Medicare Eligibility

When am I Eligible for Medicare?

This is the questions that is on the mind of a lot of people in their 60’s. Turning 65 is a big milestone for many people. Not only are you a year older, you are now officially eligible to enroll into Medicare Part A and Part B.Medicare Guide 2021 If you’ve been able to receive Social Security for the past two years, then you also qualify for Medicare benefits.

Remembering your Medicare eligibility age can be confusing, as there are many different eligibility ages when you reach your 60’s. For instance, you are able to begin receiving Social Security retirement benefits at age 62, however, most people do not reach full retirement age until 67 ½. This means that although you can start drawing benefits at age 62, you will not draw the full benefit you would be entitled to at age 67 ½. Somewhere in the middle of those two ages at age 65 is when you become Medicare eligible, whether you draw Social Security benefits or not. Confused yet? Every year in your 60’s brings a new surprise!

Technically, there is no retirement age for Medicare. It doesn’t matter if you retire at age 65 or not. This is the eligibility age for any of the Medicare benefits as long as you are a citizen of the United States and have lived here for at least five years continuously or more. This means that you have the option to enroll into Medicare at age 65, or remain covered under a creditable employer-sponsored health plan if you continue to work. It is important to weight the benefits both ways, as not everyone will make the same decision.

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What Makes Someone Medicare Eligible?

You can qualify for Medicare if you are a United States citizen or a permanent legal resident living in the U.S. for at least five years. You are qualified to receive Social Security by having worked at least 40 quarters (10 years) in your lifetime.

If you did not work the adequate quarters, but your spouse did, you may be able to qualify for Medicare using their work credits, as long as they are at the eligibility age for Social Security benefits (62).

Can I Get Medicare at Age 62?

The standard Medicare enrollment eligibility begins when turning 65. You can qualify for Medicare before that if you have been on Social Security disability for 2 years. The age when you are eligible to begin drawing your Social Security retirement benefits is at age 62, although you will not receive your full benefit at this age.

Do I Automatically Get Medicare When I Turn 65?

If you are already receiving Social Security benefits, or benefits from the Railroad Retirement Board, you will receive a notice that your Medicare will begin at age 65, unless you let contact Social Security to defer them.

If you are not receiving Social Security benefits and want your Medicare to begin at age 65, you will need to submit an application for Medicare Parts A and B. You can submit an application online during your Initial Enrollment Period, which begins 3 months prior to your 65th birthday. Visit www.StartPartB.com to enroll in Medicare online.

It is important to understand that you do not want your Medicare Part B to start until you are ready to enroll in Medicare - so if you are going to stay on your group plan past age 65 (20 or more employees) - do not start Medicare Part B.

When You Can Enroll in Medicare

medicare-eligibility-requirements

Most people become eligible for Medicare at age 65. When you get closer to your 65th birthday, there is a seven-month enrollment window when you can first apply for Medicare Part A and Medicare Part B. This window is known as your Initial Enrollment Window (IEP). Your IEP begins three months before the month of your birthday month, includes the month of your birthday, and ends three months after your birthday. If you want to begin your Medicare coverage when you turn 65, this is an important window you don’t want to miss!

Not everyone has to wait until age 65 to enroll in Medicare. There are certain situations where you can apply for Medicare Part A and Part B benefits if you are under 65:

  • If you’ve been on Social Security disability income benefits for two years and are permanently disabled, then you will qualify.
  • If you have end-stage renal disease. This is when you’re required to get dialysis or waiting for a transplant due to kidney failure.
  • Another qualification is Lou Gehrig’s disease or ALS, which stands for Amyotrophic Lateral Sclerosis.

If you do not qualify for Medicare Disability and you do not plan on enrolling into Medicare during your Initial Enrollment period, there are other enrollment periods you may qualify for, such as a Special Enrollment Period or the General Enrollment Period. Visit our Medicare Enrollment Periods page for more information on these specific enrollment periods.

Did you know that Medicare.Gov has an easy to use eligibility and premium calculator? Click the button above and it will take you there.
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Medicare Part A Eligibility

When you turn 65 years old, you’re likely eligible for premium-free Medicare Part A. This eligibility is dependent on if you or your spouse has worked in the United States legally for at least ten years.

With your work history, you have actually been paying taxes on your income were used toward your hospital benefits for Part A. This is also the reason why many don’t pay any premiums upon eligibility for Medicare. When it comes to your hospital stays, Medicare Part A will cover most of this.

If you didn’t work, you may be wondering “can I have Medicare Part A if I was a stay-at-home-parent?”

Luckily, if your spouse worked the required 40 quarters to qualify for premium-free Part A, you can qualify under their work history. Your working spouse, however, must be at least 62, which is the age he/she is eligible for Social Security benefits, and you must have been married at least 10 years.

