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, you are also eligible for Medicare benefits after a waiting period. In order to obtain Social Security Disability benefits, you must apply. You can apply online at the Social Security website. It is easy to start your application for disability benefits.
The program helps with the cost of health care, but it does not cover all medical expenses or the majority of 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, 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 they end and turn into retirement benefits, read our article “When Do SSDI Benefits End?”
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, including physical therapy or occupational 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 vaccines and early-detection screenings.
Medicare Part B coverage includes:
- Ambulance transport
- Yearly wellness doctor visits
- Cardiovascular disease screenings
- Flu shots
- Diabetes tests
- 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 released in December 2021, retirees with traditional Medicare ended up spending an average of $6,168 per year on covering the costs of insurance premiums and medical services.
Considering that the average Social Security benefit in 2022 is just $1,657 per month – or $19,884 per year – a retiree with a typical benefit and average medical expenses could end up spending just over 31% of their entire Social Security check on paying out-of-pocket expenses for their medical needs. Find out more about Biden’s current plans to deal with healthcare expenses.
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 prescription drug coverage as well.
In some cases, your out-of-pocket costs with a Medicare Advantage plan will be lower than they would be with Original Medicare, making them an affordable 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 prescription 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 purchase a prescription drug plan (PDP) 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 is dependent on its coverage, deductible, and coinsurance or copayment amount.
When choosing a Medicare Part D plan, check the plan’s formulary, which is the list of drugs that it covers. Formularies can vary by plan. Therefore, they may not all cover your necessary medications. For this reason, it is important to review available coverages when comparing Medicare Part D plans.
WHEN DO YOU BECOME ELIGIBLE FOR MEDICARE BENEFITS?
Most of the time, Medicare eligibility begins 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 your Part B premiums more expensive.
If you’ll be signing up for original Medicare (as opposed to Medicare Advantage), you’ll need a Part D plan for prescription 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, claiming benefits is an option you should consider. But that doesn’t mean you should rush to file.
You won’t be eligible for your full monthly benefit based on your earnings history until you reach full retirement age. If you were born in 1957, full retirement age doesn’t start until 66 and 6 months. If you file for retirement benefits 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 more about how divorce can impact your Medicare benefits here.
THREE THINGS TO DO TO HELP WITH COSTS OF MEDICARE BENEFITS
Here are a few 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 by choosing more comprehensive coverage than traditional Medicare, you could also lower the costs you must personally pay for during the year.
- See if you’re eligible for Medicaid. If your income and resources are low enough, then you might be able to get additional medical care coverage 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 preventative healthcare habits, so you can avoid needing significant 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, you should check with your local welfare office.
CANNON DISABILITY LAW 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, learn more about Medicare Advantage plans here.
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.
CANNON DISABILITY LAW’S ATTORNEYS
If you want to learn more about the lawyers and staff at Cannon Disability Law you can go to 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, we will answer them. You can learn more about SSA’s appeal forms here. Call us for free today.
Additionally, we represent clients in many states, including Nevada, Utah, Idaho, and California Find out more about Nevada SSDI benefits here. Learn more about Utah SSDI benefits and California SSD and SSI benefits here.
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.