Will I Automatically Get Medicare with Social Security Benefits?

If you’re receiving Social Security benefits you’ll likely be automatically enrolled in Medicare Part A and Part B. Discover how these benefits work together and whether they'll cover all your health needs.

Will You Automatically Receive Medicare Coverage with Social Security Benefits?

In some cases, yes. 

If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically be enrolled in both Part A and Part B starting the first day of the month you turn 65. 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. 

If you’re under 65 and have a disability, you’ll automatically get Part A and Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months.  

How Do Social Security and Medicare Work Together?

Social Security benefits provide partial replacement income if you’re a qualified retiree or disabled person, as well as for spouses, children, and survivors. The amount that you receive is determined by the Social Security Administration. 

Medicare is a United States federal health insurance program that reduces the cost of healthcare services. Medicare plans cover people age 65 or older, younger people who meet eligibility requirements, and individuals with certain diseases. 

Although the Centers for Medicare & Medicaid Services (CMS) is the agency in charge of the Medicare program, Social Security processes your application for Original Medicare (Part A and Part B).

Medicare Eligibility

You are eligible for premium-free Medicare Part A if you are age 65 or older and you or your spouse earned 40 credits or worked and paid FICA taxes for at least ten years. 

You don’t need to apply for Medicare Part A and Part B if you’re already receiving Social Security retirement benefits. Enrollment will happen automatically. For example, if you took retirement benefits at 62 instead of full retirement age, you’ll be enrolled in Medicare three months before your 65th birthday. You could also be automatically enrolled if you’ve been receiving Social Security Disability Insurance (SSDI) for 24 months.

You should receive your red, white, and blue Medicare card in the mail three months before your 65th birthday. That serves as proof of enrollment.

What Do Medicare Part A and B Cover?

Medicare Part A

Medicare Part A (hospital insurance) is usually premium-free and covers inpatient care in a hospital, care in a skilled nursing facility, short-term nursing home care, hospice care, and home health care. If you’re in a Medicare Advantage Plan or other Medicare plan, that plan may have different rules. But your plan must give you at least the same coverage as Medicare Part A.

Medicare Part B

Medicare Part B comes with an extra monthly cost and covers outpatient care, preventative services, ambulance services, and durable medical equipment. Part B is similar to standard health insurance and has a premium. 

There is a monthly standard base rate premium that’s set annually by the IRS. Most people pay the standard Part B premium amount. If your Modified Adjusted Gross Income (MAGI) as reported on your IRS tax return from two years ago is higher than a certain amount you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your standard base premium. 

The Part B premium will be automatically deducted from your benefit payment if you receive a Social Security, Railroad Retirement Board, or Office of Personnel Management benefit. If you don’t receive these benefits you’ll receive a monthly or quarterly premium bill. 

What Does Medicare Part B Cover?

Medicare Part B covers doctor’s visits, lab tests, and coverage for orthopedic, cardiology, radiology, and other specialists from A to Z—including inpatient and outpatient mental health care. Screening for common medical conditions, annual wellness checks, vaccinations, and second opinions about a medical issue are also covered by Part B. In general, Part A and Part B cover 80% of Medicare-approved services. You would be responsible for the remaining 20%.

What If Part A and Part B Don’t Cover What I Need?

Speak with your doctor or health care provider to find out if Medicare Part A and B cover the care that you need. If your care or prescriptions are not covered you might choose a Medicare Advantage Plan (Part C) and/or Medicare Prescription Drug Plan (Part D or PDP). 

Either online or by phone, Connie Health can help you determine if a Medicare Advantage (Part C) or Medicare Prescription Drug Plan (Part D or PDP) could save you money and provide the care you need. There are specific times when you can sign up for these plans or make changes to the coverage you have. 

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