If you or your spouse haven’t worked the 40 quarters required for premium-free Part A, then you can purchase this part of Medicare. The cost for your Medicare Part A premium will depend on the amount of quarters you worked. In 2021, if you worked between 30-39 quarters, you will pay a monthly premium of $259 for your Medicare Part A. If you worked less than 30 quarters, you will pay a monthly premium of $471.

If you are receiving Social Security benefits, or are a member of the Railroad Retirement Board, you will automatically be enrolled in Medicare Part A at age 65. You will receive your red, white, and blue Medicare card approximately 3-4 months prior to your 65th birthday, which will show your enrollment dates. Previously, all 65 year-olds were enrolled automatically in Medicare Part A. In recent years, however, Social Security now requires Medicare eligible persons to enroll into Medicare Part A themselves. One of the main reasons enrollees must elect for Medicare Part A is that if you are continuing to work and are contributing to an HSA account, you must stop these contributions 6 months prior to enrolling in Medicare Part A.

automatically-get-medicare-at-65

You may not be eligible for a Medicare Advantage Plan if you have End-Stage Renal Disease. However, there is a specific Medicare Advantage Plan, known as the Special Needs Plan, that you can be eligible for. The Special Needs Plan is used for individuals with chronic or disabling health conditions, dual-eligibility in Medicaid and Medicare, or live in medical institutions, such as nursing homes.

Medicare Part B eligibility

Once you turn 65, you’ll also be eligible for Part B of Medicare. For this part of Medicare, you’ll be responsible for a premium that you’ll pay monthly. The standard premium for Medicare Part B in 2021 is $148.50. This part of Medicare is known as your outpatient coverage, and will provide you with the following benefits:

  • Doctor Visits
  • Lab work
  • Surgery fees and a host of others.

To get more of an idea of what benefits are covered under Part B, check out our Part B page for more information.

Just like with Medicare Part A, if you are receiving Social Security benefits, or are a member of the Railroad Retirement Board, you will automatically be enrolled in Medicare Part B at age 65. If you are not receiving these benefits, you must apply for Medicare Part B yourself if you plan to transition into Medicare when you turn 65. It is important to keep in mind that depending on when you enroll during your Initial Enrollment Period impacts when your Medicare Part B will begin-

 

Part B Sign-Up Date

Part B Coverage Begins- 1st of the Month

During the 3 Months Before Your 65th Birthday

Month of your Birthday

During the Month of Your Birthday

Month After your Birthday

During the Month After Your Birthday

3 Months After your Birthday

During the 2nd Month After Your Birthday

5 Months After your Birthday

During the 3rd Month After Your Birthday

6 Months After your Birthday

Give us a call at 877-88KEITH (53484), an experienced agent will walk you through how to apply for Medicare Part B to ensure that your coverage begins when you need it!

Not everyone is required to enroll in Medicare Part B at age 65. If you are continuing to work past age 65, or your spouse is, and you are on a creditable employer-sponsored health plan with more than 20 employees, you can remain on your current coverage even though you are Medicare eligible. Once you or your spouse retires and you leave this coverage, you will likely qualify for a Special Enrollment Period to initiate your Medicare Part B coverage without any late penalty fees.

However, if you do not have creditable health care coverage, such as COBRA or retiree coverage, and do not enroll in Medicare Part B at age 65, you’re Medicare transition will be much more difficult. You will have to apply for Medicare Part B during the General Enrollment Period, which is from January 1st– March 31st, with coverage beginning on July 1st. You will also be required to pay a lifetime late enrollment penalty for Medicare Part B, which will be determined by the amount of time you delayed coverage. These two factors are the most important reason that you do not want to delay your Part B enrollment if you do not have creditable health care coverage. 

If a delay is needed due to other insurance, it is best to talk with an agent that specializes in Medicare. They’ll be able to guide you to the special election periods. These periods are for you to use, so you aren’t subject to the late enrollment penalty, as this will follow forever.

If you want to enroll in a Medicare Advantage Plan that offers prescription drug coverage, you need to be enrolled in both Part A and Part B, as well as live within the service area.

Medicare Supplement and Part C Eligibility

Many people who enroll in Medicare elects to remain on Original Medicare and enroll into a Medicare Supplement plan for additional coverage. This option gives enrollees the freedom of Original Medicare, while limiting out-of-pocket expenses.

Once you have enrolled in Medicare Part A and Medicare Part B, you are eligible to enroll in a Medicare Supplement plan, also known as a MediGap plan.

Medigap Plan G

Typically, you will want your Medicare Supplement plan to begin on the same day your Medicare coverage begins so you have no gaps in your coverage. When you Medicare Part B begins, you have 6-months to enroll into a Medicare Supplement plan with no medical underwriting. This means that insurance carriers cannot assess your health history or deny you coverage into a plan based on your previous medical records. This is crucial if you have a significant medical history. Usually, you can apply for a Medicare Supplement plan up to 6-months before your Part B coverage is set to begin.

Give us a call at 877-88KEITH (53484), an experienced agent will walk you through all of your Medicare Supplement plan options, as well as the process of applying for these plans.

