Friday, April 12, 2024

How Do You Know If You Are Medicare Eligible

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Enrolling In Medicare With A Disability

Medicare Basics: Parts A, B, C & D

Just like when you become eligible for Medicare at age 65, when you are eligible with disability, you have an Initial Enrollment Period of 7 months.

Your Initial Enrollment Period will begin after you have received either disability benefits from Social Security for 24 months or certain disability benefits from the Rail Road Retirement Board for 24 months.1 In other words, your IEP starts on the 25th month of disability benefits.

You will be automatically enrolled in Medicare Part A and Part B, but if you decide you want to get a Medicare Advantage or Part D prescription drug plan, you will need to enroll yourself directly with the private plan provider. You will need to enroll during your IEP to avoid late enrollment penalties.

NOTE: If you become eligible for Medicare because of ALS or ESRD, your situation is different. See the below special sections for eligibility and enrollment for ALS and ESRD.

Do I Have To Apply For Medicare Part B

If youre under age 65 and already receiving Social Security or Railroad Retirement Board disability benefits, youll be automatically enrolled in Medicare parts A and B when you turn 65. If you dont wish to have Medicare Part B, you can defer it at that time.

If youre not currently receiving these benefits, youll have to actively enroll in Medicare.

Important Medicare Deadlines

Its extremely important not to miss any Medicare deadlines, as this can cause you to face late penalties and gaps in your coverage. Here are the Medicare deadlines to pay close attention to:

  • Original enrollment. You can enroll in Medicare Part B 3 months before, the month of, and 3 months after your 65th birthday.
  • Medigap enrollment. You can enroll in a supplemental Medigap policy for up to 6 months after you turn 65 years old.
  • Late enrollment. You can enroll in a Medicare plan or Medicare Advantage plan from January 1March 31 if you didnt sign up when you were first eligible.
  • Medicare Part D enrollment. You can enroll in a Part D plan from April 1June 30 if you didnt sign up when you were first eligible.
  • Plan change enrollment. You can enroll in, drop out of, or change your part C or Part D plan from October 15December 7, during the open enrollment period.
  • Special enrollment. Under special circumstances, you may qualify for a special enrollment period of 8 months.

Medicare Eligibility If You Are Under 65

People younger than 65 may qualify for Medicare if they have certain costly medical conditions or disabilities.

If you are under 65, you can qualify for full Medicare benefits if:

  • You have been receiving Social Security disability benefits for at least 24 months. These do not need to be consecutive months.
  • You have end-stage renal disease requiring dialysis or a kidney transplant. You qualify if you or your spouse has paid Social Security taxes for a specified period of time, based on your age.
  • You have amyotrophic lateral sclerosis, also known as Lou Gehrigs disease. You qualify for Medicare immediately upon diagnosis.
  • You receive a disability pension from the Railroad Retirement Board and meet certain other criteria.

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You Have A Disability

If you have a disability and are receiving Social Security or Railroad Retirement Board disability payments, youre eligible to enroll in Medicare Part B, regardless of your age.

According to the Social Security Administration, qualifying disabilities may include:

  • sensory disorders

If you have a Medicare Part C plan, it takes the place of original Medicare.

Medicare Part C Eligibility

Insurance Services in NJ

Medicare Part C, also called Medicare Advantage, is an insurance option for people who are eligible for Medicare. These plans are offered through private insurance companies.

You dont need to buy a Medicare Part C plan. Its an alternative to original Medicare that offers additional items and services. Some of these include prescription drugs, dental, vision, and many others.

To be eligible for a Medicare Part C plan:

  • You must be enrolled in original Medicare .
  • You must live in the service area of a Medicare Advantage insurance provider thats offering the coverage/price you want and thats accepting new users during your enrollment period.

To enroll in original Medicare , in general, you must qualify by:

Read Also: How Do You Apply For Medicare Part B Online

People Who Have Both Medicare & Medicaid

People who have both Medicare and full Medicaid coverage are dually eligible. Medicare pays first when youre a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.

You can still pick how you want to get your Medicare coverage: Original Medicare or Medicare Advantage . Check your Medicare coverage options.

