Does Everyone Qualify For Medicare

Who Is Eligible For Medicare Part D

• What Does Medicare Part D Cover?

Before you can take advantage of a Part D plan, you must first be eligible to sign up. There are specific criteria you need to meet in order to qualify for the program.

To be eligible for Part D, you must first be eligible for Medicare at large. The rules for Medicare eligibility are straightforward. Beyond that, there are other specific rules for enrolling in Part D that you need to know.

Medicare Eligibility: Key Takeaways

• Generally, youre eligible for Medicare Part A if youre 65 and have been a U.S. resident for at least five years.
• When youre notified youre eligible for Part A, youll be notified that youre eligible for Medicare Part B.
• You need to be eligible for both Medicare Part A and B in order to enroll in Medicare Advantage.
• To be eligible for Medicare Part D prescription drug coverage, you must have either Medicare Part A or Part B, or both.
• If youre enrolled in both Medicare Part A and B, and dont have Medicare Advantage or Medicaid benefits, then youre eligible to apply for a Medigap policy.

For the vast majority of Americans who look forward to receiving Medicare health benefits, eligibility is as uncomplicated as celebrating your 65th birthday.

But your eligibility to receive Medicare coverage without having to pay a premium and your eligibility for other Medicare plans depends on such factors as your work history and your health status. Heres what you need to know:

Medicare Prescription Drug Coverage

Medicare drug coverage helps pay for prescription drugs you need. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage .

Learn more about how to get Medicare drug coverage.

Each plan can vary in cost and specific drugs covered, but must give at least a standard level of coverage set by Medicare. Medicare drug coverage includes generic and brand-name drugs. Plans can vary the list of prescription drugs they cover and how they place drugs into different “tiers” on their formularies.

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Medigap Eligibility In 2021

Eligibility for Medigap lasts for six months, starting from the month you turn 65 and have Medicare Part B in place. In other words, you must be 65 and enrolled in Medicare to sign up for a Medigap policy. Once youre 65 and enrolled in Part B, you have six months to enroll in Medigap without being subject to medical underwriting. During this initial eligibility window, you can:

• Buy any Medigap policy regardless of health history
• Buy a plan knowing that youll pay the same rate as someone without any medical problems
• Buy any Medigap plan available in your state as long as its sold by an approved Medigap seller

Once that 6-month window closes, you can still sign up for Medigap, but the conditions change. Outside of the initial signup window, youre no longer guaranteed coverage if you have medical problems. And if you find a plan at all, it will likely cost much more because itll be based on medical underwriting. The best time to sign up for supplemental coverage through a private Medigap policy is when you first become eligible i.e., when you turn 65 and enroll in Medicare Part B.

What If You Need Help With Other Medicare Costs, Like Prescription Drug Coverage?

Other Ways To Get Medicare Coverage At Age 65

If you dont qualify for premium-free Medicare Part A coverage, you may be eligible to buy coverage. However, you must still be a U.S. citizen or a permanent resident for at least five years to qualify.

Other Medicare Eligibility Options

• You can pay premiums for Medicare Part A hospital insurance. Premium costs vary based on how long you have worked and paid into Medicare.
• You can pay monthly premiums for Medicare Part B medical services insurance. Youll pay the same premiums as anyone else enrolled in Part B.
• You can pay monthly premiums for Medicare Part D prescription drug coverage. Your premium will be the standard rate and would depend upon the plan you choose.

You will not be able to purchase a Medicare Advantage plan or Medigap supplemental insurance unless you are enrolled in Original Medicare Medicare Parts A and B.

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If I Retire At Age 62 Will I Be Eligible For Medicare At That Time

• IV.

Medicare is federal health insurance for people 65 or older, some younger people with disabilities, and people with end-stage kidney disease. Most commonly, you are eligible for Medicare when you turn 65, but there are other health insurance options if you are younger and do not have coverage through you or your spouses employer.

What you should know

Medicare was established in 1965 in order to provide health coverage for seniors who would otherwise not be covered by employer-sponsored health insurance plans. If you retire at the age of 62, you may be eligible for retirement benefits through social security, but early retirement will not make you eligible for Medicare.

Should I Sign Up For Medical Insurance

With our online application, you can sign up for Medicare Part A and Part B . Because you must pay a premium for Part B coverage, you can turn it down.

