on 2018 tax returns) will pay higher monthly Part B
premiums. For free publications on Medicare Part B,
visit http://www.ssa.gov/pgm/formspubs.htm.
If you are not eligible for free hospital insurance, you can
buy medical insurance, without having to buy hospital
insurance, if you are age 65 or older and you are a U.S.
citizen or a lawfully admitted noncitizen who has lived
in the United States for at least five years. Such persons
can also buy hospital insurance under Part A, but the
premium is very expensive (in 2020, $252 monthly if
you have 30-39 quarters of work coverage or $458
monthly if you have fewer than 30 quarters). If you are
eligible for SSI or have an income below the limit for
QMB as discussed below under Help for Low-income
People, then Medicaid will pay your Part A and Part B
premiums, but you must first submit a conditional Part
A application at the Social Security office either during
your initial enrollment period that ends in the third
month after the month that you reach age 65 or during
the first quarter of any calendar year after that.
Medicare Advantage plans (Part C)
If you have Medicare Parts A and B, you can join a
Medicare Advantage plan. With one of these plans, you
cannot enroll in a Medigap policy, because Medicare
Advantage plans generally cover many of the same
benefits that a Medigap policy would cover, such as extra
days in the hospital after you have used the number of
days that Medicare covers.
Medicare Advantage plans include:
• Medicare health maintenance organization (HMO)
plans
• Medicare preferred provider organization (PPO) plans
• Medicare private fee-for-service plans
• Medicare specialty plans
If you decide to join a Medicare Advantage plan, you
use the health card that you get from your Medicare
Advantage plan provider for your health care instead of
your Medicare card. You may have to pay a monthly
premium for your Medicare Advantage plan in addition
to your Part B premium because of the extra benefits it
offers.
People who become newly entitled to Medicare may
enroll in any Medicare Advantage or Part D prescription
drug plan of their choice during their initial enrollment
period (as explained under Signing up for Medicare) or
during the annual open enrollment period from October
86 Senior Resource Directory 2020-2021
15 – December 7 each year. There are also other special
enrollment periods in other situations. For example,
people live in a nursing home or who have recently left
a nursing home, people who have recently lost their
employer coverage, and people who qualify for extra
help because of SSI, QMB, SLMB, QI, or LIS eligibility
or who have just lost their extra help or have just had a
change in their extra help status have special enrollment
periods. People in nursing homes have continuous open
enrollment status, and those who receive extra help may
change plans one time in each of the first three quarters
of each calendar year, but no longer have continuous
open enrollment and can only enroll for the following
year during the annual open enrollment period.
Medicare prescription drug plans (Part D)
Anyone who has Medicare hospital insurance (Part A)
or medical insurance (Part B) is eligible for prescription
drug coverage (Part D). You may also have prescription
coverage equivalent to Part D as part of coverage through
a Medicare Advantage plan under Part C. Joining a
Medicare prescription drug plan is voluntary, and you
pay an additional monthly premium for the coverage
unless you qualify for full extra help because of your
income. You can wait to enroll in a Medicare Part D plan
if you have other prescription drug coverage, but if you
don’t have prescription coverage that is on average at least
as good as Medicare prescription drug coverage, you will
pay a penalty if you wait to join later. You will have to pay
this penalty for as long as you have Medicare prescription
drug coverage unless you qualify for full or partial extra
help because of your income.
People who become newly entitled to Medicare may enroll
during their initial enrollment period (as explained under
Signing up for Medicare). After the initial enrollment
periods, the annual coordinated election period to enroll
or make provider changes is October 15 – December 7
each year. There are also be special enrollment periods
as was discussed above under Medicare Advantage Plans
(Part C).
Help for some low-income people
If you cannot afford to pay your Medicare premiums and
other medical costs, you may be able to get help from
your state. States offer programs for people who are
entitled to Medicare and have low income. The programs
may pay some or all of Medicare’s premiums and also
may pay Medicare deductibles and coinsurance. To
qualify, you must have Part A (hospital insurance) and a
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