You’ve got options when it comes to health insurance. The most important thing is to understand the type of plans available, so you can pick the one that fits your and your family’s needs. Two of the most common plan types are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).

• HMO Insurance Plans

HMO insurance plans require members to get care within their network of doctors and hospitals. You will only have coverage if you stay within the network. You’ll select a primary care physician who will coordinate all the care you receive, even from specialists. Usually, the premiums and out-of-pocket costs for HMO plans are cheaper than those of PPO plans.

• PPO Insurance Plans

PPO insurance plans also use networks but give members more flexibility. You can receive care outside the network, though you might pay more if you choose to do so. You won’t have to choose a primary care physician or obtain referrals to see specialists.

When you’ve just gone through an event leaving you without health insurance coverage, you may feel overwhelmed. Emergencies do not exclusively occur when you have health insurance. Luckily, there is an option – short term health insurance. Benefits are not the same across every insurance company, but these typically have a low cost. While not suitable as a policy to hold onto forever, it will help you in times when you’re waiting to switch to something permanent.

Why Get Temporary Insurance With a Short Term Health Insurance Plan?

Short term health insurance, often colloquially referred to as temporary insurance, is best for those in dire circumstances in which there is nowhere else to turn. For instance, someone whose employment has been terminated may not just be without health insurance, but a reliable stream of income. For this person, short-term health insurance can help during this period of uncertainty, because premiums can be as low as $55 per month.

It’s also good for someone who is waiting to join something else, but needs some sort of health coverage until the desired health insurance plan’s enrollment period begins. This can also apply to someone waiting for Medicare benefits to begin. College students attending an out-of-town university may be interested in this as well, proving that short term health insurance plans can be useful for all walks of life.

What Are The Benefits of Getting Temporary Insurance?

Benefits are dependent on the company offering the short term health insurance. A common item that short term policies cover is emergency hospitalization.

Some companies allow policyholders to seek treatments without being confined to a provider network. Others provide coverage for physical therapy, home health care, and coverage for up to three years.

This is also very affordable considering the duration of coverage, and how extensive some short term health insurance policies can be. Premiums, deductibles, copays, and coinsurance costs are often very low.

What Are The Drawbacks of Short Term Health Insurance?

Short term health insurance can be more difficult to get approved for. It’s not a guaranteed issue policy, so insurers can reject you on the basis of pre-existing conditions and current physical state. If you have questions about short term health insurance options get in touch with the The Burkes Group team today.

When you sign up, you’ll have to answer a questionnaire that asks for information pertaining to pre-existing conditions, body weight, whether you’re enrolled in another policy, and Medicaid eligibility. You can be rejected because of having unfavorable answers to these questions.

Common items absent from short term health insurance include mental health services, maternity services, and prescription medications.

Your coverage may also be delayed, as some short term health insurance plans have a waiting period before benefits begin.

Understanding ACA Plans in Texas

At The Burkes Group we are here to help you understand the intricacies of the Affordable Care Act and highlight the different ACA plans that are available. The passage of the Affordable Care Act made it easier to qualify for Medicaid, and health insurance companies were forbidden from rejecting individuals from health coverage for having pre-existing conditions. Another result was the creation of Health Insurance Marketplace plans, which are divided into four different categories – bronze, silver, gold, and platinum.

All ACA plans must cover such items as hospitalizations, preventive services, prescriptions, mental health, and laboratory services

What Are The Differences Between The Types of ACA Plans?

Plans differ in premium amounts, how much the insurance company covers, and who they’re ideal for.

Affordable Care Act Bronze plans are ideal for those who do not require frequent medical treatment. They have the lowest premiums, but the cost sharing places more financial responsibility on the policyholder compared to the coverage for the other plans. The deductibles are also high as well. With a bronze plan, the insurance company pays roughly 60% of the medical care costs, while you pay the remaining 40%.

Silver plans are the true middle ground with regards to ACA plans. The premiums and deductibles fall on neither end of the extreme. This is better for someone who gets routine appointments, and qualifies for additional savings. Once the deductible is met, your insurance will cover 70%, while you will pay 30% of your medical costs.

