Medi­care en­roll­ment break­down

Daily Press (Sunday) - - Success -

Re­tire­ment brings many new is­sues to tackle, and one of the most con­fus­ing can be Medi­care. Open en­roll­ment is upon us and fig­ur­ing out how to get cov­er­age can be frus­trat­ing for even the most well-in­formed re­tirees.

In or­der to be el­i­gi­ble for Orig­i­nal Medi­care, which in­cludes Part A (hos­pi­tal in­sur­ance) and Part B (sup­ple­men­tal med­i­cal in­sur­ance), you must be a U.S. cit­i­zen or per­ma­nent res­i­dent.

There are three ways to be el­i­gi­ble for Medi­care: by reach­ing age 65; by be­ing dis­abled be­fore 65 and en­ti­tled to So­cial Se­cu­rity or Rail­road dis­abil­ity ben­e­fits for at least two years; by hav­ing end stage re­nal dis­ease with six work cred­its in the past three years.

You may qual­ify for pre­mium-free Part A in any of three pos­si­ble sit­u­a­tions: You are el­i­gi­ble for So­cial Se­cu­rity re­tire­ment, dis­abil­ity, fam­ily or sur­vivor pay­ments; you are el­i­gi­ble for a pen­sion from the Rail­road Re­tire­ment Board; you have worked long enough (self or spouse) in govern­ment work and paid Medi­care taxes. If you met any of those con­di­tions, you, your qual­i­fy­ing spouse and your qual­i­fy­ing for­mer spouse are el­i­gi­ble for Medi­care, in­clud­ing free Part A.

Some in­di­vid­u­als are au­to­mat­i­cally en­rolled in Medi­care: those get­ting pay­ments from So­cial Se­cu­rity or the Rail­road Re­tire­ment Board; those un­der 65 and get­ting So­cial Se­cu­rity dis­abil­ity pay­ments for 24 months; and those with amy­otrophic lat­eral scle­ro­sis. With­out these con­di­tions, you must en­roll in or­der to be cov­ered.

At 65, you can sign up en­roll in Medi­care dur­ing the ini­tial en­roll­ment pe­riod for Part A and/or Part B dur­ing the seven-month pe­riod that be­gin­ning three months be­fore the month you turn 65 and end­ing three months after the month you turn 65. If you sign up for Part A and/or Part B dur­ing the first three months of your ini­tial en­roll­ment pe­riod, in most cases your cov­er­age starts the first day of your birth­day month.

If your birth­day is on the first day of the month, your cov­er­age will start the first day of the prior month. If you en­roll the month you turn 65 or dur­ing the last three months of your ini­tial en­roll­ment pe­riod, the start date for your cov­er­age will be de­layed. If you don't sign up for Part A (and don't qual­ify for free pre­mium) or Part B when you are first el­i­gi­ble, you may have to pay a late en­roll­ment penalty.

If you are cov­ered un­der a group plan based on cur­rent em­ploy­ment (your own, a spouse's or, if you're dis­abled, a fam­ily mem­ber's) you can sign up for Part A and/or Part B any­time you are still cov­ered by the group health plan, and dur­ing the eight­month pe­riod after the em­ploy­ment ends or the cov­er­age ends, whichever hap­pens first. If you sign up dur­ing a spe­cial en­roll­ment pe­riod, you can avoid a late-en­roll­ment penalty.

The Cen­ter for Medi­care and Med­i­caid Ser­vices has an­nounced 2019 Medi­care Part A and B pre­mi­ums and de­ductibles. The Medi­care Part A hos­pi­tal in­pa­tient de­ductible that ben­e­fi­cia­ries will pay when ad­mit­ted is $1,364 in 2019, an in­crease of $24 from 2018. Medi­care Part A cov­ers in­pa­tient hos­pi­tal, skilled nurs­ing fa­cil­ity and some home health care ser­vices.

In­di­vid­u­als who have at least 40 quar­ters of Medi­care-cov­ered em­ploy­ment do not have to pay Part A pre­mium.

The stan­dard Medi­care Part B monthly pre­mium for 2019 will be $135.50, an in­crease of $1.50 per month over 2018. Medi­care Part B cov­ers physi­cian ser­vices, out­pa­tient hos­pi­tal ser­vices, cer­tain home health ser­vices, durable med­i­cal equip­ment, and cer­tain other med­i­cal and health ser­vices not cov­ered by Part A.

Ap­prox­i­mately 2 mil­lion Medi­care ben­e­fi­cia­ries will pay less than the full Part B stan­dard monthly pre­mium in 2019 be­cause of the statu­tory hold harm­less pro­vi­sion, which lim­its cer­tain ben­e­fi­cia­ries' in­crease in their Part B pre­mium to be no greater than the in­crease in their So­cial Se­cu­rity ben­e­fits.

High earn­ers pay sig­nif­i­cantly more. The mod­i­fied ad­justed gross in­come from a par­tic­i­pant's tax re­turn from two years ago de­ter­mines pre­mi­ums.

A fact sheet for 2019 pre­mi­ums and de­ductibles is avail­able at: https:// www.cms.gov/news­room/fact­sheets/2019-medi­care-parts-b-pre­mi­ums-and-de­ductibles. El­liot Raphael­son wel­comes your ques­tions and com­ments at raphel­liot@gmail.com.

STYLEPHOTOGRAPHS/DREAMSTIME

By El­liot Raphael­son

The Sav­ings Game

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