Generally, US residents who turn age 65 will qualify for Medicare. People who qualify for disability at an earlier age will generally get Medicare after 2 years. Talk to us for more details.
Medicare has two Parts: Part A, Hospital Coverage and Part B, Doctor's services. Typically Part A is at no cost if the person has worked and paid FICA payroll taxes for 10 years (or been married to someone who paid them for 10 years). Those that don't meet the work requirements may purchase Part A on a sliding scale up to $506/month. Part B typically costs $164.90/month (in 2023) unless the person is on the higher income side in which they may have to pay an additional amount each month known as an IRMAA adjustment. Ask us for the latest IRMAA adjustments which vary by income and marital status, and can change every year.
Typically, a person will want to have one or the other. It is not allowed for a person to have a Connect for Health (C4) policy with a tax credit and be covered under Medicare. Some people who may not qualify for Medicare, have to pay more for Medicare Part A and B than a C4 tax credit policy, or choose to stay on an employer provided group plan with over 20 employees (including ICHRA's) may choose to not enroll on Medicare when they are first eligible. This is a tricky area as generally Medicare, and sometimes Medicare-Medicaid, will be less expensive and potentially better coverage than a policy through C4. Assistors will likely need help guiding people in this area as there is extensive certifications required to discuss some Medicare options.
Yes, a member can have both Medicare and Medicaid. They will typically always need to enroll on Medicare when they qualify (age 65 or disabled) to qualify for Medicaid (lower income AND LOWER ASSETS in this case). These cases require specialists that are certified to sell D-SNP (Dual eligible Medicare Advantage policies). Medicare and Medicaid coordinate to possibly pay all or some of the members costs including copays, Part B premiums, and even grocery costs depending on the level of income and assets.
People who are eligible for Medicare have three options to sign up: Seek the help of a specialist (we can help on this), Sign up online at SSA.gov, call 1-800-Medicare (1-800-633-4227), or call their assigned county office. We have specialists that will make sure Assistors stay connected to their clients throughout the enrollment process.
Medicare which includes Part A (Hospitals) and Part B (Doctor's Services) is generally called Original Medicare. It is the foundation of all Medicare medical services and is the first thing to get. There can be penalties for people who do not join Medicare when they are first eligible, with some exceptions for people that are on a group plan with over 20 employees. Having a Connect for Health CO policy will not avoid the Medicare penalties unless it is part of an ICHRA group policy with over 20 employees. Medicare Part D is for drug coverage in addition to the Parts A and B medical coverage. Generally, members will want to sign up for this when first eligible (unless they decide to stay on a group policy that has Part D Creditable coverage) to avoid late Part D enrollment penalties. We have specialists that understand these rules and penalties and will work closely with Assistors. Original Medicare has many gaps, like only paying 80% of Doctor's services no matter how large the bill is. It is generally recommended that members either get a Medicare Supplement (sometimes called Medi-gap) or Medicare Advantage policy to provide much better coverage. Many Medicare Advantage policies which include Part D are provided at no cost to the member. This is a specialized field that requires extensive federal certification and we can help provide these services.
Penalties are specific to the situation, but late enrollment for Medicare Part B will generally add 10% of the cost of the part B premium per month for each year the Part B is delayed. Example: A Medicare eligible individual that delayed signing up for Part B for 3 years, will generally pay an extra 30% on Part B for the rest of their life. This penalty does not apply if the member was on a qualifying group plan. A Medicare eligible individual will pay an extra $0.35/month (varies by year) for each month the member does not have Part D when they sign up, unless on a qualified group plan with Part D creditable coverage. Example: A Medicare eligible individual delays getting Part D for 10 months. They would pay an additional $3.50 per month for part D for the rest of their life. In some very rare circumstances very high income members who don't need Part D may find it advantageous to delay enrollment because of the high IRMAA adjustment that also applies to Part D. Again, we have help here.