What If I Haven’t Worked Long Enough To Qualify For Medicare?

You need to earn about 40 “credits” or “quarters” by paying Social Security and Medicare payroll taxes while working — equal to about ten years of work — to get Part A services without paying premiums. Your payroll taxes have already covered the premiums. Not having worked long enough to “qualify” means that you can’t […]

What Doesn’t Medicare Cover?

Medicare doesn’t cover several important healthcare services that many beneficiaries need. Understanding these gaps helps you plan for additional coverage options. Original Medicare requires significant out-of-pocket spending through deductibles and coinsurance. Part A has a $1,736 deductible per benefit period, while Part B requires a $283 annual deductible plus 20% coinsurance for most services. There’s […]

What is a Medicare National Coverage Determination?

A national coverage determination (NCD) is a US Government determination of whether Medicare will pay for an item or service. Medicare coverage is limited to items and services considered “reasonable and necessary” for diagnosing or treating an illness or injury (and within the scope of a Medicare benefit category). In the absence of an NCD, […]

How do I report Medicare Fraud and Abuse?

Medicare fraud and abuse can happen anywhere, and usually results in higher health care costs and taxes for everyone. Some examples include: – A provider that bills Medicare for services or supplies they never gave you, like charging you for a visit you never had, or a back brace you never got. – A provider […]

What is the Medicare Part B giveback?

Over half of Medicare Advantage plans have $0 premiums. When you enroll in one of these plans, you pay the premium for Part B and the Advantage plan. Some of these plans with $0 premiums go further and offer “giveback” rebates. These rebate the enrollees’ Part B premiums. While most Advantage plans do not provide […]

How do I drop Part A & Part B Medicare Coverage?

Generally, you can only drop Part A (Hospital Insurance) if you have to pay a premium for it, also called Premium-Part A. There are some risks to dropping coverage: – Your costs for health care: You may have to pay all of the costs for services that Medicare covers, like hospital stays, doctors’ services, medical […]

What are the Medicare Enrollment periods ?

‘- Initial enrollment period The initial enrollment period is a seven-month period that includes three months before you turn 65, your birthday month, and three months after you turn 65. – Annual election period The Medicare annual election period (AEP) happens every fall from Oct. 15 to Dec. 7. During this time, you can join, […]

Do I have to Sign Up for Medicare at Age 65?

You don’t have to sign up for Medicare at age 65, but delaying enrollment can have serious financial consequences. If you’re still working and have employer health coverage, you can delay Medicare enrollment without penalty through a Special Enrollment Period that extends eight months after your employment or coverage ends, whichever comes first. However, if […]

Why is my first Medicare bill so high?

There can be several reasons. Medicare generally bills in 3-month increments if you don’t have your premiums automatically deducted from Social Security. Beneficiaries are responsible for multiple Medicare costs, including monthly premiums, deductibles, and coinsurance or copayments. Most Medicare beneficiaries collect Social Security benefits, and for these enrollees, Medicare premiums are deducted from their monthly […]

How does a caregiver manage my Medicare healthcare?

As a caregiver managing someone’s Medicare healthcare, you’ll need proper authorization to act on their behalf. Start by becoming an authorized representative through Medicare by completing form CMS-1696, which allows you to discuss their Medicare coverage and help with claims. For broader authority, obtain a durable power of attorney that specifically includes healthcare decisions. With […]