Question: What is Medicare? I am getting to the age where I will need to get Medicare, but I do not have a good understanding of what it is or the process of getting it.
Reply: At MedicareCard.com, we understand that Medicare can be a complex and overwhelming topic. If you’re approaching the age where you need to enroll in Medicare but don’t understand what it is or how to get started, we’re here to help. Our team of experts is dedicated to providing you with all the information you need to make informed decisions about your healthcare coverage. In this article, we’ll answer your question, “What is Medicare?” and provide a comprehensive guide to Medicare enrollment.
Medicare is a health insurance program covering people with specific eligibility criteria. It is available for individuals who are:
- Sixty-five years of age or older.
- People under 65 with specific disabilities.
- People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant).
The program has two parts – Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers hospital care as an inpatient, critical access hospitals, skilled nursing facilities, hospice care, and some home health care. On the other hand, Part B helps pay for doctor’s services, outpatient hospital care, and other medical services not covered by Part A, such as physical and occupational therapists and some home health care.
Most people do not have to pay for Part A, while most pay monthly for Part B. However, the cost of Part B may vary depending on your income level and whether you enrolled when you first became eligible. You can choose different ways to get the services covered by Medicare, such as opting for a Medicare Prescription Drug Plan to add drug coverage or a Medicare Advantage Plan that provides all your Part A, Part B, and often Part D coverage.
Enrolling in Part B is your choice, and you can sign up for it anytime during a seven-month period that begins three months before you turn 65. If you are unsure if you have Part A, look at your red, white, and blue Medicare card. If you have Part A, “HOSPITAL (PART A)” is printed on your card.
Your state may help you pay for Part A and B if you have limited income and resources. You can visit the Social Security website or call their support team for more information. You can review your health and prescription needs each year and switch to a different plan in the fall.
In summary, Medicare is a comprehensive health insurance program that provides coverage for eligible individuals. It has two parts, Part A and Part B, which cover hospital and medical expenses, respectively. In addition, you can choose different ways to get the services covered by Medicare.
What disabilities are eligible for Medicare?
Medicare is available to individuals under 65 who have specific disabilities. The Social Security Administration (SSA) defines a disabling medical condition for Medicare as a physical or mental condition that can be diagnosed and documented by medical evidence, an impairment that significantly limits the ability to perform basic work-related activities such as walking, sitting, and concentrating, an impairment that is expected to be long-term (more than a year) or terminal, and a condition that leaves you unable to engage in substantial gainful activity (SGA).
Some examples of disabling medical conditions that are eligible for Medicare coverage include Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, and End-Stage Renal Disease (ESRD). Certain cancers, respiratory illnesses, and musculoskeletal disorders also qualify for Medicare coverage.
If you have a disabling medical condition, contact the SSA to determine eligibility for Medicare coverage. The SSA can guide the application process and help you understand the medical evidence required to prove your disability. By doing so, you can receive the coverage and care you need to manage your condition and improve your quality of life.
Some examples of impairments not covered under ADA are:
It is important to note each individual should be assessed on a case-by-case basis, and this list is not all-inclusive and does not cover all possible scenarios related to these conditions.
- Appendicitis
- Short bouts of depression
- Weight conditions within normal ranges
- Normal height deviations
- Traits and behaviors
- Cultural or economic disadvantages
- Normal pregnancies
- Quick temper
- Poor judgment
- Irritability
- Physical characteristics such as being left-handed, hair color, eye color
- Homosexuality, bi-sexuality, gender disorders
- Broken limbs, sprains, concussions
- Gambling addiction
- Lack of education
- Old age
- Current use of illegal drugs
- Sexual behavioral disorders
- Disorders caused by the use of illegal drugs
- Stress may be shown to be related to a mental or physical impairment, but traits such as irritability, chronic lateness, and poor judgment are not, in themselves, cognitive impairments.
- Broken limbs, sprains, concussions, appendicitis, common colds, or influenza generally would not be disabilities.
- Complications to common non-covered conditions can often result in eligibility under the ADA.
How Long Does It Take to Get Disability Medicare?
