Essential Medicare Advice for New U.S. Citizens

Applications for U.S. citizenship are rising. According to the National Partnership for New Americans (NPNA), roughly one million immigrants applied in 2017.

The country is well known for the benefits U.S. citizens enjoy—and at age 65, one of the most popular benefits is Medicare.

What exactly is Medicare?

Original Medicare is a national, government-funded program available to U.S. citizens ages 65 and up – designed to provide medical insurance and reduce out-of-pocket costs for health care for seniors.

Original Medicare comes in two parts:

  • Part A – covers inpatient expenses in a hospital, hospice, or skilled nursing facility. FICA payroll taxes fund Part A, so if you have paid U.S. payroll taxes for at least 10 years (40 quarters), you may qualify for premium-free Part A.
  • Part B – covers doctor visits, and outpatient diagnostic tests and services. Most Americans enrolled in Original Medicare pay $135.50 in 2019 for Part B benefits.

Once working citizens turn 65 and choose to retire and enroll in Medicare, Medicare is the primary source of health coverage. You are not required to enroll in Medicare at age 65, but if you don’t, and later decide you want health coverage, you may have to pay a late enrollment penalty with your premium.

If you enroll in Original Medicare (Part A and Part B), you still have out-of-pocket expenses. Both Part A and Part B have deductibles, which is the amount you must pay out of pocket before Medicare pays. In 2019, the Part A deductible is $1,364 and the Part B deductible is $185. Part B typically covers 80% of allowable charges for covered services; you pay 20%.

You may purchase a Medicare Supplement Plan, or Medigap, through a private insurance company if you want help covering your out-of-pocket expenses under Original Medicare.

Your out-of-pocket costs may also be lower if you choose a Medicare Advantage plan instead of Part A and Part B. Medicare Advantage plans are private health plans approved by the Centers for Medicare and Medicaid Services. You don’t lose any benefits by choosing a Medicare Advantage plan, but you may find a plan with extra coverage for things such as routine vision and dental care not covered under Original Medicare.

Part D is the Medicare prescription drug program. Although the coverage is voluntary, most people enroll when they first become eligible. If you don’t have a prescription drug plan from another source and don’t buy Part D prescription drug coverage right away, but later decide to buy it, you may pay a late enrollment penalty with your premium. Note that many, if not most, Medicare Advantage plans include prescription drug coverage.

Medicare eligibility

If you are a legal citizen of the United States or lawful permanent resident, you can apply for Medicare at age 65. However, if you are already 65 by the time you obtain citizenship, you might have to wait until the annual enrollment Period to apply for Medicare (October 15 through December 7). Otherwise, your initial enrollment period begins three months before the month you turn age 65, includes your birth month, and extends an additional three months.

If you are an immigrant or in the U.S. on a green card, you must have lived in the U.S. lawfully for at least 5 years as a permanent resident before you are allowed to apply for Medicare.

How to apply for Medicare

You can enroll in Medicare in three ways:

  • apply online at www.socialsecurity.gov
  • visit your local Social Security office and apply in person
  • call the Social Security office at 1-800-772-1213 to apply by phone

Typically, only U.S. citizens can apply online or over the phone. Green card holders who may be eligible for Medicare benefits generally should visit their local Social Security office to apply.

You will be automatically enrolled in Original Medicare (Part A and Part B) if you are eligible, unless you elect to enroll in a Medicare Advantage plan.

About the Author: Danielle K. Roberts is a Medicare Supplement Accredited Advisor, member of the Forbes Finance Council and co-founder of Boomer Benefits located in Fort Worth, TX. Her award-winning agency is licensed and appointed in 47 states and has helped tens of thousands of Medicare beneficiaries understand their benefits since 2004. Since starting her agency 15 years ago, she and her brother have grown their agency into a multi-million-dollar company that employs workers of all ages. They were recently awarded the 2019 Health Insurance Advisory Firm of the Year Award by Finance Monthly.