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Original Medicare combines coverage from Part A and Part B. Medicare Part A serves as hospital insurance and provides coverage for inpatient hospital care, skilled nursing facility care, home health care, and hospice care.
It is highly advised that even if you choose to delay your enrollment in Medicare Part B, that you still enroll in Part A as soon as you become eligible. You can do this during the Initial Enrollment Period, which begins three months before turning 65 and ends three months after turning 65.
Enrollment and Costs
For most Medicare beneficiaries, enrollment into Part A is done automatically. In fact, you will be automatically enrolled in both Part A and B if you get benefits from Social Security or the Railroad Retirement Board. Suppose you are eligible for Medicare because of a disability. In that case, you will be automatically enrolled once you have received disability benefits from Social Security or the RRB for 24 months. If you have ALS (Amyotrophic Lateral Sclerosis), you will also be automatically enrolled during the same month your disability benefits start.
If you are automatically enrolled, you will get a “Welcome to Medicare” package that will arrive three months before you turn 65. You will receive your Medicare card in this package. You will also receive a booklet, which is highly recommended that you read through. You will need to decide if you want to stay enrolled in Part B, if you want prescription drug coverage, and if you want a Medicare Supplement plan to go alongside your Original Medicare coverage.
If you choose to stay enrolled in Part A but not Part B, you may have to pay a late enrollment penalty on top of your Part B premium when you decide to enroll in it later. However, most beneficiaries receive premium-free Part A, meaning they do not have to pay a monthly premium for this part if they are automatically enrolled or have paid Medicare taxes while working for at least ten years. Suppose you are not eligible for premium-free Part A. In that case, you will have to sign up for Part A during the Initial Enrollment Period.
As of 2021, if you are required to pay a premium for Part A, you will either pay $259 or $471 each month. Part A also has a deductible for each benefit period, which is $1,484.
Medicare Part B
Original Medicare combines coverage from Part A and Part B. Medicare Part B serves as medical insurance and covers outpatient medical expenses that are considered medically necessary to diagnose or treat a health condition.
What Does Part B Cover?
There are several services covered under Part B, but to receive the coverage provided, you must receive your care or treatment from a Medicare-approved facility.
Part B covers two main types of services, which include medically necessary services and preventive services. With Part B, you will receive coverage for:
- Durable medical equipment
- Mental health services (this includes inpatient, outpatient, and partial hospitalization)
- Ambulance services
- Clinical research
And certain outpatient prescriptions, such as:
- Those with used with durable medical equipment
- Injectable osteoporosis drugs or other injectable drugs
- Blood clotting drugs
- Oral ESRD drugs
- And more
Eligibility and Enrollment
If you are 65 or older, have a disability, or have End-Stage Renal Disease (ESRD), Medicare Parts A and B will become available to you. Many people will receive premium-free Part A, but others will have to pay a monthly premium. However, Part B's eligibility requirements will ultimately depend on if you were able to receive premium-free Part A or if you must pay a premium.
Suppose you are eligible for premium-free Part A. In that case, you will most likely be automatically enrolled in Part A, which will also automatically enroll you in Part B. The most common way to be automatically enrolled is to have received benefits from Social Security or the Railroad Retirement Board at least four months before qualifying for Medicare. However, if you are not automatically enrolled, you will need to enroll during your Initial Enrollment Period, which begins three months before your 65th birthday. Failing to enroll during this period could lead to permanent late enrollment penalties, which are added onto your monthly premiums
If you are required to pay the Part A premium, here are the requirements you must meet for Part B:
- You are 65 or older
- You are a U.S. resident
- You are a U.S. citizen
- You are a permanent legal resident who has live in the U.S. for at least five years
You will have out-of-pocket costs associated with Part B. As of 2021, the Part B premium is $148.50 but could be higher for those who make a higher income. Part B also has a yearly deductible of $203.
Are You Nearing 65? Contact Us Today!
Advocate Health Advisors of Englewood, FL, is here to help you through the Medicare enrollment process! If you still have questions about Medicare Part A and are curious to know if you will be automatically enrolled, don’t hesitate to give us a call at (800) 709-5513. We can answer any Medicare questions that you may have so you can stay completely informed.