New To Medicare Guide
Medicare is a U.S. federal health insurance plan that provides coverage to retirees and, in some cases, younger individuals who are affected by chronic health conditions.
Medicare coverage consists of several parts, and each one covers different aspects of healthcare.
In most cases, individuals are automatically enrolled in Medicare at 65 if they are a U.S. citizen and eligible for Social Security benefits as a result of their employment history.
Medicare is an umbrella term that includes several different healthcare plans, also known as Parts, which cover various aspects of healthcare:
Medicare Part A covers inpatient care and hospital visits
Medicare Part B extends coverage to preventive care and medically necessary services
Medicare Part C is offered by private insurance companies and also includes the benefits of other Parts
Medicare Part D specifically covers prescription drug needs
Additionally, Medicare Supplements are designed to provide coverage in areas that standard Medicare Parts may not include, such as copayments or coinsurance.
Medicare and Medicaid are both federal health insurance programs. However, Medicaid is designed to provide health coverage to low-income individuals regardless of their age, while Medicare provides health coverage to seniors and retirees regardless of their income.
If a person is dually eligible for both programs, they can receive both Medicare and Medicaid benefits.
Medicare Beneficiary Guide
Unless your loved one is already receiving Social Security benefits, you will need to assist them in enrolling in a Medicare plan that’s right for them.
This happens during the enrollment period, which starts three months before your loved one’s 65th birthday.
Unfortunately, if the enrollment period is missed, late enrollment penalties and fees may apply.
Once the enrollment is complete, you simply wait for the Medicare effective date when your loved one’s coverage starts.
In most cases, the effective date will be on the first day of the month of their 65th birthday. However, if their birthday falls on the 1st of the month, the effective date will be one month prior.
When your loved one receives a medical service, they must pay a certain amount out-of-pocket, which is known as their Deductible.
Once this pre-set amount is spent on the relevant services, your beneficiary’s Medicare plan will kick in and cover the rest of the bills, as long as they make the coinsurance payment or copayment.
The deductible, coinsurance, and copayment depend on the precise plan, the insured’s income, and the length of time during which they receive treatment, among other factors.
If your loved one is expecting to receive health coverage under their Medicare plan, it’s important to note that not all doctors will accept it.
Some doctors and healthcare providers choose to opt out of participating in the Medicare program. If you receive treatment from them, you will have to pay for their services in full.
To avoid that, be sure to choose a doctor from the provider network that’s covered under the chosen plan.
Medicare Insurance Before 65Contrary to popular belief, Medicare is not just available to people aged 65 and older. Here’s how an individual can qualify even earlier.
If your loved one has been receiving Social Security Disability benefits for at least 24 months, they can apply for and immediately start receiving Medicare insurance.
If your loved one has been diagnosed with End Stage Renal Disease, they may qualify for Medicare insurance, regardless of their age. A three-month course of dialysis or a kidney transplant can make you eligible for Medicare benefits.
If your loved one has been diagnosed with ALS, they are automatically enrolled into Medicare Plans A and B the moment they start collecting Social Security Disability benefits, regardless of age.
Neurocognitive disorders, such as dementia or Alzheimer’s Disease, also qualify your loved one for Medicare insurance.
Helping Your Loved One Enroll in Medicare
If you’re helping a family member sign up for Medicare, know that you aren’t alone. Along with these tips, we recommend speaking to an experienced agent to help you through the process.Get Help from Our Experts
Have Documents of Authorization
It's useful to have documentation stating you have the medical power of attorney as well as the Medicare “Authorization to Disclose Personal Health Information” form.
Gather Necessary Information
Take the time to learn more about Medicare and what each Part entails to help you better understand and assist your family member in making decisions.
Ask Specific Questions
Have as much information about your loved one’s medical history as possible: what medications they take, what providers they go to, and what they can afford.