If you choose to join a Medicare Advantage Plan, there are special plans for dual eligibles that make it easier for you to get the services you need, include Medicare coverage , and may also cost less, like:

  • Special Needs Plans
  • Medicare-Medicaid Plans
  • Program of All-Inclusive Care for the Elderly plans can help certain people get care outside of a nursing home

I’m On Disability When Will I Be Eligible For Medicare

You may be eligible for Medicare before age 65 if you have a qualifying disability. Eligibility usually starts after you’ve received disability benefits for 24 months. You will be automatically enrolled in Medicare Parts A and B. You may make other coverage choices during your IEP. Your 7-month IEP includes the month you receive your 25th disability check plus the 3 months before and the 3 months after.

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Medicare Eligibility At 65 And Older

You can apply for Medicare the year you turn 65, but you generally must meet three eligibility requirements to qualify for full Medicare benefits at this age.

The chief requirement is that you must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years.

In addition, you must meet one of the following other requirements:

  • You or your spouse must have worked long enough to also be eligible for Social Security benefits or for railroad retirement benefits. This usually means you have worked for at least 10 years. You must be eligible for these Social Security benefits even if you are not yet receiving them.
  • You or your spouse is either a government employee or retiree who did not pay into Social Security but did pay Medicare payroll taxes while working.

If you pay Medicare payroll taxes for 10 full years, you wont have to pay premiums for Medicare Part A, which covers hospital care.

You dont need the work credits to qualify for Medicare Part B, which covers doctor visits or outpatient services, and Medicare Part D, which covers prescription drugs. Everyone pays premiums for both regardless of work history.

If you are still working at 65, you dont have to sign up for Medicare but there are benefits to signing up while still employed. Similarly, if you have never worked, you can still get Medicare. It may be more expensive depending on your spouses work history.

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Medicare & You: Understanding Your Medicare Choices
Can I get help paying for Medicare?

If you need help with your Part A and B costs, you can apply for a Medicare Savings Program.

You may also qualify for Extra Help to pay for your Medicare prescription drug coverage if you meet certain income and resource limits.

What if Im eligible for Medicare, but my spouse isnt and wants to stay covered under our current Marketplace plan?

If someone gets Medicare but the rest of the people on the application want to keep their Marketplace coverage, you can end coverage for just some people on the Marketplace plan, like a spouse or dependents.

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What Information Is Needed To Check Medicare Eligibility

Information Needed to Check Medicare Eligibility. One must provide identification, and this includes a full name, address, date of birth, and Social Security number. Some questions may involve the work history of the spouse or partner to see if one or both may be eligible for Social Security benefits and Medicare.

What Is The Medicare Premium For 2021

In 2021, the Medicare Part B premium for most people is $148.50. The number of fully-taxed covered quarters of work will also affect the monthly amount received for Social Security or Railroad Retirement Board pension benefits. The number of quarters needed varies on the bases of age, disability, or kidney disease.

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Getting Medicare Enrollment Assistance

If you have questions about or need help with Medicare eligibility or enrollment due to disability, you will want to talk with Social Security office. You can also go to your local State Health Insurance Assistance Program office for Medicare counseling.

If you get approved for disability benefits but arent yet eligible for Medicare yet , you can reach out your local state human services agency to see if Medicaid may be an option for you.11


How Old Do You Have To Be To Get Social Security

When Can I Collect Medicare

Are age 65 or older. Receive Social Security Disability benefits. Have certain disabilities or permanent kidney failure . If you would like to find out if you may be eligible for any of Social Security’s benefit programs, take the U.S. Social Security Administrations Benefit Eligibility Screening Tool.

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Canceling Your Marketplace Plan When You Become Eligible For Medicare

In most cases, if you have a Marketplace plan when you become eligible for Medicare, youll want to end your Marketplace coverage.


Don’t end your Marketplace plan until you know for sure when your new coverage starts. Once you end Marketplace coverage, you cant re-enroll until the next annual Open Enrollment Period .

Your Medicare coverage start date depends on your situation.

How To Know If You Are Eligible For Medicare

  • You receive Full Medicaid benefits
  • You are a Qualified Medicare Beneficiary without other Medicaid
  • You receive QMB Plus
  • You are a Specified Low-Income Medicare Beneficiary without other Medicaid
  • You receive SLMB Plus
  • You are a Qualifying Individual
  • You are a Qualified Disabled and Working Individual

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How Long Do You Have To Live To Qualify For Medicare

You qualify for full Medicare benefits if: You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years and. You are receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits but are not yet collecting them.

