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Section 1 Introduction
- Introduction
- Federal Government Administration
- Fundamentals of Medicare: State Responsibilities
- Fundamentals of Medicare: Participating Providers
- Voluntary and Involuntary Termination of Provider Agreement
- Disclosure of Health Insurance Information
- Privacy Act
- National Provider Identifier
- Legacy Provider Numbers/Provider Transaction Access Numbers (PTANs)
- Medicare Administrative Contractors
- Fundamentals of Medicare: Information References
- Acronyms
- Fundamentals of Medicare: Glossary of Terms
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Section 2 Medicare Basics
- The History of Medicare
- What Is the Medicare Program and How Is It Funded?
- Medicare Eligibility and Premiums
- The Social Security Administration and Medicare Enrollment
- The Medicare Card
- Medicare Part A
- Inpatient Hospital Care
- Skilled Nursing Facility Inpatient Care
- Home Health Care Benefit
- The Hospice Benefit
- Medicare Part B Medical Insurance
- Fundamentals of Medicare - Medicare Program Exclusions
- Medicare Advantage Organizations
- Medicare Secondary Payer
- Supplemental Insurance
- Coordination of Benefits Trading Partners
- Section 3 Fraud and Abuse
- Section 4 Getting Ready to Bill Medicare
Section 2: Medicare Basics
The Social Security Administration and Medicare Enrollment
The SSA office has the responsibility for handling Medicare enrollment and managing premium billing and payment. Premiums may be deducted from a beneficiary’s Social Security check or a beneficiary may receive a monthly/yearly bill that may be paid directly to the local Social Security office.
If a beneficiary fails to pay their Part B premium for three months in a row, the SSA office will terminate the Part B coverage. Coverage can be resumed if “back payment” is made, that is if a beneficiary pays the past due premiums. In addition, coverage can be restarted in the future once the beneficiary is able to meet the monthly premium requirement.
People who are already receiving Social Security benefits when they turn 65 are automatically enrolled in Medicare. The SSA office mails these individuals an information packet on Part A and Part B benefits approximately three months prior to their 65th birthday. A beneficiary’s Medicare coverage is active on the first day of the month in which the person turns 65, regardless of the day within the month on which their birthday falls.
Those people who are not receiving Social Security benefits before their 65th birthday must contact their local SSA office within the three months prior to their 65th birthday. Although beneficiaries have a seven-month period (three months prior to their 65th birthday and the four months after) to enroll in Medicare, if they wait until after their 65th birthday to enroll, their Medicare start date may be delayed. A beneficiary that does not enroll during their seven-month enrollment period has to wait to enroll until the next general enrollment period, which is January 1 through March 31 each year.
Disabled individuals who are under 65 and have been receiving Social Security or Railroad Retirement Benefits (RRB) for 24 months will be automatically enrolled in Medicare Part A and Part B. Similar to those individuals who are entitled to Medicare when they turn 65, disabled individuals who are receiving SSA or RRB benefits will receive an enrollment package three months before the 24-month period is up.
Individuals eligible for Medicare because of ESRD can go to the Social Security Office to enroll in Medicare. These individuals are not automatically enrolled.
When enrolled, Medicare beneficiaries are automatically given Medicare Part A and Part B. However, since Medicare Part B has a monthly premium, beneficiaries are not required to keep that coverage. If a beneficiary chooses not to have Part A or Part B, he/she must return the form enclosed in their enrollment package to the Social Security Office indicating that he/she does not wish to be covered.
In addition to the above responsibilities, the Social Security Office also provides information about the Medicare program to the public in conjunction with the efforts of the MACs.
Reviewed 6/4/2024