Common Questions about Medicare
When it comes to safeguarding your well-being, health insurance can be one of your most vital assets, potentially helping you cover everything from doctor’s visits to emergency room trips to medications. It can, however, also be complicated—especially when it comes to Medicare. Check out this guide to dispel some of the most common points of confusion about these plans.
Who qualifies for Medicare?
Most people likely know that Medicare is primarily for those sixty-five and older, but you may also be eligible before then if you are receiving Social Security Disability Insurance (SSDI) or have been diagnosed with end-stage renal disease (ESRD). For SSDI, there is a two-year waiting period after you get your first check, at which point you automatically become enrolled; this wait is not required if you have SSDI due to an ALS diagnosis. Enrollment and the beginning of benefits can vary for ESRD depending on the specific circumstances.
Is enrollment automatic, and when must it be done?
Whether or not you have to enroll yourself largely depends on when you start receiving social security benefits. If they begin at least four months before your sixty-fifth birthday, you will be automatically enrolled in Medicare when you turn sixty-five. However, if your benefits have not begun yet, you will need to sign up for Medicare manually, which you can do online or with an agent.
Should you need to enroll, you will have a seven-month window to do so—three months before your birthday, your birthday month, and three months after. If you fail to sign up in that time, you will have to wait for the general enrollment period between January 1 and March 31 and may have to pay penalty fees as part of your premiums for as long as you have coverage.
When can changes be made?
The primary opportunity to make changes is during the open enrollment period, which occurs every year between October 15 and December 7. During this time, you can join, drop, or switch plans based on your needs. There’s also a specific enrollment period for Medicare Advantage policyholders between January 1 and March 31. Additionally, you may be able to adjust your plans if you qualify for a special enrollment period, such as if you move or lose current coverage.
Is Medicare free?
Like other health insurances, you will always have a deductible, copays, and coinsurance regardless of which Medicare policies you have. You’ll also be required to pay a premium for Parts B (medical coverage) and D (drug coverage) and potentially for Medicare Advantage (Part C). However, you may be eligible for premium-free Part A (hospital coverage) as long as you work for a certain duration, typically ten years, in a job where you paid Social Security taxes before turning sixty-five.
For more information about the basic parts of Medicare, check out this guide.
How much are premiums?
For those who have to pay for Part A, the premium is one of two standard amounts for everyone. In 2024, it’s either $278 or $505 each month based on how long you worked and paid taxes. Part B premiums are set at a minimum of $174.70 per month for this year, but they may be higher depending on your reported income from two years prior. For instance, individuals who made more than $103,000 (but less than $129,000) will have to pay $244.60. As for Part D and Medicare Advantage, those premiums are dependent on which plan you join as well as other factors like your income before retirement.
Can Medicare be combined with other health insurance?
In general, the answer is yes, though it can depend on the plan. For instance, if you are still working and on your employer’s insurance after you turn sixty-five, it can be worth it to sign up for Medicare as well to supplement your coverage. Conversely, you cannot be enrolled in Medicare Part A and/or B and open or contribute to a health savings account (HSA) because HSAs require having a high-deductible health plan. You can, however, continue to spend from an HSA account you had prior to getting Medicare; as long as you use it for qualified medical expenses, the funds will remain tax-free.
Medicare can be incredibly complex, but it doesn’t have to be confusing. To help clarify any questions you may have, reach out to an insurance agent who specializes in Medicare. They can assist you in understanding the various plans and walking you through your options so you can find the solution that fits your unique financial and health needs.