Medicare Coverage Periods and Strategies

The Medicare system is complicated and many people are unaware of all the rules that go into it. Some people mistakenly believe that their coverage starts on the day they turn 65, but this isn’t always true, so it’s always a good idea to check MedicareFAQ!

The Centers for Medicare and Medicaid Services, or CMS, has a few different categories of coverage periods that may affect your Medicare benefits. Let’s take a closer look at each one:

Standard Coverage Period – This is the period during which you are eligible to receive full coverage on most doctor visits and medical tests. Generally this begins when you enroll in Part B (even if it isn’t yet time to start paying premiums). The standard benefit period lasts as long as two years before qualifying for catastrophic coverage. In some cases where someone becomes entitled to Social Security Disability Insurance payments or Supplemental Security Income payments after their initial eligibility expired they can obtain retroactive Standard Coverage under certain circumstances.

As soon as someone turns 65 they qualify for both Medicare Parts A and B without having to enroll in either.

Initial Coverage Period – This is the period during which you are eligible for full coverage on doctor visits and medical tests after qualifying for Medicare Part A (due to age or disability). The Initial Benefit Period lasts up until two years from when your entitlement begins, at that point you qualify for catastrophic coverage.

Catastrophic Coverage Period – This is a reduced level of benefits available to individuals who have reached their Initial Coverage Period but have not yet enrolled in Medicare Prescription Drug Plans. Catastrophic plans cover only three pints per month of prescription drugs but there are no deductibles or co-payments required by recipients once they meet their yearly deductible limit of $1300.

First Three Months of Eligibility – This applies to individuals who are entitled to Medicare and enroll in it for the first time within three months after their 65th birthday or become disabled during this period.

Special Enrollment Periods – These periods may apply if you have a terminal illness, lose employer coverage, experience another qualifying life event (marriage!), change your legal residence, etc.