There are three ways to become eligible for Medicare benefits:

First, if you are 65 years of age or older and a U.S. citizen or a resident who has lived five consecutive years in the U.S. 

Second, if you have been receiving Social Security Disability income for 24 months with no age restrictions.

Last if you have end-stage renal disease or have had a kidney transplant, once again with no age restrictions.

You will automatically be enrolled in Medicare Part A and Part B if you are receiving your Social Security benefits at the time you turn 65, and you will receive your Medicare Card about three months before your 65th birthday.

If you are receiving Social Security Disability for 24 months you will then be enrolled automatically to Parts A and B of Medicare beginning in your 25th month of disability.

When you turn 65  and decide not to receive Social Security, you must enroll yourself into the Medicare system. There is a seven-month Initial Enrollment Period surrounding your 65th birthday; three months before your 65th birthday, your birthday month and three months after your birthday month. If you missed enrolling during that seven-month period, you may enroll during the next General Enrollment Period. The General Enrollment Period runs from Jan. 1 to March 31 each calendar year.

You have the option to decline Part B, but penalties may apply if you decline Part B or if you failed to apply during your seven-month Initial Enrollment Period.

There are two parts of Medicare. One is Part A (hospital coverage) and the second is Part B (medical coverage). For 2014, generally there is no charge for Part A. There may be a penalty applied for receiving Part A if you missed or declined enrollment when you became eligible at age 65. For 2014, there is generally a charge of $104.90 for Part B. As your income level starts to rise above $107,000 annually, your Part B premium also rises.

There are two ways to receive your Medicare benefits. One is through the original Medicare, the other is through a Medicare Advantage Plan.

Original Medicare includes your Part A and Part B. Medicare is billed directly for your hospital and medical services. Medicare pays 80 percent and you are billed 20 percent co-insurance. You have the option to take out any number of supplemental policies to cover the co-insurances and deductibles associated with Parts A and B. Additional coverage for your prescriptions through Medicare Part D is also an option that is generally taken. There may be a penalty in some circumstances applied to your monthly Part D premium if you delay enrolling when you are eligible at age 65. In Original Medicare you may choose any physician that accepts Medicare insurance, anywhere in the United States.

However, some people opt for the Medicare Advantage Plan. When you take out a Medicare Advantage Plan, instead of medical and hospital services getting processed directly through Medicare, these services are now billed to the insurance company of your choice that is handling your health coverage. Medicare Advantage Plans use a different co-insurance fee schedule. You will no longer be billed 20 percent for Parts A and B services, but instead will have a set fee for each service. Medicare Advantage plans generally have the Part D Prescription plan included in their policies. In the Medicare Advantage Plans, you need to be aware that the physician and hospital that you decide to use must be a participating member of your particular insurance plan. The best way to ensure that they participate is by calling the Billing Department of your medical practitioner or facility.

There are two basic ways to get help with Medicare costs. One way is through the Medicare Savings Program the other is through the Low Income Subsidy. To qualify for either program you must meet certain income guidelines.

The Medicare Savings Program may pay your Medicare Part A and Medicare Part B  deductibles, co-insurance and co-payments. The Low Income Subsidy may help you pay your Part D Prescription plan monthly premium and minimize your co-payments for your prescriptions at the pharmacy.

This is the basics of your Medicare benefits and getting help with your Medicare costs. There are several types of detailed situations and coverage options that might pertain to each individual health insurance needs. For a more-personal, individualized assessment of your health care needs under Medicare and assistance in applying for Medicare Savings Program or the Low Income Subsidy you can contact your local Office for the Aging. For Delaware County residents, the contact number is 746-6333, and for Otsego County residents the contact number is 547-4232.


Wayne Shepard is director of the Delaware County Office for the Aging. ‘Senior Scene’ columns can be found at

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