Gold plans are ACA plans which have high premiums, but are relatively low in other expenses. This is for those who need more frequent treatments. Once you meet your deductible, your gold plan will pay 80% for your services.

Lastly in the list of Affordable Care Act plans are platinum plans, which have the highest premiums, but have the lowest costs in other categories. The coverage is more immediate due to its low deductible. It covers 90% of medical costs, leaving you to pay the remaining 10%. Platinum plans are essentially the inverse of bronze plans.

When Can I Get A Marketplace Plan?

Health Insurance Marketplace Plan enrollment is available during the open enrollment period. This takes place between November and December.

Another time to join is during a special enrollment period. In 2021, the special enrollment period lasts until August 15.

But the special enrollment period also extends to those going through qualifying events that have occurred within the past 60 days. These are sudden and significant changes in life circumstances. Examples include getting married or divorced (if this results in current coverage changes), losing current health insurance coverage, and having a child.

The dates for when a qualifying event leads to effective coverage are exemplified here:

• For having a child, the coverage begins on the day of the birth
• If getting married, you have until the last day of the month to join. Your coverage will then begin on the first day of the following monthAC

Health insurance keeps medical costs from becoming insurmountable. There are many sources to obtain coverage from, with each having their own guidelines and criteria for eligibility. Different health insurance policies provide certain levels of coverage, so when you are considering a health insurance plan, it’s important to select one that meets your financial and medical needs.

Where Can I Get Health Insurance?

You can get health insurance through any one of these sources:

• Federal and/or state government
• Membership organization
• Health insurance broker
• Private insurance company
• Your employer
• Online Health Insurance Broker

Government-issued health insurance is typically reserved for medically needy, lower-income, and/or senior citizens. Medicaid and Medicare are two notable examples. Some individuals can be automatically enrolled, depending on personal circumstances.

Health insurance through membership organizations operates similarly to large group health insurance. Examples include alumni associations and unions.

Brokers work one-on-one with you to search for the best health insurance policies. Brokers have a broader perspective because they work with more than one insurance company.

As for a private insurance company, you are going directly to the source of your health insurance policy. This will involve more research, but you have the opportunity to get a firsthand look at what is available.

Employer health insurance is a common form of health insurance. Plans can be small group or large group health, depending on the number of employees your employer has. The coverage is broader and typically has a lower premium compared to other types of insurance.

Online health insurance is fast and effective, but you may be asked to reveal more information about yourself than you would if you were to get insurance elsewhere.

When Can I Get Health Insurance?

Different health insurance policies restrict enrollment to enrollment periods, which are limited to certain times during the year. Once the enrollment period has passed, you will have to wait until the next one comes. Marketplace insurance, for example, is allowing enrollment up until August 15 in 2021.

However, there are special enrollment periods for those who have a sudden change in life circumstances during any part of the year. This could be moving to a new city, getting married or divorced, having a child, or losing the policy you currently have. You may qualify for short-term insurance as well.

What Are The Costs?

With health insurance, you will have costs such as:

• Premiums – payments you must make in order to keep your policy
• Deductibles – amount you need to pay out-of-pocket before your coverage kicks in
• Coinsurance – the percentage of the overall cost you pay after your insurance has paid its share
• Copayments – predetermined payment amount you make for every appointment
• These amounts vary based on the policy and the company you’ve obtained it from.

We Are The Source

When it comes to affordable health insurance with the best prices, The Burkes Group is at your service. Our goal is to find you the insurance you need at the price you deserve, and if you have any questions or concerns, we’re always a call away. Call us today at (877) 987-5569 to learn more!

The Medicare landscape is dynamic and responsive to consumer needs. Private insurers create products designed to help people save money on their health care. While Medicare Supplement Insurance has been a bulwark of this strategy, some facets of these plans are relatively unknown. One example is the high deductible Medigap Plans currently available but somewhat rarely used. Are these good plans? Should you try a high deductible Medigap plan? In this informative guide, we’ll discuss all the details about these plans and help you make a decision based on your unique circumstances.

