Are you unsure whether you can enroll in Medicare yet all you read makes no sense? We understand your aggravation with the cumbersome Medicare enrollment rules! Not to mention Part A, B, C, D, Medicare Advantage Plans, and Medigap coverage. This just complicates matters and makes it more difficult to determine whether you qualify or not.
Fortunately, you have arrived at the correct location if you are attempting to determine your eligibility. We will explain the basic eligibility requirements in detail, as well as any unusual situations that may apply. You’ll also learn about some of the distinctions between the various components and when you can enroll in each. Continue reading to determine if you qualify for coverage.
Medicare Eligibility – Who Is Eligible?
Let’s begin with the fundamentals and then move on to particular rules and scenarios. Medicare was established to assist in providing health insurance for older adults who were no longer employed and so did not have access to an employer-sponsored health plan. Because the majority of health insurance plans in the United States are employer-sponsored, these older adults did not have many options. Medicare is normally available to those aged 65 or over who are citizens or permanent residents of the United States. This is in contrast to Medicaid, which is jointly administered by the state and federal governments and aimed at assisting low-income families in obtaining healthcare.
Medicare is comprised of two distinct components: Medicare Part A and Medicare Part B. There are further sections C and D, but we shall discuss them later. For the time being, understand that Original Medicare is comprised of Parts A and B. Part A covers hospitalization and inpatient services such as hospice care or nursing facility care. Part B provides typical health insurance coverage for physician visits, outpatient services, and medical equipment.
To qualify for Part A under typical circumstances, you must be 65 years old and a citizen or permanent resident of the United States. If you or your spouse has worked and paid Medicare taxes for at least ten years, you or your spouse are not required to pay a Part A premium. If you do not meet the work requirement, you may still be able to purchase Part A coverage by paying a monthly payment.
Thus, if you meet any of the following conditions, you will automatically receive premium-free Part A coverage when you reach the age of 65:
- Social Security or the Railroad Retirement Board provide retirement benefits to you.
- You are eligible for these benefits but have not yet made an application.
- You or your spouse worked for a government agency that was covered by Medicare.
Additionally, if you have been receiving Social Security disability benefits for 24 months or have end-stage renal illness or Lou Gehrig’s disease, you may be eligible for premium-free Part A coverage. Even if you are under the age of 65, certain conditions will qualify you for coverage. After 24 months of receiving disability compensation, you will be automatically enrolled in Part A. The 24-month waiting period does not apply if your disability was approved owing to ESRD or Lou Gehrig’s illness. You immediately become eligible. If you have been diagnosed with ESRD, you must apply manually; however, if you have Lou Gehrig’s disease, you will be automatically enrolled.
Apart from the reasons indicated above, you can also qualify for premium-free Part A coverage if you are a dialysis or transplant recipient. If you fall into one of these categories, you do not have to be 65 years old to qualify for coverage.
The wonderful news is that if you qualify for Part A benefits, you are also eligible for Part B benefits! Part B coverage, on the other hand, carries a charge. This payment may be taken from your Social Security or Railroad Retirement Board benefits upon retirement. If you do not receive these benefits, Medicare will send you a bill every three months for your premium. The monthly premium for Medicare Part B in 2021 is $148.50. If your annual income exceeds $88,000, the premium increases proportionately. Additionally, Part B needs a $203 annual deductible.
When Will I Be Eligible to Receive Medicare Part A Benefits?
Medicare benefits begin on the first day of the month following your 65th birthday. If you have been receiving Social Security or Railroad Retirement Board benefits for at least four months, you will be enrolled in Part A coverage automatically. If you are not currently receiving these benefits, you can still enroll manually. If your birthday falls on a month’s first day, your benefits will begin on the first day of the month preceding your birthday. When you are ready to begin coverage, you can quickly apply for Medicare online.
If you are under the age of 65 and receive SSDI benefits, you will be automatically enrolled in both sections A and B after receiving 25 months of disability compensation. If you are disabled due to Amyotrophic Lateral Sclerosis (ALS), you will be enrolled immediately once your disability benefits begin. The rules are slightly different in the case of ESRD. You will need to apply for benefits manually. Your eligibility is determined by a variety of circumstances, including whether you are on dialysis, have had a kidney transplant, and have worked and paid Medicare taxes. To determine your eligibility, you can go directly to Medicare’s website and use the eligibility checker.
When Am I Eligible to Begin Receiving Part B Benefits?