What Is The Texas Health Information Counseling And Advocacy Program

Medicare Enlightenment: A simple way to learn what you need to know about Medicare

If you are eligible for Medicare, the Texas’ Health Information, Counseling and Advocacy Program can help you enroll, find information and provide counseling about your options. This partnership between the Texas Health and Human Services system, Texas Legal Services Center and the Area Agencies on Aging trains and oversees certified benefits counselors across the state.

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Who Is Eligible For Medicare Advantage Plans

Youll automatically qualify for Medicare Advantage once you qualify for Part A and Part B coverage. Advantage plans are sold by private companies and are designed to cover some of the out-of-pocket costs Original Medicare does not cover.

4 Medicare Advantage Eligibility Requirements

  • You must be a U.S. citizen, a U.S. national or lawfully present in the U.S.
  • You must be enrolled in Medicare Parts A and B.
  • You must live in the chosen Medicare Advantage plan providers service area.
  • You must not have end-stage renal disease .
  • While regular Medicare Advantage does not cover ESRD, you may qualify for a Medicare Special Needs Plan . SNPs are special types of Advantage plans specifically designed for a particular condition or financial situation.

    You can keep your Medicare Advantage plan if you purchased it before developing ESRD. You can also buy an Advantage plan after being medically determined to no longer have ESRD usually from a successful kidney transplant.

    Don’t Leave Your Health to Chance

    Other Ways To Get Medicare Coverage

    If you do not qualify on your own or through your spouses work record but are a U.S. citizen or have been a legal resident for at least five years, you can get full Medicare benefits at age 65 or older. You just have to buy into them by:

    • Paying premiums for Part A, the hospital insurance. How much you would have to pay for Part A depends on how long youve worked. The longer you work, the more work credits you will earn. Work credits are earned based on your income the amount of income it takes to earn a credit changes each year. In 2022 you earn one work credit for every $1,510 in earnings, up to a maximum of four credits per year. If you have accrued fewer than 30 work credits, you pay the maximum premium $499 in 2022. If you have 30 to 39 credits, you pay less $274 a month in 2022. If you continue working until you gain 40 credits, you will no longer pay these premiums.
    • Paying the same monthly premiums for Part B, which covers doctor visits and other outpatient services, as other enrollees pay. In 2022 the amount is $170.10 for individuals with a yearly income of $91,000 or less or those filing a joint tax return with $182,000 in income or less. Rates are higher for people with higher incomes.
    • Paying the same monthly premium for Part D prescription drug coverage as others enrolled in the drug plan you choose.

    You can enroll in Part B without buying Part A. But if you buy Part A, you also must enroll in Part B.

    You can get Part D if youre enrolled in either A or B.

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    Medicare Eligibility Who Qualifies For Medicare Benefits


    To be eligible for Medicare Part A and Part B, you must be a U.S. citizen or a permanent legal resident for at least five continuous years. In most cases, you have to be age 65 or older, and in other cases you might qualify for Medicare before age 65 if you qualify by disability. This page will help to explain Medicare eligibility in further detail.

    Who Is Eligible For Medicare

    Medicare Savings

    Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease . Medicare has two parts, Part A and Part B . You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

    • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
    • You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
    • You or your spouse had Medicare-covered government employment.

    To find out if you are eligible and your expected premium, go the eligibility tool.

    If you did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

    • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
    • You are a kidney dialysis or kidney transplant patient.

    While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

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    How Old Do You Have To Be To Get A Medigap Policy

    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.

    Healthmarkets Can Answer Your Medicare Eligibility Questions

    If you are eligible for Medicare and are ready to shop for a plan, HealthMarkets can help. We make it easy to compare plans, get free Medicare quotes, and enroll. Answer a few short questions and to see what kind of Medicare plan might work for your lifestyle, and which plans fit. Get started now.


    References:1.MDCR Enroll AB 2. January 19, 2021. Retrieved from | 2.Part B costs. Retrieved from Accessed on December 13, 2021 | 3.Part A costs. Retrieved from Accessed on December 13, 2021

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    What Is A Cwf

    Common Working File is a system that contains all Medicare beneficiary information as well as claim transactions, which includes Medicare Part A, Part B and Durable Medical Equipment. The Fiscal Intermediary Standard System and Multi-Carrier System processing systems interface with CWF to process claims.

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