In Elder Law News

Three senior women clap and celebrate together around a table.More than 65 million seniors across the country benefit from Medicare, a government health insurance program.

When Does Medicare Start?

At age 65, you become eligible for Medicare if you are a U.S. citizen. You do not have to wait until you retire to apply for the program.

You can enroll in Medicare beginning three months prior to your 65th birthday. You can also do so during the month of your 65th birthday or during the three months that follow. (If it’s your first time enrolling in Medicare, learn more about rules that are making it easier to sign up.)

Can I Get Medicare at Age 62?

Certain individuals may be able to secure Medicare coverage earlier than age 65. For instance, if you have end-stage renal disease, ALS, or a disability, it’s possible you could qualify.

What Are the Different Parts of Medicare?

Medicare's four main parts cover different aspects of health care:

  • Part A covers institutional care in hospitals and skilled nursing facilities. Part B pays for doctor visits and preventative care. This includes routine lab tests and certain outpatient treatments. Parts A and B serve as the so-called “traditional” parts of Medicare.
  • You can choose to enroll in the alternative to traditional Medicare, Medicare Part C, or Medicare Advantage. Part C plans bundle Parts A and B (and sometimes Part D) with other benefits, such as dental or vision care.
  • Medicare Part D coverage, which is often optional, covers many of your prescription medications.

Medicare Updates for 2024

Although 2024 Medicare premiums are seeing an increase, there are nevertheless a few bright spots.

Starting on January 1, 2024, Medicare enrollees may be pleased to hear about several positive changes taking place. These include the following five updates:

1. Medicare’s mental health coverage is expanding.

  • If you need a licensed mental health provider, you will be more likely to able to find a professional near you who accepts Medicare. About 400,000 more of these providers added nationwide by Medicare will include marriage and family therapists as well as mental health counselors.

  • Medicare can now help if you require treatment for alcohol abuse or substance use disorder. Older Americans are currently suffering from a substance abuse epidemic. In 2022, roughly 4 million seniors aged 65 and older were living with an addiction. Covered treatments will now include such services as psychotherapy, prescription drugs, and screenings.

  • Medicare will now cover up to 19 hours per week for intensive outpatient mental health care for qualifying patients. This includes enrollees who are struggling with serious mental health illnesses or substance abuse.

2. Up to 3 million more people could qualify for extra help paying their Medicare Part D premiums.

As of the start of 2024, the Medicare Extra Help Program will strive to boost its number of enrollees through various outreach efforts. Extra Help assists low-income seniors and people with disabilities. However, many who are eligible do not currently participate in the program, sometimes because they remain unaware of its existence.

In addition, another 300,000 individuals who already are part of the program will see their benefits expand further. They'll see their out-of-pocket costs for their prescription medications drop by an average of $300 a year. These enrollees also will not have to pay a premium or deductible.

3. If your specialty medications are particularly pricey, you will see considerable savings in 2024.

Many people rely on certain expensive medications to treat such serious health conditions as cancer. Even with Medicare Part D, they may have no choice but to pay tens of thousands of dollars out of pocket each year for them.

If your prescription drugs covered by Medicare cost you more than $8,000 out of pocket, you will not be responsible for any other co-pays or coinsurance for the remainder of the calendar year. This is because Medicare Part D enrollees, as of 2024, will no longer have to pay a 5 percent co-pay for catastrophic coverage.

Note that if you rely solely on brand-name prescription medications, you will end up spending roughly $3,300 out of pocket to avoid the 5 percent co-pay. (Even better, come 2025, Part D enrollees will not pay more than $2,000 out of pocket for their prescription drugs in any given year.)

4. You’ll pay no more than $35 a month for insulin supplies covered by Medicare Part D.

As part of the Inflation Reduction Act, price cuts on insulin became effective on January 1, 2024. Medicare Part D plans therefore cannot charge enrollees more than $35 per month for insulin included in their plan. Part D deductibles for insulin supplies will no longer apply, either.

The cost of this medication has tripled over the past decade or so. Even for people who require insulin daily, many are still unable to afford it. In 2022, more than a million individuals with diabetes chose to ration their insulin supply because of the cost, according to one report.

5. If you suffer from chronic pain, Medicare will now cover your monthly services.

For the first time, people receiving Medicare who have persistent or recurring pain lasting longer than three months now can have such services has medication management and pain assessment covered by their plan. (You will still need to pay for your Medicare Part B deductible and coinsurance.)

Work With a Professional

If you need assistance navigating Medicare, reach out to a qualified elder law attorney in your area. They can help you understand how to apply for or qualify for Medicare benefits.

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