Medicare Eligibility and Enrollment Guide

978 4 minutes read

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Medicare has been a Godsend to millions of Americans, especially the older demographics. The number of Americans benefiting from Medicare continues to rise. Medicare enrollment was 63,964,675 as of October 2021. 36,045,321 were in Original Medicare. Other health plans and Medicare Advantage took up 29, 919,354.

Access to healthcare is an ongoing concern, especially for older people. There is also the spillover effect of relieving the health burden from carers. The costs tend to fall on those caring for older people.

The lack of health insurance coverage amongst older populations is a critical concern. Indeed many do not have the capacity to access healthcare because of their related costs.

Medicare provides a guarantee of affordable health insurance. beneficiaries also get a full range of medical services.

Our article explores Medicare eligibility and enrollment guide. But first, let us understand Medicare in a little more detail.

Table of Contents

Understanding Medicare

The Medicare federal social insurance program came into effect in 1965. At first, its aim was to provide health insurance for older people. Over time, it evolved. It now covers disabled people and those suffering from specific health conditions. These include end stage renal disease (ESRD) resulting in kidney failure. Medicare will pay for dialysis or a transplant if need be.

Please note that as a federal program, the rollout is uniform across the country. So, let’s say you live in Florida. You can apply for Florida Medicare plans in your home state. But you will still have to go through the same eligibility and enrollment guide as you would in any other state.

Medicare Plans

There are different Medicare parts you need to be aware of.

Medicare Part A also goes by the name hospital insurance. It covers care in a nursing facility, home care, and inpatient hospital stays. There is no monthly premium if you have been paying Medicare taxes while working. If not, you can buy the premium for $499 per month.
Medicare Part B or Medical insurance covers doctor services. Others are preventive services, medical supplies and outpatient care. There is a $170.10 premium everyone must pay.
Medicare Part C or Medicare Advantage comes from private Insurance companies.
Medicare Part D or Prescription drug takes care of prescription drug costs.

You can get Medicare coverage through two options.

Original Medicare encompases Medicare Part A and Part B. You will be eligible to pay a deductible and co-insurance of about 20%. If you want Part D, you can buy it as a separate plan.
Medicare Advantage allows for coverage via a private company. But, it must fall under Medicare-approved plans. The best advantage plan Medicare comes as a bundled plan with Part A, B, and D. You can also get extra services like dental, vision, and hearing plans.

How to Apply for Medicare and Enrollment Windows

You must meet the Medicare eligibility criteria for Medicare Florida or anywhere else. That means:

Age 65 and above
Below age 65 but with eligible disabilities receiving social security disability benefits
Suffering from ALS or ESRD

As we said, standard Medicare enrollment rules apply to each state. But, there may be state-specific changes in things like enrollment windows.

For instance, when you apply for Medicare in Florida, there are three critical windows. These are:-

Initial Enrollment

Initial enrollment for Medicare Florida is three months before your 65th birthday. You also have the birthday month and three months after. That gives you seven months to register for Medicare plans in Florida. You can also apply if you have been getting disability benefits within the last two years. The same applies if you have an ALS or ESRD diagnosis.

So what happens if you miss this window? Well, you will have to wait until the next general enrollment window.

General Enrollment

The general enrollment falls from 1st January to 31st March every year. But you will have to wait until 1st July for the cover to kick in. Please note you may be liable to penalties if you enroll now. That will be 10% of the monthly premium. But, this only applies to Medicare Part A and Part B.

Medigap or Medicare Supplement Plan Enrolment

To enroll for Medigap, you should do it in the first month you register for Medicare part B.

But do note these may differ from state to state. You can change your Medigap plan within California’s 91-day open enrollment window. Nevada has 61 days, Oregon 31 days, and Louisiana 93 days.

The Medigap enrollment period is the time to get the best Medicare advantage plans in Florida. You don’t have to worry about pre-existing conditions. There are also some of the best plan options and pricing.

Medicare Annual Enrollment or Medicare Open Enrollment Period

The open enrollment falls from 15th October to 7th December. Please note that you must already have signed up for Medicare. You get the opportunity to make any changes to your existing plan.

Medicare Enrollment

You get automatic enrollment in Medicare when you meet the eligibility criteria. That means you are 65 years old and have been collecting social security benefits. If not, do take note of the enrollment windows we have highlighted above to register.

There is the option of delaying enrolling for part B if:-

You have an alternative cover from your employer, union, or other sources
You receive health benefits from your spouse’s health insurance cover
Have health insurance from a previous employer. These include retiree health insurance or COBRA

Seek the services of licensed Medicare advisors to assist with the application process. They will advise you on the best Medicare plans to ensure you get optimal coverage.

There are also other options, including online applications and through the social security offices. Previous railroad employees can contact the Railroad Retirement Board.

Final Thoughts

We have shared a Medicare eligibility and enrollment guide above. But please note that there is so much more you need to know. That is why we stated that it is a good idea to talk to Medicare advisors if you want to enroll. This is a critical step if you hope to get the best Medicare plans in Florida or any other state you may be living in.

It also helps to take time to understand the different parts and what they cover. The good news is that you also have the option to improve the coverage. All you need to do is apply for Medicare Advantage or Medigap.

@Maneez SEO

978 4 minutes read