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Medicare and Medicaid

Medicare and Medicaid

Medicare Under 65

You are eligible for Medicare under 65 years old if: 
•    You have been diagnosed with End-Stage Renal Disease (ESRD)
•    You have received Social Security Disability Insurance (SSDI) checks for at least 24 months

For ESRD Medicare coverage to begin, you must currently be receiving dialysis treatments or have had a kidney transplant.
You must also have at least one of the following:
•    SSDI Eligibility
•    Railroad Retirement Benefits Eligibility
•    You, a Spouse, or a Parent Have Paid Medicare Taxes for a Sufficient Amount of Time

You are automatically enrolled in Original Medicare after you receive your 25th month of Social Security Disability Insurance (SSDI). However, if you suffer from Amyotrophic Lateral Sclerosis (ALS), your Medicare coverage will start without the two-year waiting period.

Those who qualify for SSDI will receive a Medicare letter when the required 24-month period of time has passed. If this does not happen, we recommend contacting the local Social Security office.

Because Medicare under 65 is health needs-based, you will not be denied coverage for any underlying health conditions. Even if your condition remains the same or degrades, your coverage will not change.

Understanding your Medicare application process can seem impossible. The paperwork, applications, and phone calls feel unending. Let me help you!

I will walk you through the entire application process to ensure that you are well taken care of. If you would like a free quote and consultation, give me a call at (843) 212.6395. 

Important Medicare Enrollment Dates

If you are turning 65 years old soon, there are several Medicare enrollment dates that you must remember: 

Initial Enrollment Period (IEP) 

When you are first eligible for Medicare, you have a seven-month period to sign up. This seven-month period begins three months before your 65th birthday, includes the month you turn 65 and ends three months after you turn 65.

If you are collecting Social Security or Railroad Retirement benefits before your IEP starts, you will automatically be enrolled in Original Medicare. You are also automatically enrolled if you have received at least 2 years of disability benefits, or if you suffer from Lou Gehrig’s disease or end-stage renal disease (ESRD).

If you do not meet any of these requirements, it will be up to you to apply for coverage during your IEP. Applying for coverage early in your IEP will allow your coverage to start as soon as necessary. If you wait till the end of this 7-month period, you may experience a gap in coverage.

Special Enrollment Period (SEP) 

Special Enrollment Periods allow you to sign up for Original Medicare Part A and/or Part B outside of the regular enrollment periods.
•    Permanently move out of your service area
•    Lose creditable prescription drug coverage
•    Enter, reside in, or leave a long-term care facility (Ex. Nursing Home)
•    Have Medicaid or are in a Medicare Savings Program 
•    Have other exceptional circumstances

Annual Election Period (AEP) 

Annual Election Period runs from October 15 through December 7 and is a good time to make changes to your Medicare health or prescription drug coverage.
During Annual open enrollment, Medicare beneficiaries who want to make a change or add coverage to their Medicare insurance have a span of time between October 15 and December 7, may make any change to be effective January 1st of the coming year.
Medicare beneficiaries may:
•    Switch from Original Medicare to a Medicare Advantage Plan
•    Switch from Medicare Advantage to Original Medicare
•    Switch from an Advantage plan without Prescription Drug Coverage to one with It
•    Switch from a Plan with Prescription Drug coverage to one without
•    Join or Drop a Part D Prescription Drug Plan

Annual Open Enrollment
The Annual Open Enrollment period allows those eligible to apply for Medicare if they missed their initial application window. Annual open enrollment for Original Medicare occurs from January 1–March 31 each year. This means that, during this time, you may apply for Medicare Part A and Part B if you missed your initial enrollment period (IEP) or are not eligible for a special enrollment period (SEP).













Medicaid eligibility, is based on financial need.   Modified Adjusted Gross Income (MAGI) is used to determine your financial eligibility for Medicaid. You are exempt from this consideration based on disability (including blindness) and age (65 or older)—if you fall under these categories, your Medicaid eligibility is based on Supplemental Security Income (SSI) rather than MAGI.

These requirements allow people to receive both Medicare and Medicaid at once. 
Both plans will put money towards your healthcare costs and greatly reduce out-of-pocket costs.

Medicare will pay money towards costs first; then Medicaid will pay its remaining share. The amount of money Medicaid will pay towards the costs of services depends on the level of coverage each beneficiary receives.  

If you are fully eligible for both forms of coverage, all of your costs will be covered. If you are partially dually eligible, you may still have some out-of-pocket costs. There are different dual-eligibility programs that determine this:

Medicare Savings Programs
You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if you meet certain conditions. 

T White Insurance will help you better understand your Medicare coverage options. 

Medicare has neither reviewed nor endorsed this information. Not connected with or endorsed by the United States government or the federal Medicare program.

2021 open enrollment B

Generally speaking, the most notable difference between Medicare and Medicaid is eligibility. 

Medicare eligibility, is largely based on age, health, and/or work history. 
To be eligible for Medicare, you must either:
•    Be a U.S. Citizen and Be 65 Years Old or Older
•    Have End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease
•    Be Receiving/Can Receive Social Security or Railroad Retirement Benefits
•    Be Under 65 and Have Received Certain Disability Benefits from the RRB for at Least 24 Months
•    Be Under 65 and Have Received Disability Benefits from Social Security for 24 Months or More

Medicare and Medicaid Together

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