Enrolling in Medicare Part a and Part B
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CENTERS for MEDICARE & MEDICAID SERVICES Enrolling in Medicare Part A & Part B The information in this booklet describes the Medicare Program at the time this booklet was printed. Changes may occur after printing. Visit edicare.govM or call 1-800-MEDICARE (1-800-633-4227) to get the most current information. TTY users can call 1-877-486-2048. “Enrolling in Medicare Part A & Part B” isn’t a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings. 3 Contents 5 Section 1—The Medicare Program 5 What’s Medicare? 5 Medicare has different parts 5 Medicare Part A (Hospital Insurance) 6 Medicare Part B (Medical Insurance) 9 Can I get Part B if I don’t have Part A? 9 How do I know if I have Part A or Part B? 10 Medicare Part C (also known as Medicare Advantage) 10 Medicare Part D (prescription drug coverage) 10 For more information 11 Section 2—Part A & Part B Enrollment 11 When can I sign up? 13 Getting Part A and Part B automatically 17 Signing up for Part A and Part B 19 Turning 65 and you or your spouse is still working 21 Medicare and End-Stage Renal Disease (ESRD) 24 Retiree coverage 24 Can I still get Medicare at 65? 26 Veterans’ benefits 26 I have Health Insurance Marketplace coverage 27 I have coverage through a health savings account (HSA) 28 Living outside the U. S. 29 Section 3—For More Information 29 Where to get more information 29 Medicare publications 31 Section 4—Definitions 4 5 Section 1—The Medicare Program What’s Medicare? Medicare is health insurance for: ■ People 65 or older ■ Under 65 with certain disabilities ■ People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) Medicare has different parts Medicare Part A (Hospital Insurance) Words in Part A helps cover your inpatient care in hospitals. Part A also includes blue are coverage in critical access hospitals and skilled nursing facilities (not defined custodial or long-term care). It also covers hospice care and home on pages health care. You must meet certain conditions to get these benefits. 31–33. Can I get Part A? Generally, you’re eligible for Part A if you: ■ Are 65 or older and you meet the citizenship and residency requirements. ■ Get disability benefits from Social Security or the Railroad Retirement Board for at least 25 months. ■ Get disability benefits because you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease). ■ Have ESRD and meet certain requirements. How much does Part A coverage cost? You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes for at least 10 years while working. If you aren’t eligible for free Part A, you may be able to buy Part A if you’re: ■ 65 or older and you have (or are enrolling in) Part B and meet the citizenship and residency requirements. ■ Under 65, disabled, and your free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get free Part A for up to 8 ½ years after you return to work.) 6 Section 1—The Medicare Program In 2018, people who have to buy Part A pay premiums up to $422 each month. In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. What’s a Part A late enrollment penalty? If you get Part A for free, you won’t have to pay a Part A late enrollment penalty if you decide to enroll after you first become eligible. If you aren’t eligible for free Part A, and you don’t buy it when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could’ve had Part A, but didn’t sign up. For example, if you were eligible for Part A for 2 years but didn’t sign up, you’ll have to pay a 10% higher premium for 4 years. Usually, you don’t have to pay a penalty if you meet certain conditions that allow you to sign up for Part A during a Special Enrollment Period. See page 13 for more information about Special Enrollment Periods. Medicare Part B (Medical Insurance) Part B helps cover medically necessary services like doctors’ Words in services, outpatient care, and other medical services that Part A blue are doesn’t cover. Part B also covers many preventive services. Part B defined coverage is your choice. However, you need to have Part B if you on pages want to buy Part A. 31–33. How much does Part B coverage cost? You pay the Part B premium each month. Most people will pay the standard premium amount, which is $134 in 2018 if you sign up for Part B when you’re first eligible. This amount can change every year. You can find up-to-date premium amounts on Medicare.gov. Important: In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty for as long as you have Part B. Also, you may have to wait until the General Enrollment Period (from January 1 – March 31) to enroll in Part B and coverage will start July 1 of that year. Section 1—The Medicare Program 7 Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more. If your yearly income in 2016 was File individual File joint tax File married & You pay tax return return separate tax each return month (in 2018) $85,000 or less $170,000 or less $85,000 or less $134.00 above $85,000 above $170,000 Not applicable $187.50 up to $107,000 up to $214,000 above $107,000 above $214,000 Not applicable $267.90 up to $133,500 up to $267,000 above $133,500 above $267,000 Not applicable $348.30 up to $160,000 up to $320,000 above $160,000 above $320,000 above $85,000 $428.60 If you have questions about your Part B premium, call Social Security at1-800-772-1213. TTY users can call 1-800-325-0778. What’s a Part B late enrollment penalty? In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty for as long as you have Part B. The late enrollment penalty takes the standard premium amount and increases it by 10% for each full 12-month period that you could have had Part B, but didn’t. For example, if you were first eligible for Part B in July 2015, but didn’t enroll until January 2018, you’d have a 20% late enrollment penalty. The standard premium amount would be increased by 20% for as long as you have Part B. 8 Section 1—The Medicare Program How can I pay my Part B premium? If you get Social Security, Railroad Retirement Board (RRB), or Office of Personnel Management (OPM) benefits, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill. If you choose to buy Part A, you’ll always get a bill for your premium. There are 4 ways to pay these bills: 1. Mail your premium payments to: Medicare Premium Collection Center P.O. Box 790355 St. Louis, MO 63179-0355 If you get a bill from the RRB, mail your premium payments to: RRB Medicare Premium Payments P.O. Box 979024 St. Louis, MO 63197-9000 2. Pay by credit card. To do this, complete the bottom portion of the payment coupon on your Medicare bill and mail it to the address above. 3. Sign up for Medicare Easy Pay, a free service that automatically deducts your premium payments from your savings or checking account each month. Visit Medicare.gov to learn more and to find out how to sign up. 4. Make an online bill payment. Ask your bank if it allows customers to pay bills online. Not all banks offer this service and some may charge a fee. You’ll need to give the bank this information: ■ Account number: your Medicare number without dashes (you’ll find this number on your red, white, and blue Medicare card.) ■ Biller name: CMS Medicare Insurance ■ Remittance address: Medicare Premium Collection Center P.O. Box 790355 St. Louis, MO 63179-0355 Section 1—The Medicare Program 9 If you have questions about your premiums or need to change Words in your address on your bill, call Social Security at 1-800-772-1213. blue are TTY users can call 1-800-325-0778. If your bills are from the RRB, defined call 1-877-772-5772. TTY users can call 1-312-751-4701. on pages 31–33. Can I get Part B if I don’t have Part A? If you aren’t eligible for free Part A, you can buy Part B without having to buy Part A, if you’re: ■ 65 or older ■ A resident of the U.S., and one of these: —a U.S.