Your other option for additional coverage is a Part C plan, also known as a Medicare Advantage plan. With Part C, this means you’ll get all your Original Medicare benefits through a private insurer. Keep in mind that many of these plans will have a much small network, but many will, however, include a Part D coverage for your prescribed medications. Eligibility for these plans requires enrollment in Medicare Part A and Part B, and you must live in the plan’s service area.

Even though you can enroll in a Part C plan, you can’t drop Part B, and you still must pay for those premiums. To have any eligibility for Medicare Advantage or if you want to get a Medigap plan, then you must be enrolled on both Parts A and B.

Medicare Part D Eligibility

If you’re actively enrolled in Medicare Parts A and B, you are eligible for Medicare Part D. Your residence must also be within your plan’s service area as Part D plans are based on where you live. This part of Medicare is optional, but covers many of your prescribed medications, it is highly recommended that you enroll in this part of Medicare if you have no other drug coverage. Medication cost is expensive, and this part will lower your copays so you won’t pay too much out-of-pocket.

Remember, there are also penalties for late enrollment into Part D. These penalties are only if you don’t have other credible coverage like an employer group insurance plan. You will only see a late penalty for Medicare Part D if you do not enroll when you are first eligible. It is also important to remember that this penalty is a lifetime penalty, so we want to avoid it as much as possible!

Visit our Part D page for more information on when to enroll and possible late-enrollment penalties

Frequently Asked Questions

  • Is everyone 65 or older eligible for Medicare? Unfortunately, no. First and foremost, you must be a United States citizen or a permanent resident who has lived in the U.S. for at least five continuous years.
  • At what point do I qualify for my Medicare Benefits? If you age into Medicare, then your qualification age is 65. It doesn’t matter if you’ve applied for any Social Security benefits or not.
  • I’m under 65; am I eligible for Medicare? For many years, you had to be 65 to qualify for Medicare. This has since changed, but there are specific qualifications that must be me:
  • If you’ve been on Social Security disability income benefits for two years and are permanently disabled, then you will qualify.
  • If you have end-stage renal disease. This is when you’re required to get dialysis or waiting for a transplant due to kidney failure.
  • Another qualification is Lou Gehrig’s disease or ALS, which stands for Amyotrophic Lateral Sclerosis.
  • I’m 62, can I enroll in Medicare? Although you are eligible to receive Social Security benefits at age 62, that does not mean you are automatically eligible for Medicare benefits. Unless you qualify for Medicare disability (see above) you must wait for age 65 to enroll in Medicare.
  • How early can I apply for my Medicare benefits? Due to the seven-month Initial Enrollment Period, you can apply for Medicare up to three months before you turn 65 years old.
  • How long did I have to work so I can be eligible for Medicare? The eligibility for Medicare has nothing to do with your work history. Depending on how long you have worked will be whether or not you get Part A for free or you have to pay the monthly premiums. If you have at least ten years’ worth of work history, then your taxes from your payroll will have paid for Part A. Anything less than that, and you’ll be responsible for paying for premiums.
  • Is signing up for Medicare mandatory? No, it isn’t. This is unless you don’t have any health coverage that is considered credible, like your employer group coverage. If not, you will face some costly penalties when you enroll for your Social Security benefits, as this will automatically enroll you in Part A. You can only have both and not one without the other.
  • When it comes to Medicare and Medicaid, who is eligible? For those 65 or older and that have specific disabilities, Medicare will be your health insurance system. However, Medicaid is a federal and state joint program that will provide benefits for those who have low incomes. You can qualify for both. If this happens, then Medicare will be your primary insurance, and Medicaid will be your secondary insurance.
  • Am I eligible for Part D of Medicare? If you’re enrolled in Parts A and B, then you are eligible for Part D enrollment. Keep in mind that you must enroll when first eligible. The only exception is if you already have some form of credible coverage. If not, then you’ll have a costly penalty for enrolling late.

How to Find Out About Your Eligibility

This can be tricky and even challenging for a lot of people. Determining your eligibility comes with a lot of questions about when you can enroll, what the qualifications are, and even if there are any requirements for Medicare. This is understandable as navigating the Medicare landscape isn’t always easy. Though the process may be overwhelming, there are people who can help. 

Give us a call at 877-88KEITH (53484), an experienced agent will help you determine your Medicare eligibility and when you can complete your Medicare Enrollment.

When it comes to Medicare, you’re not alone. There are people willing to help you and make sure you are enrolled on time and with any additional coverage that you may need. Your health care is essential to living out your golden years without worrying about astronomical medical bills or whether or not you’ll be able to afford your prescriptions. Finding help is simple and will help you get the coverage you need so you can rest easy and live the life you were meant you once you retire. Don’t let costly medical expenses keep you from enjoying your life and much deserved rest. Learn about all the eligibility requirements and enroll as soon as possible to keep your health care going and the bills down.

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