Medicare is divided into parts, which are differentiated by letters of the alphabet. If you will be turning 65 shortly, take some time to understand Medicare Part A and B what it covers, and the costs involved.
Part A
Part A provides hospitalization coverage, including hospital stays, skilled nursing facility care, home health care (skilled nursing, physical therapy), and hospice care. For most individuals, Part A is free, there is no charge for coverage as long as you meet a few requirements. As long as you are a permanent resident of the United States and you or your spouse paid Social Security taxes while employed, enrollment is automatic. There are deductibles and co-insurance that you are responsible for.
Not Covered
Private room
Personal care items (shampoos, toothpaste, etc.)
Television, phone charges
First three pints of blood
24-hour home care
Meals and homemaker services not related to treatment
In-home personal care (bathing, dressing, etc.)
Part B
Part B covers expenses that are necessary to treat or prevent a disease or condition. Fees that occur outside of room and board while in the hospital are those related to diagnostic testing, preventative care, and supplies needed to diagnose or treat. Fees for visiting the doctor are also included. Part B also provides coverage for many tests and screenings. The standard monthly premium for 2024 is $174.70 (or higher depending on your income). Most people who get Social Security benefits pay this amount.
Not Covered
Elective and cosmetic surgery
Alternative medicine – acupuncture, homeopathy
Vaccinations and immunizations
Prescription and Non-Prescription drugs
General dental work, dentures
Long term care
Hearing aids and exams for fitting
Eye examinations for prescribing glasses
Out-of-Pocket
There are out-of-pocket costs associated with Medicare, deductibles, coinsurance, and copays. Many seniors choose to supplement coverage to cover costs. You do not have to accept Part B, and you may opt-out by signing the back of your card and returning it by mail. If you are still working and receiving coverage from your spouse or through an employer, accepting Part A, but delaying Part B may make sense.
Enrollment
Typically, the best time to enroll in Part A and B Is when you are first eligible, during your Initial Enrollment Period. Unfortunately, If you do not qualify for Part A and need to enroll for Part B and miss your enrollment, you may have to wait until the General Enrollment Period, Jan 1-Mar 31, with coverage starting on July 1.
Penalty
if you don’t enroll in Part B at this time, you will be responsible for a penalty for each 12-month period you were eligible for but didn’t enroll. A 10 percent penalty will be reflected in your premium and will continue for as long as you receive benefits. If you have coverage through your spouse, you may delay enrollment without a penalty. You may be eligible for a Special Enrollment where you won’t be charged a penalty. If you are subject to the penalty, in addition to a premium increase, you may have to wait until January (General Enrollment Period) to enroll for coverage that begins in July. The monthly rate for Part B is based on your income.
Effective Dates
In the event you have not enrolled automatically and choose to enroll in Medicare yourself, effective coverage dates vary based on the month you sign up. If you sign up during your Initial Enrollment Period (the 7 months beginning 3 months before your 65th birthday and ending 3 months after your 65th birthday) effective start dates are shown below.
The same month you turn 65, coverage begins 1 month after you enroll.
1 month after you turn 65, coverage begins 2 months after you enroll.
2 months after you turn 65, coverage begins 3 months after you enroll.
3 months after you turn 65, coverage begins 3 months after you enroll.
References:
https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html
https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-how-to-sign-up-for-part-a-and-part-b.html
MUC55-2017-BCBS
