $45.50. The premium is usually deducted directly from the Social Security, Railroad Retirement or Civil Service Retirement check.

How does enrollment in Medicare work?

Enrollment in Medicare is handled in two ways: some seniors are enrolled automatically, while others have to apply.

Automatic enrollment

Seniors who are not yet 65 and are already receiving Social Security or Railroad Retirement benefits will be automatically enrolled in both Part A and Part B, effective the month they turn 65. Likewise, disabled seniors will be automatically enrolled in Part A and Part B beginning in the 25th month of disability.

In both cases, a Medicare card will be mailed to the seniors about three months before they are entitled to start receiving Medicare. Those who do not want Part B should inform the Social Security Administration.

Applying for Medicare

Individuals who are not already receiving either Social Security or Railroad Retirement Benefits should apply for Medicare Part A and Part B three months before turning 65, or if they require regular dialysis or a kidney transplant. If an individual does not apply three months before turning 65, Part B coverage will be delayed. Then it will be necessary to wait until the next general enrollment period to sign up. To apply for Medicare, contact any Social Security Administration office.

General enrollment periods

General enrollment periods are held each year from January through March, and Part B coverage starts that July. Don't put off enrolling. Unless seniors still have insurance from a current employer, the premiums for Medicare Part B go up 10 percent for each 12 months they could have enrolled but did not. For those who have to pay premiums for Part A and delay enrolling, the increase in the premium is 10 percent no matter how late enrollment for coverage occurs.

If seniors do not enroll in Part B during the initial enrollment period, they will have to wait until the next general enrollment period to enroll. Seniors can delay Part B enrollment without having to pay higher premiums if they:

  • Are age 65 or older and have group health insurance based on their own or their spouse's current employment.

  • Are disabled and have group health insurance based on their own or any family member's current employment.

Even individuals who continue to work after turning 65 should sign up for Part A of Medicare because it may help pay some costs not covered by the work-based group health plan. However, working seniors may not find it advisable to sign up for Part B if they still have health insurance through their employer because they will need to pay a monthly premium for the additional coverage. They will not be assessed a penalty if they enroll for Part B coverage at a later point.

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