MEDICARE BENEFITS INFORMATION
WHAT IS MEDICARE?
Medicare is the United States health insurance program for people who are 65 years or older. However, if you receive Social Security Disability benefits, then you also get Medicare benefits after a waiting period. In order to obtain SSD benefits, you must apply. You can apply online at the Social Security website. It is easy to start your application for SSD benefits. If you need help filing an application, then call us.
The program helps with the cost of health care, but it does not cover all medical costs or most long-term care costs. You have choices for how you get Medicare coverage. If you choose to have Original Medicare (Part A and Part B) coverage, then you can buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company.
Medicare benefits also come with Social Security retirement benefits at age 65. If you need to learn more about SSDI payments and what happens when you retire, then read our article “When Do SSDI Benefits End?”
THE HISTORY OF MEDICARE BENEFITS
The Medicare benefits program started in 1965 as part of the Social Security Amendments of 1965. The reason it began was there were concerns about the lack of affordable health insurance for seniors in the USA. On July 30, 1965, Medicare was signed into law by President Lyndon B. Johnson as part of his Great Society program.
Funding for Medicare comes from general revenue, payroll taxes, and premiums paid by those who receive it. Eligibility is usually based on age (65 or older) or on whether you are getting SSD benefits. However, some younger individuals with specific medical conditions may also be able to get Medicare coverage.
Medicare has had a huge impact on health coverage in the United States. It provides necessary health coverage to millions of seniors and individuals on SSD benefits. This coverage helps ease the financial burdens of medical care.
THE KEY COMPONENTS OF MEDICARE
Medicare has four different parts that cover various aspects of your health. Here is a list of the four key parts of Medicare which will be discussed in more detail later in this article:
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- Part A (Hospital Insurance): Covers hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Part B (Medical Insurance): Covers outpatient care, visits to the doctor, and some home health care.
- Part C (Medicare Advantage): A private insurance plan that combines coverage from Part A and Part B, often with more benefits. It may also include coverage for prescription drugs (Part D).
- Part D (Prescription Drug Coverage): Provides drug coverage through private insurance plans.
UNDERSTAND THE FOUR PARTS OF MEDICARE BENEFITS
Social Security enrolls you in Original Medicare, which includes Part A and Part B. Below is a brief explanation of Part A and Part B.
Part A: Hospital Insurance
Medicare Part A is one half of Original Medicare, the health insurance managed by the federal government, and is hospital insurance. Part A covers the following services:
- Inpatient care in a hospital for injury or illness
- Care in skilled nursing facilities on a short term basis after a hospital stay
- Nursing home care (if it’s deemed medically necessary for you to have skilled nursing care)
- Hospice care and short term respite care
- Home health services, such as physical therapy
Part B: Medical Insurance
Medicare Part B is medical insurance, and is the other half of Original Medicare. It pays for medically necessary services that you need to diagnose or treat your condition that meet the accepted standards of care. It also covers preventative care, such as most flu shots and early detection tests.
Medicare Part B coverage includes:
- Ambulance transport
- Yearly doctor visits
- Cardiovascular disease tests
- Flu shots
- Diabetes tests
- Mammograms
- Medical equipment, including blood sugar monitors and wheelchairs
Unlike Medicare Part A, which usually doesn’t have a premium, there is a monthly premium for Medicare Part B. According to the U.S. Centers for Medicare & Medicaid Services, the standard Part B premium amount in 2022 is $170.10. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, then you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). The IRMAA is an extra charge added to your premium.
According to an AARP report, retirees with traditional Medicare ended up spending an average of $6,168 per year on covering the costs of insurance and medical services.
Considering that the average Social Security benefit in 2022 is just $1,907 per month – or about 23,000 per year – a retiree with a typical benefit and average medical costs could end up spending over 31% of their entire Social Security check to pay for their medical needs. Find out more about Biden’s current plan to deal with health costs.
Part C: Medicare Advantage Plans
Many people opt for Medicare Part C, also known as a Medicare Advantage plan, rather than Original Medicare.
Unlike Original Medicare, which is covered by the federal government, Medicare Advantage plans are issued by private health insurance companies. Medicare Part C plans combine the coverages of Part A and Part B, and they often cover benefits Original Medicare doesn’t, including hearing, dental, or vision services. Many plans even offer drug coverage as well.
In some cases, your costs with a Medicare Advantage plan will be lower than they would be with Original Medicare, making them a good alternative. In fact, the average premium is just $21 per month in 2021, in addition to your Medicare Part B premium.
Part D: Prescription Drug Plans
Many people are surprised to find that Original Medicare — Parts A and B — don’t include coverage for medications. If you want insurance for your medications, you can enroll in a Medicare Part D plan. This is an optional benefit that provides prescription drug coverage. With Medicare Part D, you can buy a drug plan that fits your needs.
According to the Kaiser Family Foundation, the national average premium for a prescription drug plan is $30.50 in 2021. In 2022, the Medicare Part D premium is around $32.08 and the amount is projected to go down and be around $31.50 in 2023. Your specific plan’s cost depends on its coverage, deductible, and coinsurance or copayment amount.
When buying a Medicare Part D plan, check the plan’s formulary, which is the list of drugs that it covers. The list of drugs that Medicare Part D pays for can vary by plan. Therefore, it may not all cover your necessary medications. For this reason, it is important to review available coverages when you compare Medicare Part D plans.
