Since 1965, when Congress amended the Social Security Act, most Americans have reason to feel that turning 65 is a good thing. At that age, they are eligible for Medicare, which is the federal health insurance program that covers those who are 65 or older. In addition, Medicare is available to: some people under the age of 65 who have disabilities and receive benefits from the Social Security Administration or the Railroad Retirement Board, those with permanent kidney failure (also known as End- Stage Renal Disease) and people with amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
Medicare has four parts: A for hospital insurance; B for medical insurance; C (also called Medicare Advantage or MA plan), offered by private companies; and D, which covers prescription drugs. Parts A and B are the most well known to the general public.
What does Part B cover?
Part B covers all medically necessary services, including any care by a doctor, as well as supplies. In addition, Part B covers:
- Services and supplies, such as X-rays or physical therapy, that are required to diagnose or treat a medical condition
- Care by a doc tor at his or her office, hospital or other healthcare station
- Use of an ambulance
- Services that detect illness at an early stage or to prevent illness, such as flu shots or cancer screenings
- Some types of home healthcare
- Some mental healthcare
When and how does Part B coverage begin?
If you are already receiving Social Security benefits when you turn 65, the Social Security Administration (SSA) will likely automatically enroll you in Part B coverage. For those with a birthday on the first day of the month, Medicare coverage begins the first day of the prior month. If you have a disability, such as Lou Gehrig’s disease, you will automatically start Part B Medicare coverage the same month you start receiving disability benefits.
If you have a disability and are under the age of 65, you will start getting Part B benefits automatically after you have been getting benefits from the SSA or the Railroad Retirement Board (RRB) for 24 months.
An automatic enrollment in Medicare means that the red, white, and blue Medicare card will be mailed to you either: three months prior to your 65th birthday or after you have been disabled for 25 months.
You will need to sign up for Medicare coverage if:
- You have end-stage renal disease and therefore are eligible for coverage.
- You are not getting Social Security benefits when you turn 65, perhaps because you are
- You live in Puerto Rico, where you automatically get Part A, but want to sign for Part B, which is not automatic.
It is not necessary to sign up for Part B each year. But everyone on Medicare has a yearly chance, from October 15 through December 7, to drop their Medicare Part B plan (part of Original Medicare) and enroll in a Medicare Advantage (Part C) plan. This is called the open enrollment period. Medicare Advantage plans offer the same benefits as Part B and Part A combined, and oftentimes, include additional benefits for a small monthly charge. Once you drop Part B, however, it cannot be picked back up until the following general enrollment period for Original Medicare, which lasts from January 1st thru March 31st.
If you do not enroll in Part B when first eligible for Medicare benefits, you can also enroll for the first time during the general open enrollment period, from January 1st to March 31st. If these circumstances exist, you may be hit with a late enrollment penalty.
What does Part B Medicare cost?
The amount you pay for Medicare Part B each year depends upon the amount of your income reported two years earlier on your IRS tax return. Below, the breakdown for monthly premiums, based on income, is provided:
For example, those who filed a tax return of $85,000 or less will pay $104.90 for part B in 2015.
There may be a late enrollment penalty if you do not sign up for Part B when you are first eligible. Generally, the penalty is assessed as 10 percent, added to the monthly premium for every 12-month period of time that you could have enrolled in Medicare, but did not. Therefore, if you waited two full years (24 months) to enroll in Medicare Part B after first turning 65, your premium will be increased by 20 percent.
For some Part B services, there may be no extra costs, but some may charge for a doctor visit. You may save money by choosing a doctor or service provider who accepts Medicare.
How do you know if you are adequately covered by Medicare Part B?
If you are unsure whether you are carrying Part B Medicare coverage, check your Medicare card. If you have the coverage, it will be listed. If you do not have it, you can get it, although the costs may be higher if your initial enrollment period has ended. Fees for Part B Medicare depend upon your income.
Coverage for Medicare is based on:
- Laws, both federal and state
- Medicare national decisions concerning what should be covered
- Decisions made by local state companies engaged in processing Medicare claims
To check whether your coverage is adequate, check with your doctor or other healthcare provide. If you need something that Medicare doesn’t cover, you may have to agree that you will pay for the certain item or service. You can also check directly with Medicare about your coverage. Call (800) MEDICARE (633-4227).