If youre eligible at age 65, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday.

If you choose not to enroll in Medicare Part B and then decide to do so later, your coverage could be delayed and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didnt sign up for it, unless you qualify for a “” .

If you dont enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a general enrollment period from January 1 through March 31. Your coverage begins on July 1 of the year you enroll. Read our publication for more information.

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D Eligibility With Medicare

Once you are eligible for Medicare, you can decide which parts you want to sign up forParts A, B, C, or D.

Your first decision will be whether to opt for Original Medicare or a Medicare Advantage plan. You cannot have both. For clarification, Medicare Advantage plans offer everything that Parts A and B do but may provide additional benefits for an added cost.

In order to apply for Part D, you may enroll in Part A, Part B, or both. There is no option to apply for Part D alone.

Alternatively, you can choose to sign up for a Medicare Advantage plan. There are Medicare Advantage Prescription Drug Plans that include Part D coverage.

In summary, you will need to have one of these Medicare plans or combinations to be eligible for Part D coverage:

• Part D + Part A
• Part D + Original Medicare
• MA-PD

There are times you may be eligible for Medicare but are not allowed to enroll in a Part D plan. This occurs when you reside outside of the country or U.S. territories. When you return to the United States, you will be eligible to sign up. When you are incarcerated, you receive benefits from the prison system, not Medicare. You may enroll in Part D after you are released.

What Is A Special Election Period

A special election period or special enrollment period is when someone can change their Medicare Advantage coverage outside of the official AEP or IEP.

When certain qualifying events happen, such as moving to a new area or losing existing insurance coverage, this triggers an SEP.

There are various rules and approved reasons that affect what changes an individual can make to their Medicare coverage.

The government has a calculator that people can use to determine whether they are eligible for Medicare coverage and, if so, the likely premium.

People can use the calculator at Medicare.gov.

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Your First Chance To Sign Up

Generally, when you turn 65. This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65.

Avoid the penaltyIf you miss your 7-month Initial Enrollment Period, you may have to wait to sign up and pay a monthly late enrollment penalty for as long as you have Part B coverage. The penalty goes up the longer you wait. You may also have to pay a penalty if you have to pay a Part A premium, also called Premium-Part A.

Find Out About Your Medicare Eligibility

Determining your Medicare eligibility is sometimes tricky. We get many questions about how to qualify when to enroll in Medicare, and how to set up Medicare supplement insurance. Though the process may seem overwhelming to you, our experts deal with these processes every day. We can guide you easily through the process.

You are not alone let a Florida Medicare Agency licensed agent to assist you in making this entire process easier.

Get Your Free Copy of the Ultimate Medicare Quick Reference Guide from Florida Medicare Agency!

This guide helps you learn about the different parts of the Medicare program, including Medicare Part A and Part B , Part C and Part D .

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

Florida Health Agency is a licensed health insurance agency certified to sell Medicare products. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Get In Touch

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Some Beneficiaries Qualify For Medicare Before Age 65

Not everyone who receives Medicare is a senior citizen. In 2013, nearly 17% of all Medicare beneficiaries qualified for coverage before the age of 65.

Other than age, there are three ways to qualify for Medicare:

• If you are permanently disabled and have received Social Security Disability Insurance or certain benefits from the RRB for two consecutive years, you will be automatically enrolled in Medicare Part A and Part B.
• If you have Amyotrophic Lateral Sclerosis , also known as Lou Gehrigs Disease, you will be automatically enrolled in Medicare Part A and Part B when you receive your first SSDI benefits.
• If you have End Stage Renal Disease , you will qualify for Medicare generally three months after youve begun a course of regular dialysis or had a kidney transplant, but you must sign up for the program.

Medicare Supplement Insurance Helps Cover Some Costs

Once youve qualified for Medicare, its important to have a thorough understanding of all of your coverage options. Connect with a licensed insurance agent today to find out how Medicare Supplement Insurance can help you cover some of the out-of-pocket health care costs that Original Medicare doesn’t.

Learn more about lowering your out-of-pocket costs through Medicare Supplement Insurance with this helpful guide.