WHEN DO YOU BECOME ELIGIBLE FOR MEDICARE BENEFITS?
Most of the time, Medicare benefits begin at age 65. You can sign up for coverage three months before the month of your 65th birthday. You should enroll in Medicare on time, because if you don’t, you could end up subject to penalties that make Part B coverage more expensive.
If you’ll be signing up for original Medicare (as opposed to Medicare Advantage), you’ll need a Part D plan for drug coverage. Medicare Part A will cover your hospital care and Part B will cover your outpatient care. However, drug coverage is separate.
The earliest age you can sign up for Social Security retirement is 62. Therefore, if you are turning 65 this year, taking benefits is an option you should consider. But that doesn’t mean you should rush to file.
You won’t be able to receive your full monthly benefit based on your work history until you reach full retirement age. If you were born in 1957, your full retirement age doesn’t start until 66 and 6 months. If you retire at age 65, then you will have a reduced payment for the rest of your life. Please also be aware that your marital status can affect your Medicare benefits. Find out how divorce can impact your Medicare benefits.
THREE THINGS THAT HELP WITH COSTS OF MEDICARE BENEFITS
Here are three helpful steps you may wish to take to help with the costs of Medicare:
- USE OPEN ENROLLMENT TO GO SHOPPING. You can receive Medicare, but there may be a better alternative for you, like Medicare Advantage Plans. You can also add a Medigap plan to fill coverage caps in traditional Medicare. While your premiums may go up if you choose more coverage than traditional Medicare, you could also lower the costs you must personally pay for during the year.
- SEE IF YOU QUALIFY FOR MEDICAID. If your income and resources are low enough, then you might be able to get more medical care through Medicaid. Medicaid covers things that Medicare doesn’t cover. Also, it can help keep costs down.
- TALK TO YOUR DOCTOR. Your doctor may be able to help you find cheaper medications. Also, your doctor can help you practice good health habits, so you can avoid the need for expensive medical services.
MEDICARE SAVINGS PROGRAMS – Help With Your Monthly Premium
If you don’t have enough money to pay your monthly Medicare premium, there are state programs that help pay those premiums. These programs are called Medicare Savings Programs. Your state pays for these programs with Medicaid money.
The program that pays the most for premiums is called the Qualified Medicare Beneficiary (QMB) program. It will pay for all of your Medicare Part A and Part B premiums, deductibles, and coinsurance. However, to get a payment from the program your income level must be low. In short, your income must be the same as the federal poverty level.
There are two other programs that can help you pay for your Medicare premiums. First, there is the Specified Low-Income Medicare Beneficiary (SLMB) and second, there is the Qualifying Individual (QI) programs. Both programs have slightly higher income limits than the QMB program. The SLMB and QI programs pay all or part of your Medicare Part B monthly premiums. However, please note, they do not pay for any Medicare deductibles or any coinsurance amounts. If you need to know whether or not you qualify for help to pay for your Medicare premium, then you should check with your local welfare office.
OUR LAW FIRM CAN HELP YOU WITH MEDICARE BENEFITS
One of the services that Cannon Disability Law provides to our clients is a free review about Medicare benefits and your options. Once our clients win their Social Security case, they also win Medicare benefits 29 months after their onset date of disability. This includes the 5 month waiting period and the 24 month waiting period for Medicare to begin.
If you have a medical condition on the compassionate allowance list, it is rare, but possible for the SSA to waive the 24 month waiting period. We consider it part of our job to help you understand your Medicare options. For example, we can help you learn about Medicare Advantage plans.
Most of our clients want to keep their current doctors, even if Medicare becomes their primary source of health insurance. You may have a long treatment relationship with your doctor. Likewise, your doctor may be an expert, who has treated you and your particular medical condition for a long time. We want you to be able to keep seeing the doctor that you trust.
Our Medicare expert, Andria Summers, can help you figure out what is best for your particular situation. She will review your original Medicare plan with you. After that, she will review your options under the Medicare Advantage plans. Ms. Summers goal is to help you choose the best Medicare plan. She will try to help you keep your doctor and be able to afford your medications. Meeting with Ms. Summers is a free service for all of our clients who are paid SSD benefits.
OUR ATTORNEYS CAN HELP YOU WIN BENEFITS
If you want to learn more about the lawyers and staff at our law firm than read our About Us page. For example, Andria Summers can help you with your Medicare plan. She has also won thousands of SSDI cases. Dianna Cannon has been helping her clients win benefits for thirty years. Brett Bunkall also has many years of experience helping people obtain their SSI and SSD benefits.
In the past 30 years, we have won over 20,000 SSDI and SSI cases for our clients. Also, we have helped many receive Medicare benefits. Our experts can help you apply for benefits using the SSA’s website. However, we will need your help to apply for SSI benefits. Why? Because only you know your personal financial information. SSI benefits require you to have minimal assets and low monthly income.
Likewise, if you need an appeal, we can help you do that too. There are also many forms that will need to be filled out. Don’t worry. If you have questions about these forms, then we will answer them. You can review SSA’s appeal forms. Call us for free today.
Additionally, we represent clients in many states, including Nevada, Utah, Idaho, and California. Find out about Nevada SSDI benefits. Learn about Utah SSDI benefits and California SSD and SSI benefits.
No matter where you live, we want to be your legal team. Also, no matter what state you live in, we can talk to you for free about Medicare benefits. Contact us today and will do our best to answer your questions about your Medicare benefits.