Obtaining Disability Medicare can be a complex process, and the time it takes to get it can vary depending on the situation. If you receive Social Security Disability Insurance (SSDI) benefits, you are eligible for Medicare after 24 months. During this time, you may have the option to get health insurance through a former employer, so it’s worth checking with them about possible coverage.
However, if you have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), your Medicare benefits will begin as soon as you start collecting your SSDI benefits without any qualifying period. If you have End-Stage Renal Disease (ESRD), your eligibility for Medicare coverage generally starts three months after a kidney transplant or a course of regular dialysis.
Living with a disability can present numerous challenges, and the last thing you need is the extra financial burden of not having access to necessary healthcare services. Medicare coverage can be a vital lifeline by providing the assistance you need and access to essential healthcare services. Suppose you are unsure whether you qualify for Medicare based on your disability. In that case, contacting the Social Security Administration and starting the SSDI benefits and Medicare coverage application process is a good idea. They can guide you through the process and help you understand the medical evidence required to prove your disability. With the proper support and resources, you can receive the coverage and care you need to manage your condition and improve your quality of life.
The General Enrollment Period of Medicare
The General Enrollment Period (GEP) is an additional opportunity for eligible individuals to enroll in Medicare Part B. If you missed signing up for Part B when you first became eligible, you can do so during the GEP, which runs from January 1 through March 31 each year. You can sign up for Part B at your local Social Security office or by calling 1-800-772-1213 (TTY users should call 1-800-325-0778).
It’s important to note that if you don’t sign up for Part B when you first become eligible and don’t have other coverage, you may have to pay a late enrollment penalty. The cost of Medicare Part B will go up 10% for each entire 12-month period that you could have had Medicare Part B but didn’t take it, except in exceptional cases. You will have to pay this penalty as long as you have Medicare Part B.
However, there are some exceptions to this penalty. For example, if you have insurance through your or your spouse’s current employer or union, you may be able to delay signing up for Part B without penalty. You can contact your employer’s benefits administrator or the Social Security Administration for more information if you need clarification.
If you are enrolled in Medicare Part A and need to enroll in Part B, you can do so during the GEP without penalty. Your Part B coverage will start on July 1 of the year you sign up. Again, you can sign up for Part B at your local Social Security office or by calling 1-800-772-1213 (TTY users should call 1-800-325-0778).
In summary, the General Enrollment Period is a window of opportunity for individuals who missed enrolling in Medicare Part B during their initial enrollment period. You can enroll in Part B during this period, but you must be aware of the potential late enrollment penalty. If you have any questions or concerns, please get in touch with the Social Security Administration or your employer’s benefits administrator for clarification.
What are the Reasons for Denial of Disability Claims?
It is a known fact that first-time applications for Social Security Disability (SSDI) have a high rejection rate. Shockingly, up to 40% of initial applicants will have their disability claims denied by the Social Security Administration (SSA). There are several reasons for these rejected applications, and one of the top reasons is insufficient documentation of a disability.
The SSA requires hard evidence that an individual is not only disabled but also meets the SSA’s definition of disabled. Medical records play a critical role in supporting your case and must demonstrate the nature of your disability and substantiate your need for benefits. The lack of proper documentation of the extent and impact of your disability can lead to a rejection.
To bolster your case, you must cooperate with an attorney specializing in disability law. They can help you gather all the necessary medical records and other relevant evidence to present to the SSA. Your lawyer can also help you prepare for the hearing and ensure you have all the documentation required to support your claim.
In summary, while the high rejection rate of SSDI applications may be alarming, there are steps you can take to increase your chances of success. Ensuring that your disability is adequately documented and that you have a knowledgeable lawyer to guide you through the process can make all the difference.
In conclusion, Medicare is a valuable program that provides health insurance coverage for eligible individuals. Part A and B cover hospital and medical expenses, while different Medicare plans offer additional services such as drug or all-in-one coverage. For those who have disabling medical conditions, Medicare can be a lifeline to manage their conditions and improve their quality of life. While obtaining Disability Medicare can be lengthy, it is worth exploring options for coverage through former employers during the waiting period. Understanding the eligibility criteria and available options can help individuals make informed decisions and get the necessary coverage.