What Are High Deductible Medigap Plans?

These unique plans are a modification of standard Medicare Supplement Insurance plans. These are also known as Medigap plans. Medigap plans have been a common tool to help people save money on their health care since the Medicare program began in 1966. They are designed to work with Parts A and B of Original Medicare.

Since Medicare is designed for you to pay some of the costs of your care, people sometimes find their out-of-pocket spending to be uncomfortably high under Original Medicare. That’s where Medicare Supplement Insurance comes into play. These private health insurance companies offer these plans to help cover many of the costs you’re typically expected to pay. In other words, they cover the gaps in Original Medicare.

Medigap Plans are standardized across the United States, except Massachusetts, Michigan, and Wisconsin, with their own rules. The coverages vary by Plan, and there are ten standardized plans known by letter: A, B, C, D, F, G, K, L, M, and N. The fact that these plans are standardized means that the coverage for each project is the same regardless of which insurance company you use. This makes shopping for Medigap plans very easy; since the ranges are standard, you can compare programs based on price and the insurer’s financial strength rating

What Are The High Deductible Medigap Plans?

Not all of the ten standardized Medigap plans have high deductible options. Only Medigap Plans F and G have a high deductible option. These plans are often referred to as HDF and HDG.

With these two Medigap plans, you must meet a deductible before the plan pays any benefits. The deductible is much higher than the standard Medicare Part B deductible. It’s even higher than the Part A deductible.

However, in exchange for having a high deductible, you can access significantly lower monthly premiums than you otherwise could with Medicare Supplement Insurance. The great thing about these high deductible Medigap plans is that once you meet the annual deductible, both high deductible Plan F and high deductible Plan G will cover 100% of your medical costs for the rest of the year (assuming they’re Medicare-covered items). In other words, they provide very comprehensive coverage once you’ve met the deductible.

Other Plans Similar To High Deductible Medigap Plans

Two other standardized Medigap plans have features similar to high deductible Plans F and G. These are Medigap Plan K and L. They are not technically high deductible plans. However, because they’re structured, they have some overlap in function. With Plans K and L, you receive only partial coverage throughout the year instead of having to meet a high deductible before the plan starts paying benefits. For instance, Plan K will cover 50% of your Part B costs (generally your highest expense under Medicare). Plan L will cover 75% of this gap. The same coverage applies to the Part A deductible and any co-insurance you have to pay for lengthy hospital stays.

Here’s where the similarity to high deductible Medigap plans comes in. Both Plans K and L have a maximum out-of-pocket amount. You will never pay more than this amount in one year. Since high deductible Plans F and G pay 100% of your Medicare-approved costs after you reach the deductible, this makes the deductible function like an out-of-pocket maximum. Also, because you’re paying a part of your costs throughout the year, the premiums are also on the low side for Plans K and L, just like high deductible plans.

How High Are The Deductibles On High Deductible Medigap Plans?

The deductibles on high deductible Plans F and G change each year and are set by Medicare (CMS). For 2022, the deductibles are $2,490. This is the amount that you’ll have to pay before your Medigap plan begins paying any claims. As high deductible health insurance plans go, this is a meager amount. There’s even better news, however. While you’re working to satisfy your deductible, you’re not paying the total cost of your medical bills. Medicare is still the primary payer of your claims. This means that Medicare is paying 80% of your Part B costs. You’ll only be paying the leftover 20% until you hit the deductible. Once you hit that deductible, remember that your plan will pay all of your Medicare-covered costs for you.

Who Is Eligible For High Deductible Medigap Plans?

High deductible Medigap plans are theoretically available to everyone eligible to enroll in the standardized Medigap plans. This generally means that all of these apply to you:

• You are enrolled in Part A and B of Original Medicare, and
• You are at least 65 years old

Some states have rules in place that allow you to get Medigap coverage if you’re younger than 65 years old. However, other states don’t have these rules, so if you’re in Medicare and younger than 65, you may not be able to get a high deductible Medigap plan until you reach 65 years old.

