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Turning 65 – Medicare Coverage for Seniors and Other Eligible Parties

Medicare provides health insurance coverage to seniors as well as certain non-seniors who meet special criteria. Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) are referred to as Original Medicare and will cover some basic medically necessary treatments. These treatments include hospital stays, rehabilitation, nursing services, doctor visits, chemotherapy, x-rays, lab work and testing, as well as other specified outpatient medical procedures that are performed at a doctor’s office. Below is some basic information concerning eligibility for Medicare, enrollment in Medicare, and the options available to you when it comes to covering gaps in Medicare coverage.

Medicare Eligibility

To be eligible for Medicare Part A and Medicare Part B you must be:

  • 65 years old or older
  • Eligible to receive Social Security
  • A United States citizen or a legal resident of the United States for five years

Medicare Part A and Medicare Part B is also available to certain individuals under the age of 65 who are United States citizens or have been legal resident of the United States for five years. You are eligible for Medicare in these circumstances if you:

  • Have a permanent disability and have received Social Security disability insurance (SSDI) or Railroad Retirement Board disability benefits for at least two years
  • Require a kidney transplant or are undergoing dialysis for end-stage renal disease (severe kidney disease)
  • Have Lou Gherig’s disease (ALS)

Medicare Enrollment

People who meet the above age criteria and are already enrolled in Social Security will be automatically enrolled in Medicare when they turn 65. If this is not the case, you will need to apply for Medicare benefits on your own.

The initial enrollment period for Medicare benefits begins three months before your 65th birthday and last seven months from that starting point. Those who miss this initial enrollment period may apply for Medicare Part B from January through March. Be sure to enroll on time. For every full year you delay Medicare enrollment following initial eligibility, a 10% penalty will be applied to your monthly premium.

Special enrollment for Medicare applies to those at the age of 65 who have health insurance coverage through their employer, their spouse, or through a union. These individuals may apply for Medicare Part B up to eight months after losing this group coverage without incurring the 10% penalty.

Gaps in Original Medicare Coverage

Even though Medicare does help in a number of different situations, not all medical treatments are covered. These are referred to as gaps in coverage. There are, however, different ways to cover these gaps in Original Medicare. You can either opt for Medicare Advantage plans or Medicare supplement insurance plans (Medigap). There are a number of pros and cons to weigh when it comes to making this decision, many of which will be determined by your current health care needs and future health care needs. The team at Medicare Benefits Direct will help you determine which is best for you.

Contact Medicare Benefits Direct for a Medigap Quote

To compare rates for Medicare supplement plans or to learn more about gaps in Original Medicare coverage and the best way to deal with them, contact Medicare Benefits Direct today. We look forward to discussing your options with you.