Medicare Rules

2014 Medicare and Medigap Updates

Medicare Rules

Medicare is the government run health insurance for people over the age of 65. Certain classes of people can receive Medicare coverage. These are people with disability and are already receiving Social Security Disability Insurance payments as well as people suffering from end stage renal disease (and require dialysis or kidney transplant) and people with Lou Gehrig’s Disease (ALS or Amyotrophic Lateral Sclerosis). However, one of the Medicare rules is that an individual with a permanent disability will generally have to wait two years from the date they start receiving disability payments for Medicare coverage to begin.

People over 65 years also need to be U.S. citizens or permanent residents of the United States and have paid or have a spouse who paid health insurance tax for a minimum of 10 years.

Medicare rules do not only govern eligibility, they also govern other aspects of the program. One aspect is the enrollment period. The Medicare rules regarding enrollment period are quite strict. An individual is eligible to enroll for Medicare during a 6 month period (3 months before his 65th birthday and 3 months after). This is referred to as the initial enrollment period. If a person fails to enroll during this initial enrollment period, they can enroll during the open enrollment period that Medicare runs annually. The open enrollment period runs from the 1st of January to the 31st of March.

It is important to enroll within the first month of your initial enrollment period so that you can get coverage as soon as you turn 65. If you do not, you may have to wait a few months before coverage begins.

For those that do not enroll for Medicare during their initial enrollment period, they may have to pay higher monthly premiums and a late enrollment penalty. A person will also be subjected to a waiting period of anything from 3 to 6 months after the special enrollment period for coverage to take effect. Another penalty for not enrolling during the initial period is the insurance company may require a physical which is not required when enrolled on time. These Medicare rules on enrollment may not apply to persons receiving Social Security payments (by reason of disability or age) as they are automatically enrolled into Medicare Part A and Part B. However, a premium must be paid for part B.

Another aspect Medicare rules govern is the benefits accrued to beneficiaries. Original Medicare will not cover a number of health care costs which include dental care including dentures, eye care including eye glasses, private duty nursing and medical costs incurred abroad.

The main aim of the Medicare rules is to maintain the integrity of the program as well as make it as efficient as possible. These rules are also to ensure that safety and quality standards are adhered.

Breaking the Medicare rules may have serious consequences such as losing coverage or legal prosecution. It is therefore crucial for people to be aware of these Medicare rules.