Besides these law-based restrictions on high deductible Medigap plans, it is also possible that insurers may decide not to offer the high deductible versions of Plan F or G in your state.

Should I Enroll In High Deductible Medigap Plans?

This is an excellent question, and the answer will, of course, vary from person to person. It is a fact that someone who wants to strictly limit their out-of-pocket costs while preserving all the flexibility of Medicare Supplement Insurance while keeping their premium cost as low as possible should consider one of the high deductible Medigap plans. They are an excellent blend of coverage and affordability.

There are at least two reasons why you might want to pass on them, however. The first reason is that you’re still exposed to a couple of thousand dollars of medical expenses each year. But, you don’t necessarily have a good idea of how much you’ll spend. You might only spend a few under dollars, or you might hit your deductible. The variable nature of these costs can make it hard to plan your cash flow in retirement. If you’re looking at a high deductible Medigap plan to keep costs down, you might struggle to handle the unpredictability of your health care costs.

A second reason to be wary of these high deductible plans is that getting “stuck” on a Medigap plan is possible. If your health declines, switching to a different, more comprehensive Medicare Supplement plan might not be possible. If that were to happen, you might not want to be stuck in a high deductible plan. For this reason, you may want to consider enrolling in a standard Medigap plan. You can “downgrade” to the high deductible version in many cases if you contact your insurance company and request this.

Finding the best Medigap plan for you can be difficult. If you’re intrigued by high deductible Medigap plans and want to see which ones are available in your area, reach out to one of our licensed agents. By working with an independent professional, you can compare benefits and quotes for all the plans available to you. Request a free, no-obligation to get started today.

Medicare Part D is one of the four different Parts of Medicare. It provides prescription drug coverage and is sold through private insurance companies. Each Part D plan will also vary in coverage and cost.

How Does Part D Work?

Part D has a list of medications it covers, and offers lists for each category of medication types. Your plan’s list of covered medications is known as a formulary. While plans differ in what they cover, all plans must cover two medications within protected classes. They must also cover all prescriptions in specific categories: immunosuppressants, anticonvulsants, antipsychotics, antidepressants, anticancer, and HIV/AIDS drugs.

Your plan has two goals in mind – get you the best medications, and enable you to purchase those medications at the lowest possible cost. Medicare Part D arranges medication costs according to the tiers they fall under. Tiers reflect cost according to whether the medication is a brand name, if it’s preferred, or if it’s a specialty drug. They are numbered 1-4, and get increasingly more expensive the higher the tier is.

Tier 1 consists of generic and preferred medications. Tier 2 consists of brand names, but they’re also considered preferred. Tier 3 is made up of non-preferred brand name medications, and Tier 4 consists of specialty drugs (making it the most expensive of all).

What Are The Costs?

Because of it being sold exclusively through private insurers, not every policy’s costs are the same.

Regardless of the plan, you will have these expenses:

• Coinsurance
• Copayments
• Premiums
• Deductibles

Your plan determines all of these costs. While monthly premiums vary, you can expect to pay an amount close to the national base beneficiary premium, which is $33.06 as of 2021. Yearly deductibles are also different, but you will not have to pay any more than $445 in any Part D plan.

If you qualify for Extra Help, you’ll pay no more than $3.70 per generic medication and $9.20 for each brand name drug covered in the formulary.

You can get Extra Help if:
You are single and have less than $19,140 in yearly income with resources under $14,610
You are married with less than $25,860 in annual income, with resources being less than $29,160

When Can I Get Part D?

You can join Medicare Part D during one of the following times:

Initial Enrollment, which begins three months before the month you turn 65 and ends three months following the month you turn 65
Annual Enrollment, which is from October 15 to December 7
Special Enrollment. This is when you lose creditable prescription drug coverage. When this happens, you have two months to join without incurring a late enrollment penalty

A Medicare Supplement, also known as Medigap insurance, is a private insurance policy designed to help you pay for coinsurance or deductibles incurred Original Medicare. Medicare Supplements can also pay for certain services or items not covered by Medicare, such as prescription drugs. However, supplement plans only work with Original Medicare, not Medicare Advantage Plans.

