Why Do Some People Get Medicare Automatically?

When you apply for retirement or disability benefits from Social Security (or the Railroad Retirement Board), it also serves as your application for Medicare.


Once you get approved for Social Security or Railroad Retirement Board benefits, you’ll automatically get Part A coverage (without having to pay a premium for it) once you’re eligible for Medicare.


If you’re getting benefits from Social Security (or the Railroad Retirement Board) at least 4 months before you turn 65, you’ll automatically get Part A coverage. You’ll also be signed up for Part B (unless you live in Puerto Rico or outside the U.S.). Because you pay a monthly premium for Part B coverage, you can choose whether to keep it or not.

If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month. You’ll get the “Welcome to Medicare” package that welcomes you to the program. This package is mailed about 3 months before your 65th birthday. In this package, you’ll get your Medicare card.

Which Plan Is Right For Me?


Costs in Original Medicare

There’s no limit on how much you pay out-of-pocket per year unless you have supplemental coverage.

Costs in Medicare Advantage

Plans have a yearly limit on your out-of-pocket costs. If you join a Medicare Advantage Plan, once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year. This option may be more cost effective for you.


Coverage in Original Medicare

Medicare covers medical services and supplies in hospitals, doctors’ offices, and other health care settings. Services are either covered under Part A or Part B.

Coverage in Medicare Advantage

Plans must cover all of the services that Original Medicare covers. Some plans offer benefits that Original Medicare doesn’t cover like vision, hearing, or dental.

Your Other Coverage

If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making any changes.


Supplemental Coverage in Original Medicare

You can add a Medigap policy to help pay your out-of-pocket costs in Original Medicare, like your deductible and coinsurance.


Supplemental Coverage in Medicare Advantage

It may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower (or included). And, many Medicare Advantage plans offer vision, hearing, and dental. You can’t use (and can’t be sold) a Medigap policy if you’re in a Medicare Advantage Plan.

What Do The Plans Cost?

Part A Premium

Most people don’t pay a monthly premium for Part A (sometimes called “premium-free Part A”). If you buy Part A, you’ll pay up to $471 each month in 2021. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $471. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $259.

Part A Hospital Inpatient Deductible and Coinsurance

You pay:
$1,484 deductible for each benefit period
Days 1-60: $0 coinsurance for each benefit period
Days 61-90: $371 coinsurance per day of each benefit period
Days 91 and beyond: $742 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
Beyond lifetime reserve days: all costs

Part B Premium

The standard Part B premium amount is $148.50 (or higher depending on your income).

Part B Deductible and Coinsurance

$203. After your deductible is met, you typically pay 20% of the Medicare-Approved Amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment (dme)

Part C Premium

The Part C monthly premium varies by plan. Compare costs for specific Part C plans.

Part D Premium

The Part D monthly premium varies by plan (higher-income consumers may pay more). Compare costs for specific Part D plans.

Where Can I Go For More Help?

You probably have more questions regarding the best Medicare coverage for you.

The best thing for you to do right now, reach out to Ben Bauman and explore all of your personalized Medicare options.

Call Ben at: 763.241.7900 or Email Ben