Medicare is health coverage for seniors 65 years and above, younger individuals living with disabilities, and those with end-stage renal medical conditions. If you are an employer who plans to enroll your employee, you need to know what it entails. Here are four things you need to understand before enrollment:
1. Individuals Can Qualify for Medicare for Different Reasons
Some people qualify when they are 65 years. Those under 65 can only be eligible after receiving the SSDI or RRB disability funding for two years. However, individuals with amyotrophic lateral sclerosis can get Medicare enrollment immediately after diagnosis. You need to understand the different qualifications people need before enrolling for Medicare to know how to help your former and current employees make the right decisions.
2. Some Individuals Get Medicare Part A and B Automatically, While Some Others Must Sign Up to Enjoy their Benefits
Medicare Part A deals with Hospital Insurance, while Part B covers Medical Insurance. All United States residents, apart from those in Puerto Rico, who are eligible for Social Security, automatically qualify for Part A and B when they become eligible for Medicare. That includes retirement and disability. Such people can enroll for Medicare a few months before they hit 65 or get their 25th month of RRB or SSD benefits.
While they can either keep or reject Medicare Part B, they can only decline Part A if they withdraw from their social security application and repay all its cash assistance. Individuals who haven’t started receiving Social Security money, or don’t qualify for Social Security Retirement, should sign up for Medicare since the system automatically signs them up for it.
They should contact Social Security to sign up for Medicare. In addition, Puerto Rico residents and those living in foreign nations with Medicare Part A should sign up for part B by filling out an online enrollment application form.
3. There are Specific Times for Medicare Enrollment
Individuals who qualify for free Part A because of age can immediately enroll when they become eligible for Medicare in the initial enrollment period. Someone can only qualify for the premium-free Part A if they or their partner submitted Medicare taxes before retirement.
Coverage for anyone who qualifies for free Part A starts six months backward from their application date and not earlier than the first month they become eligible for Medicare. Nonetheless, one can only enroll in Medicare premium Part A and Part B at a specific time as indicated below:
• The Initial Enrollment Period (IEP)
The IEP is the first seven months when someone becomes eligible for Medicare. For people who qualify because of age, their IEP starts three months before hitting 65 years. That includes their birth month and ends three months after they reach 65.
For individuals who qualify for Medicare because of disability, the IEP starts three months before they receive their 25th month of RRB or SSD benefits. It includes the 25th month and lasts until three months after that. According to the law, people can get coverage depending on their enrolment month and can extend for an extra three months.
• The General Enrollment Period
GEP lasts between the 1st of January and to 31st of March each year, and coverage starts on the 1st of July.
• The Special Enrollment Period
The SEP applies to individuals who didn’t apply for Medicare during their initial eligibility because they or their partners were still employed and had health coverage sponsored by their employer. SEP coverage begins during the enrollment month but can sometimes stay for three or fewer months before it starts.
Individuals who qualify for Medicare because of disability can be eligible for a SEP based on their current employment or that of their spouse. They may also be eligible based on their family members or partners’ current employment if their employer has 100 or more staff members.
4. Individuals Should Know if They Qualify for SEP before Enrolling for Medicare Part B
Employees and their dependents should decide whether to enroll in Part B when they first qualify for Medicare. Individuals with insurance based on their employment will choose Part B enrollment depending on their insurance on their current job.
If a person or their better half is still employed and has health insurance coverage from their employer, they can enroll for Part B during a particular enrollment period. However, they shouldn’t do that before understanding the special rules involved.
For example, Medicare doesn’t consider employment plans for retired individuals as current employment. So, such people aren’t eligible for a particular enrollment period and hence can’t enroll for Medicare later. People with Medicare because of ESRD or disability have different rules they should follow.
Whether you are an employee or employer, it is essential to understand how Medicare enrollment works and how one qualifies for health coverage. The above four pointers will give you knowledge about Medicare eligibility and enrollment.