Medicare Supplement plans are available to supplement your Original Medicare benefits. You can only purchase this plan after you enrolled for Original Medicare. Medigap pays any remaining deductibles, copays, or costs that Original Medical doesn’t cover. If you have met your Original Medicare deductible, your Medicare Supplement policy will pay the 20 percent of the bill not covered by Medicare Part A or Part B. Plans F, G, and N are the most popular.

Enrolling In Medicare Supplement

As a Medicare beneficiary, you are entitled to a one-time, 6-month open Medicare Supplement enrollment period. You have the right to buy any Medicare Supplement policy sold in your state, no matter any health problems you may have. This enrollment period starts when you turn 65 and are enrolled in Medicare Part B. If you enroll in Medicare Part B due to disability, the open Medicare Supplement enrollment period begins when you reach 65.

For those who postpone enrollment in Medicare Part B because they are still employed or covered under a working spouse’s health plan, the Open Enrollment Period starts when you enroll in Medicare Part B. All Medicare Supplement policies are guaranteed renewable, so this means your plan will continue as long as you pay the premium.

Moreover, there are more limited enrollment periods during which some patients are guaranteed the right to purchase certain Medicare Supplement policies. These options are usually activated by certain events like the termination of your other health coverage.

Medicare Supplement Plans

There are ten Medicare Supplement plans available (identified by letters A, B, C, D, F, G, K, L, M, and N), but some plans are no longer available to new enrollees. Medigap plans are standardized, so all of the same letters offer the same basic coverage irrespective of the insurance company you opt with. However, they offer different premiums or costs.

Insurance companies can’t sell you a Medigap insurance plan if you already have coverage through MA or Medicaid. Medigap plans also cover only one person.

All Medicare Supplement Plans Offer Essential Benefits

For example, all of these plans are guaranteed renewable, so you will always have your policy as long as you keep paying your premiums. You can also go to any hospital or doctor who accepts Original Medicare.

Even though Medicare Supplement plans are standardized, insurance companies’ premiums can vary significantly for the same plan. These companies can use several different methods to set prices for their premiums. Usually, what you pay depends on where you live, your gender, age, your health, etc.

All Medicare Supplement plans will increase the older you get, but some plans increase more than the others.

When you work with us at Wise Up Financial, we can help you identify insurance companies that will offer you the coverage you need at the right price.

Medicare Advantage (MA) or Part C offers coverage that matches Original Medicare with added benifits. It is part of the Medicare program offered to disabled adults and senior citizens who qualify. Private insurance firms offer Medicare Advantage. This plan usually includes the medical coverage Part A, B, and D that Medicare offers.

How Does Medicare Advantage Work?

Medicare Advantage is considered a great alternative to Original Medicare because it covers all the costs incurred under Original Medicare. There are certain MA plans that cover extra costs not paid for by Medicare, including hearing, dental, and vision expenses. However, MA plans don’t work with Medicare Supplement and Medigap Insurance.

In 2020, the average premium for a MA plan is expected to be around $23. Private insurance firms receive a set amount of money every month for MA plan care. The insurance companies, in turn, charge out-of-pocket costs to policyholders. This also allows them to create their own rules for services such as the provider networks for both emergency services and non-urgent care.

Regional Preferred Provider Organization (PPO) was created to offer those in the countryside better access to MA plans and cover the whole statewide and multi-state regions. In 2019, regional PPOs accounted for about 6 percent of all MA enrollees. About 34 percent of the people that receive Medicare benefits were enrolled in the MA plan, and the number is expected to increase.

