Medicare Eligibility

Transitioning to Medicare, a government health insurance plan for persons 65 and older, is a popular option among retirees because it offers coverage alternatives that are often less expensive than group health care plans or private insurance. Premiums and qualifications are not affected by income or medical history, which is a significant benefit. Medicare eligibility typically begins when you reach the age of 65 (or younger if you have certain impairments or disorders), but there are other restrictions that you must complete. As an example:
senior man healthcare worker going through medical reports during home visit scaled

When you reach the age of 65, you will be automatically enrolled in Medicare Part A. You are also entitled to enrol in Medicare Part B and other supplemental coverage alternatives for a monthly cost at that time. Income and medical history do not affect premiums or qualifications, which is a significant benefit. Knowing when to enrol and what benefit alternatives are available, on the other hand, are critical components of getting the correct coverage at the right time. Missing enrollment deadlines or selecting the incorrect plan might have serious financial consequences.

The Age of 65 and the Medicare Initial Enrollment Period

The initial opportunity to enrol in Medicare is referred to as the “Medicare Initial Enrollment Period,” or IEP. This is a seven-month window of opportunity. It begins three months before your 65th birthday, and ends three months later.

Your Medicare Part B coverage will begin on the date you signed up within the IEP timeframe. The graphic below from ssa.gov depicted effective dates in 2022:

If you sign up for your IEP during this month: Your Part B Medicare coverage starts:
One to three months before you reach age 65
The month you turn age 65
The month you reach age 65
One month after the month you turn age 65
One month after you reach age 65
Two months after the month of enrollment
Two or three months after you reach age 65
Three months after the month of enrollment

Original Medicare Coverage Gaps

Enrolling in Original Medicare (Part A and Part B) as early as possible in the IEP window ensures that coverage is accessible the month you turn 65. The vast majority of Original Medicare beneficiaries, however, also enrol in supplemental healthcare, commonly known as Medigap. Let’s look at why this is so.

  • Part A: Emergency hospitalisation.
  • Part B: Outpatient preventive care (doctor visits).

Great! So that’s all one would need, right? What about hospital and doctor coverage?

….In fact, no. Here are a few examples of how a medical cost might quickly grow with only Medicare Parts A and B:

Hospital Visit

A patient may be admitted to the hospital, but they are not always officially “admitted.” Instead, they are designated as “under observation.” Benefits would be given out under Medicare Part B in this situation. That means you must pay 20% coinsurance for any Part B services. This can quickly add up for recipients, especially those on a fixed income.

Prescriptions

Part A would cover any medications administered to a patient while in the hospital. Prescriptions written for pick-up, on the other hand, would not be covered. This can amount to hundreds, if not thousands, of dollars in a given year. Cancer drugs can cost more than $100,000 per patient for just one year of treatment.

Other Things Not Covered by Original Medicare:

  • Custodial care (Long-term Care)
  • Dental care and dentures
  • Hearing aids and fitting exams
  • Eye exams related to prescribing glasses
  • Acupuncture
  • Routine foot care

Choosing the Right Plan for You

There are two basic alternatives for filling the gaps in Original Medicare coverage:

  • Medicare Supplement Plans (Medigap)
  • Medicare Advantage Plans (Part C)

Different healthcare providers provide their own qualifying programmes. A simple online search will yield countless of options and reviews on various supplemental Medicare policies and carriers. The reason for this is that everyone’s needs varies. What your neighbour considers a bad strategy may be the perfect one for you.

The most difficult obstacle for most beneficiaries is determining where to begin. There are numerous options and jargon to learn. Even after you’ve passed the Initial Enrollment Period and become a Yoda-level Medicare master, plans vary from year to year. Even an individual’s needs fluctuate. This is where locating a licenced agent comes in.

Benefits of a Licensed Agent

A skilled licensed agent or broker will:

  • Explain how Medicare works and how you can make it work for you.
  • Examine your requirements, such as determining which plans cover your doctors and which prescription meds are covered.
  • Give detailed descriptions of the benefits and drawbacks of various Medicare plans.
  • You should be able to display selections from more than one carrier plan, not just one or two.
  • You should be able to display selections from more than one carrier plan, not just one or two.
  • Include family members. Your family is likely to have concerns and want to ensure that you are adequately cared for. Some of them may be unfamiliar with how Medicare works. Throughout the year, not just during your IEP window, be readily available to answer inquiries.
  • They will never charge you for their services.

Different healthcare providers provide their own qualifying programmes. A simple online search will yield countless of options and reviews on various supplemental Medicare policies and carriers. The reason for this is that everyone’s needs varies. What your neighbour considers a bad strategy may be the perfect one for you.

The most difficult obstacle for most beneficiaries is determining where to begin. There are numerous options and jargon to learn. Even after you’ve passed the Initial Enrollment Period and become a Yoda-level Medicare master, plans vary from year to year. Even an individual’s needs fluctuate. This is where locating a licenced agent comes in.

… But How Can It Be Free?

Before we get into how it can be free, if your agent or broker is charging you for Medicare consultation services, they are breaking the law. These services are provided at no cost.
It is no secret that the Medicare maze may be frustrating and perplexing. Medicare, like the federally managed healthcare programme, has incorporated the cost of plan selection consultation services into the price to allow you to enlist assistance in selecting the appropriate plan for your needs. So, whether you use a professional or find a plan on your own, navigate all the different carriers, benefits, and intricacies of Medicare, read countless hours of articles, and watch YouTube videos until you feel like you may need to upgrade your eyeglass prescription, the cost of that plan selection will be the same.

We strongly advise you to take advantage of the free benefit and use that consultation to:

  • Learn everything there is to know about Medicare benefits.
  • Minimize frustration and confusion
  • Save time researching
  • Increase your clarity and confidence in your plan choices.

Avoid Extra Charges

Some Medicare-eligible people are unsure about the next step to take, so they wait. In the world of Medicare, however, this can come with a cost.

Penalty for Medicare Part B Late Enrollment

The consequences of failing to enrol in Medicare Part B when you are first eligible might be severe. If you do not qualify for a Special Enrollment Period and do not register in Part B when you first become eligible, you will be required to pay an additional 10% for each year you could have enrolled, as well as potentially higher premium rates depending on your income level. Here’s one from Medicare.gov:

If you delayed two years (24 months) to join up for Part B and did not qualify for a Special Enrollment Period, you will be charged a 20% late enrollment penalty (10% for each complete 12-month period that you might have signed up), plus the usual Part B monthly premium ($174.70 for 2024).

So, instead of paying $164.90 for your Part B premium, you would spend $197.88 per month.

Penalty for Medicare Part D Late Enrollment

If you do not have Medicare drug coverage (Part D) or other creditable prescription drug coverage during your Initial Enrollment Period or any subsequent period for a period of 63 days or longer, you may be subject to a late enrollment penalty. This will be added to your premium indefinitely. The amount of the penalty that will be imposed to your standard premium is determined by how long you were without creditable prescription drug coverage.

Here’s how Medicare calculates the Part D penalty for someone who went four years (48 months) without creditable prescription medication coverage:

Skip to content