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How Does Medicare Work

With Medicare, you have options in how you get your coverage. Once you enroll, youll need to decide how youll get your Medicare coverage. There are 2 main ways:

Original Medicare

Original Medicare includes Medicare Part A and Medicare Part B . You pay for services as you get them. When you get services, youll pay a

deductible

at the start of each year, and you usually pay 20% of the cost of the Medicare-approved service, called coinsurance. If you want drug coverage, you can add a separate drug plan .

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance policy can help pay some of the remaining health care costs, like copayments, coinsurance, and deductibles. Some Medigap policies also cover services that Original Medicare doesn’t cover, like emergency medical care when you travel outside the U.S.

Learn more about how Medicare Advantage Plans work.

What Happens If You Dont Sign Up For Medicare At 65

When you near your 65th birthday, you will enter what is called your Initial Enrollment Period . This seven-month period begins three months before you turn 65, includes the month of your birthday and continues for three additional months. This is your first opportunity to sign up for Medicare.

If you choose not to sign up for Medicare during your IEP, there are a few scenarios that might play out depending on your situation.

Medicare Advantage plans do not have a late enrollment penalty. You can sign up for a Medicare Advantage plan at any age, as long as you are already enrolled in Medicare Part A and Part B.

Medicare Supplement Insurance does not technically have a late enrollment penalty. However, if you enroll in a Medigap plan during your Medigap Open Enrollment Period, insurance providers arent allowed to use medical underwriting to determine your plan premiums or deny you coverage. Your Medigap Open Enrollment Period lasts for six months and starts as soon as you are 65 and enrolled in Medicare Part B.

There are also some Medicare Special Enrollment Periods that may apply to a someone who is turning 65. For example, if you are living overseas at the time of your 65th birthday and then later return to the U.S., you may qualify for a Special Enrollment Period for which you can sign up for Medicare with no late enrollment penalty.

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Medicare Advantage Eligibility With A Disability

If you have a disability, you may be eligible for Medicare, including Medicare Advantage. To apply for Medicare with a disability, you must have been unable to work for a year or longer, or have been eligible for Social Security or Railroad Retirement Board benefits for 24 months.

To qualify as a disability, a condition must be severe enough to prevent a person from working, and must be on the Social Security Administration’s list of disabling conditions.

Some examples of potentially eligible disabilities include:

• Chronic respiratory disorders such as cystic fibrosis
• Chronic liver disease
• Hearing loss

When Should You Enroll For Medicare

Just because you qualify for something doesnt mean you need to sign up, right? Not always. In the case of Medicare, its actually better to sign up sooner rather than later. While its true that Medicare isnt mandatory, there are fees for signing up outside of your initial eligibility window. Also known as the initial enrollment period , this 7-month window gives you some flexibility in enrolling in Medicare once you qualify.

If you dont get automatic enrollment , then you must sign up for Medicare yourself, and you have seven full months to enroll. The IEP starts three months before the month you turn 65 and ends three months after the month you turn 65.

Coverage start dates vary based on when you sign up. If you sign up during the first three months of your IEP , then your health insurance will take effect on the first day of your birthday month. If your birthday falls on the first of the month already, then your coverage will start on the first of the previous month. The longer you wait to sign up, the later your coverage will start, which is why its a good idea to check your eligibility and enroll as soon as youre able.

This initial signup period applies to people who dont get automatically enrolled. People who are already enrolled in Social Security and those with disabilities will be automatically enrolled into original Medicare depending on their situation.

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How To Enroll In Medicare And When You Should Start Your Research Process

Getting older means making more decisions, from planning for your kids futures to mapping out your retirement years. One of the most important decisions that youll make as you prepare to retire or head into your 60s is what to do about health insurance. If youve been working, then you probably have a plan through your employer. Most people do. But once you turn 65, you become eligible for Medicare, a government-backed program designed specifically for seniors. There are also other reasons that you might be eligible for Medicare, which can muddy the waters when youre researching your options for coverage.

Medicare is administered by the Centers for Medicare and Medicaid Services , but technically speaking, youll enroll via Social Security. In this article, well outline eligibility guidelines so that you can sign up with confidence, and as always, if you have any questions about how to sign up, or what plan might be best for your needs, were always available toll free to answer any questions you might have. Well also highlight the importance of enrolling on time to avoid penalties and delays in coverage. Heres what you need to know about eligibility and Medicare.