Advantages Of Medicare Advantage

Some of the advantages of Medicare Advantages include:

• Convenient coverage options: With Original Medicare, you only get two types of coverage – medical insurance and hospital insurance. If you want extra coverage, you will need to opt for Medigap for supplemental coverage and Medicare Part D for drug prescription coverage. With the MA plan, you get all your coverage options in one convenient plan.
• Personalized plan structures: MA provides different plan types for personal conditions. For example, if you have a chronic health condition, choosing an SNP Advantage plan can help with your medical costs. And, if you want provider freedom, a PFFS and PPO plan may be the right option for you.
• Cost-saving opportunities: Research shows that you can save money on medical equipment and laboratory services by opting for an MA plan. Moreover, some MA plans have no costs for certain deductibles or premiums. Another significant benefit of MA is that there is an annual maximum out-of-pocket amount.

Coordinated medical care: Several MA plans are provided under structures that take advantage of coordinated medical care. This means that any Medicare Advantage providers you visit will be communicating with each other to offer effective, coordinated medical care.

Medicare Advantage Plans

There are several different types of MA plans that are available from Medicare-approved insurance companies. These companies are allowed to provide extra benefits beyond Medicare Part A and Part B. For example, some plans cover prescription drugs. MA plans can also offer coverage for vision, dental and other services not covered by Medicare Part A and Part B. The following are the major types of MA plans that may be available to you:

Health Maintenance Organization (HMO)

A Health Maintenance Organization has a network of contracted hospitals, doctors, and healthcare professionals who agree to offer services to the Medicare plan at a discounted rate. In exchange for this service, you will be required by the private insurance company to use the network for medical care. Most health maintenance organizations won’t cover out-of-network care unless it’s an emergency or the MA plan approves the out-of-network service in advance.

HMOs usually need you to choose a Primary Care Physician (PCP) to coordinate the applicant care and refer them to specialists as required. This plan is less expensive than other types of MA plans.

Special Needs Plans (SNPs)

SNPs are an MA plan with coverage designed for beneficiaries of Medicare with certain chronic diseases or have specific needs. It can be tailored to people who are eligible for both Medicaid and Medicare benefits, live in a long-term healthcare facility, and have severe chronic conditions such as chronic obstructive pulmonary disease or congestive heart failure.

Only the people with specific needs or conditions are allowed to purchase Special Needs Plans. Although SNPs may take the form of a PPO, POS, or HMO, you must meet specific requirements for Medicare Advantage SNP plan before you can enroll.

Private Fee-For-Service (PFFS)

PFFS is the most flexible MA plan in which the subscriber can go to any Medicare-approved hospital or doctor who agrees to accept the Medicare rule and payment terms. Instead of the Medicare Program, the insurance plan decides the amount it will have to pay and how much you have to pay for the services offered.

You may pay more or less for your Medicare-covered benefits, and you may have extra benefits not covered by Original Medicare.

Medical Savings Accounts (MSA)

Medical Savings Account is similar to a Health Savings Account. The plan has two parts: a special savings account and a high deductible insurance plan. The MA plan puts a sum of Medicare money into the Medical Savings Account that pays for some of the plan’s deductible. This money can be used to pay for Medicare-covered services. Medical Savings Accounts don’t usually include coverage for a prescription drug. If you enroll in the MSA plan, you may need to opt for only Medicare Part D.

Preferred Provider Organization (PPO)

PPO offers access to a network of hospitals and doctors that coordinate your health care. As with a Health Maintenance Organization, Preferred Provider Organization allows you to get more benefits from Medicare Part A and Part B plans and several Medicare Supplement plans. This MA plan has a network of facilities and doctors. It also allows you to use any hospital or doctor out of the network, but you may have higher copays and less coverage.

Medicare and Medicaid sometimes get confused with each other due to similarities in their names. They also have other things in common – where they come from, the benefits they offer, and the people they help. But there are some distinctions to consider, because while the benefits of having both are great, it’s possible to qualify for one but not the other.

Who Provides Medicare And Medicaid?

The source for each program is a similarity and a difference. They’re both government-funded, but the difference lies in the level of government sponsoring the program. Medicare is a federal program where the criteria for eligibility are the same no matter what state you live in.

