How Do I Apply for Medicare?

Medicare is a federal health insurance program that primarily serves people aged 65 or older. However, it also provides benefits to younger folks with certain disabilities and people with End-Stage Renal Disease. If you fall into either of these categories, you may be wondering, how do I apply for Medicare? Fortunately, that’s a question we can answer! Let’s talk about what Medicare covers and how to enroll.

What Does Medicare Cover?

Medicare is divided into several parts. Here is a simple breakdown of what each part covers:

Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare Part C, also known as Medicare Advantage, is an alternative to traditional Medicare (Parts A and B). These are health plans offered by private companies that contract with Medicare to provide all Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage.

Medicare Part D adds prescription drug coverage to original Medicare. These plans are offered by insurance companies and other private companies approved by Medicare.

What Does Medicare Cost?

Part A Cost

For many people, the premium for Part A is actually $0. This happens if you or your spouse worked and paid Medicare taxes for at least 40 quarters (10 years). Essentially, your contributions during your working years are what pays your Part A premium.

But what if you didn’t work long enough to qualify for premium-free Part A? Don’t worry – you can still get Part A. You’ll just have to pay a premium.

If you or your spouse worked for at least 30 quarters, you can get Part A at a reduced monthly premium. In 2024, that premium will be $278, the same as it was in 2023.

But let’s say you have less than 30 quarters of coverage. Or maybe you’re a person with certain disabilities who has used up other entitlements. In these cases, you’ll need to pay the full premium for Part A. In 2024, the full premium will be $505 a month, which is actually a $1 decrease from 2023.

Part A Deductible

In 2024, if you need to be admitted to the hospital under Medicare Part A, you’ll pay a deductible of $1,632. This deductible covers your share of costs for the first 60 days of Medicare-covered inpatient hospital care in each benefit period.

Now, what happens if you need to stay in the hospital beyond 60 days? For days 61 through 90, you’ll pay a coinsurance of $408 per day (up from $400 in 2023).

If you need skilled nursing facility services, here’s what you should know: for the first 20 days, you won’t have to pay a copay. But starting day 21 through day 100, you’ll pay a daily coinsurance of $204.

Part B Cost

The standard monthly premium for Medicare Part B will be $174.70 for 2024.

If you’re an individual making more than $103,000, or if you and your spouse are bringing in over $206,000 together, you’ll likely pay more than the standard rate for Medicare Part B. But, don’t feel singled out – about 8% of folks on Medicare Part B are in the same boat!

How much more will you pay? Well, that depends. It’s not a one-size-fits-all kind of deal. Your exact premium will depend on factors like your income and other considerations.

You can get more specific info on income-related monthly adjustment amounts, here.

Part B Deductible

In 2024, that Part B deductible is going to be $240.

Once you’ve paid this deductible, here’s how the rest works: Medicare will generally cover 80% of the approved cost of care for services under Part B. That includes things like doctor visits, outpatient hospital services, certain home health services, and durable medical equipment (like wheelchairs, hospital beds, home oxygen equipment, and diabetes supplies).

You’ll be responsible for covering the remaining 20% of the costs.

Medicare Advantage Cost

The estimated average premium for most Medicare Advantage Plans in 2024 is about $18.50 per month. But, this cost can change depending on your insurer and the level of coverage you choose.

You should also know that to join a Medicare Advantage plan, you also need to be enrolled in Medicare Parts A and B. And, that means you’ll pay the Part B premium as well.

Medicare Advantage Deductible

Not all Medicare Advantage plans have an annual deductible – some might start covering your costs from the first dollar you spend. However, others do require you to pay before they begin to cover your healthcare expenses.

When it comes to Medicare Advantage plans that include Part D (prescription drug coverage), things can get a bit more complex. Many of these plans may charge a separate deductible specifically for your drug coverage. This means that you would need to pay a certain amount towards your prescription drugs before the plan starts to contribute to those costs.

Medicare Out-of-Pocket Maximum

In 2024, the Medicare out-of-pocket maximum, or MOOP, for Medicare Advantage plans is $8,850, although individual plans can set lower limits if they choose. The MOOP is an annual limit on your healthcare expenses. Once you reach this limit, you no longer have to pay for deductibles, coinsurance, and copayments for covered services for the rest of the year, providing protection against excessive medical costs that may arise from serious or ongoing health issues.

Part D Cost and Deductible

In 2024, the monthly cost for Medicare’s prescription drug coverage, known as Part D, is expected to be around $55.50 on average. Some Part D plans do not have a deductible. The ones that do have a maximum out-of-pocket amount of $545.

How to Apply for Medicare

Applying for Medicare can be done in a few different ways, depending on your circumstances and preferences:

1. Automatic Enrollment

If you’re already receiving benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically be enrolled in both Parts A and B starting the first day of the month you turn 65. Your Medicare card will be mailed to you about 3 months before your 65th birthday.

2. Apply Online

Before you can apply for Medicare, you’ll need to create a My Social Security account. This account will give you access to personalized tools to manage your Social Security benefits. The Social Security Administration’s website provides an online application to enroll in Medicare that takes less than 10 minutes to complete. You can apply for either Parts A and B together, or Part A only. If you’re already covered through an employer group health plan, you may choose to delay Part B.

3. Apply by Phone

You can apply for Medicare by calling Social Security at 1-800-772-1213.

4. Apply in Person

You can apply for Medicare in person at your local Social Security office. This might be a good option if you have complex questions or want help filling out your application.

Need More Help with Medicare?

For more help with Medicare, visit these resources:

• Medicare & More – Learn how to navigate Medicare with expert articles, advice, podcasts, and other senior resources.
• Video: Medicare Does NOT Cover These 5 Things
• ToniSays.com