Due to the fact that Part B coverage is voluntary, the enrollment requirements are slightly different than those for Part A. Due to the fact that Part B is an optional benefit that requires a premium, you will not be automatically enrolled. If you desire to enroll in this coverage within your original enrollment period, you can do so. This seven-month period begins three months prior to your 65th birthday, includes your birth month, and ends three months following your 65th birthday.
Many people nowadays continue to work past the age of 65, and they prefer to delay the commencement of their Part B coverage while they remain covered by their employer’s health plan. You are eligible to a special enrollment time upon retirement in this circumstance. When you lose your job, you have eight months to enroll in Medicare Part A/B after your employer-provided coverage expires.
If you do not enroll in coverage during your initial enrollment period or during a special enrollment period when your Medicare eligibility begins, Medicare offers open enrollment periods from January to March each year. You can enroll now for coverage to begin on July 1. However, you will very certainly be charged a late enrollment penalty for failing to enroll when you were eligible.
After enrolling in Part B coverage, you should consider purchasing a Medigap policy. This is supplemental Medicare insurance that helps pay for out-of-pocket expenses and other goods not covered by Medicare. This extra insurance can help you save money over time, and you will receive the cheapest rates if you enroll as soon as you become eligible.
Eligibility for Medicare Part C
Medicare Part C is sometimes referred to as a Medicare Advantage plan. It is a hybrid of Medicare Parts A and B, or hospital insurance, and standard health insurance. To receive Medicare coverage under Part C, you must be eligible for and enrolled in Original Medicare (Parts A and B). Additionally, you must reside within the service region of the chosen advantage package.
Private insurance companies that contract with Medicare manage and administer Part C. Part C normally has the same seven-month enrollment period as Original Medicare (3 months before turning 65, the month of your 65th birthday, and three months after turning 65). If you opt to enroll later, each year from October 15 to December 7 there is an Annual Election Period for coverage beginning on January 1.
Part C coverage is optional, and enrollment in an Advantage plan is not required. Each insurance company that administers a Part C plan may establish its own out-of-pocket maximums. If you’re considering a Part C plan, you should shop around to see which plan is the best fit for your circumstances.
Eligibility for Medicare Part D
Traditional Medicare does not cover prescription drugs, but Medicare Part D does. Part D, like Part C, is handled by private insurance companies under contract with Medicare. As with Part C, you must reside within the service area of the Part D plan you select.
You must be enrolled in either Part A, Part B, or both to enroll in Part D coverage. Medicare has authorized these private insurers to handle these plans. To enquire about Part D coverage, contact your local insurance agent or use the Medicare.gov website to identify a provider.
Medicare Eligibility for Individuals Under the Age of 65
Because Medicare is designed for adults 65 and older, is it possible to obtain coverage if you are younger than 65? You very certainly can! If you are under the age of 65, you may be eligible for Medicare under certain circumstances. If the Social Security Administration (SSA) determines that you are handicapped for a period of 24 months, you are eligible to enroll in Part A and/or Part B coverage. Additionally, you are eligible if you have been receiving Railroad Retirement Board Disability benefits for a period of 24 months.
Additionally, you qualify for coverage if you have persistent renal failure and are on dialysis or have had a kidney transplant. Additionally, if you have been diagnosed with ALS, or Lou Gehrig’s illness, you may qualify. Coverage normally begins immediately following an ALS diagnosis, but if you have renal failure, you must enroll manually.
I’ve Never Worked, Am I Eligible for Medicare?
The short answer is yes, even if you have never worked, you are still eligible when you reach the age of 65. You will, however, be asked to pay an additional fee for Parts A and B. If you have never worked, you will not be eligible for the free Part A premium. Additionally, you may be eligible if your spouse meets the work criteria for premium-free coverage. Another way to qualify is if your spouse worked in a government-covered position.
If you have never worked, you will be ineligible for Social Security disability benefits, and hence will be ineligible for Medicare as well. Even if you have never worked and are under the age of 65, you may qualify for Medicare if you have kidney failure or ALS.
While the Medicare requirements may appear difficult at first, they can be simplified significantly by taking them one element at a time. To begin, determine your eligibility based on your age and job experience. If not, check to see if you meet one of the exceptions. If you are eligible, you may want to investigate enrolling in a private insurance company’s Medicare Advantage and/or Part D programs as well. If you have any questions, you may always check the Medicare website or call them.