Medicaid, on the other hand, is a joint state and federal program. Each state has its own requirements, so it is possible for a person to qualify for one state’s Medicaid program while being ineligible in another.

What Decides Eligibility?

In order to be eligible for Medicare, you must be at least 65 years old or have been collecting disability benefits for 24 consecutive months.

Medicaid eligibility hinges on annual income. Your state determines the exact amount that your income cannot exceed, and this is based off of Modified Adjusted Gross Income (MAGI). If you earn above this, you can’t get Medicaid. That is unless you are determined to be medically needy. If you meet your state’s definition of medically needy, you can spend down, in which you can deduct medical costs from your annual income so that you will meet your state’s income standards.

What Are The Benefits?

Medicare has benefits depending on what you sign up for, as Part B, C (Medicare Advantage), and D are optional. If you were to get Original Medicare (Part A and Part B) plus Part D, or a Medicare Advantage plan with a built-in prescription drug plan, you would have a highly comprehensive list of benefits. Part A provides inpatient coverage, Part B offers outpatient coverage, and Part D covers medications. Medicare Advantage is a combination of those three, with added benefits.

Medicaid covers inpatient and outpatient services, too. It also covers services not applicable to Medicare’s demographic, such as family planning, nursing and midwife services, and services for pregnant women.

Which One Should I Choose?

Qualifying for both does not require you to choose one or the other, in fact it’s strongly encouraged to have both if possible. Medicare and Medicaid work together to help you get greater savings on your care. It works like this: in an outpatient setting, Medicare negotiates a payment amount with your doctor. Medicare then pays 80% of that cost. Instead of the remainder going directly to you, Medicaid takes care of what it can of the rest. Your out-of-pocket cost will either be minimal or $0.

You may have heard about Medicare’s benefits and how it can help you save more on medical costs. Eligibility is not a one-size-fits-all but rather based on individual circumstances. Whatever the case, your ability to sign up for Medicare is just around the corner.

Is There An Age Requirement?

Medicare typically requires applicants to be 65 or over, but you can sign up for Medicare as soon as three months prior to your 65th birthday, during the Initial Enrollment Period (this period lasts until three months after the month of your 65th birthday).

Who Gets Automatic Enrollment?

Eligibility can also be thought of as who can get automatically enrolled in Medicare. Select groups do not have to enroll themselves. This includes those who receive Social Security and Railroad Retirement Board benefits. If you receive either of these, your Medicare card will arrive in the mail within the three months leading up to your 65th birthday.

You’ll be enrolled in Original Medicare (Medicare Part A and Part B together). Medicare Part A covers inpatient costs (hospital and skilled nursing facility stays, for example), while Part B covers outpatient costs (e.g. preventive services, screenings, x-rays, and durable medical equipment).

Is There An Exception To The Age Requirement?

It is possible to get Medicare while under 65. One way to get Medicare while under 65 is if you get disability benefits for 24 months. Like those who receive social security, you’ll automatically be enrolled in Original Medicare.

What Else Can I Be Eligible For?

Because Medicare and its policyholders are so diverse, there are some aspects of it accessible only to those meeting specific guidelines.

For example – not everyone who qualifies for Medicare can get Part A premium-free, just like qualifying for Medicare alone doesn’t guarantee you’ll be able to qualify for a Medicare Special Needs Plan or a Medicare Supplement plan.

Here are those aspects of Medicare and what you need in order to be eligible for them:

• Premium-free Part A – You have to have been employed in the U.S. long enough to have worked through 40 tax quarters (10 years)
• Medicare Supplements/Medigap – Join within six months of getting Medicare Part A and Part B; while you may be able to join after six months, the odds are slim
• Medicare Special Needs Plan – These plans are abbreviated as SNPs, and come in three types – D-SNP, I-SNP, and C-SNP. In order to be eligible, you need to be eligible for both Medicare and Medicaid, live in an institution, and/or have a chronic and disabling condition, respectively