Twenty Percent Co-insurance Payment

• After the deductible is met, the beneficiary is responsible for 20 percent of the Medicare-approved charge. There may be more services that the beneficiary is responsible for. These costs are determined by Medicare based on particular circumstances.
• Medicare pays 80 percent of the approved charges. If the provider accepts assignment, the payment will go directly to him/her. If assignment is not accepted, payment goes to the beneficiary.

Three Categories of Eligibility for Medicare Part B

1. Nearly everyone age 65 and over.
2. Disabled individuals of any age who have received 24 months of Social Security Disability benefits.
3. Persons of any age with end-stage renal (kidney) disease.

Role of Social Security Administration

1. Determines eligibility and handles enrollment.
2. The local Social Security office is the community resource for information and procedures surrounding eligibility and enrollment.
   • The local telephone number can be found in the U.S. government listings of the telephone directory.
   • The national toll free number for Social Security Administration is 1-800-772-1213.

Enrollment

Types of Enrollees

1. Automatically Eligible Persons:
   • Those entitled to and receiving Social Security or Railroad Retirement cash benefits through early retirement are automatically entitled to Medicare Part B upon turning 65 unless they opt out of it. Also those Federal Retirees who retired after 1982 are eligible.
   • Those entitled to, but not receiving, Social Security or Railroad Retirement cash benefits upon turning 65 must apply for cash benefits for Part B of Medicare to receive them.

    

2. Voluntary Enrollees: (Those who are not automatically eligible).
   • Those not entitled to Social Security or Railroad Retirement cash benefits must apply for Medicare Part B upon turning 65. They can apply for Part B without applying for Part A coverage.

Enrollment Periods

1. Initial Enrollment
   1. Seven-month time period surrounding the 65th birthday, (three months prior to the month of the 65th birthday, the month of the 65th birthday, and three months following the month of the 65th birthday).
   2. The effective date for coverage during the initial enrollment period depends on the enrollment date.
      • If a person enrolls during the three months prior to the month the 65th birthday occurs, coverage begins on the first day of the month in which the person turns 65.
      • If a person enrolls during the month the 65th birthday occurs, coverage begins on the first day of the month immediately following the birthday month.
      • If a person enrolls during the three months following the month of the 65th birthday, coverage begins two months after enrolling when enrollment occurs in the first month following the birthday month, or coverage begins three months after enrolling when enrollment occurs in the second or third month following the birthday month.
2. General Enrollment
   1. The first three months, (January, February, March), of any year following the year of the 65th birthday. Coverage will be effective July 1 of that year.
   2. Penalties for late enrollment are imposed for enrollments that are made more than one year past the month of the person's 65th birthday.