Who Is Eligible For Medicare
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 Medicare.gov 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.
What If Im Not Automatically Enrolled At 65
If your Medicare enrollment at 65 is not automatic, but you want to enroll, here are some more magic numbers.
3 and 7.
To start taking advantage of Medicare at 65, you need to sign up during the three months before the birthday month you turn 65. Those are the first three months of your seven-month Initial Enrollment Period.
Unless your birthday is on the first day of the month, your Initial Enrollment Period includes the three full months before turning 65, the month you turn 65, and the three months after you turn 65. If you were born on the first day of the month, IEP is the four months before your birth month, along with your birthday month and the two months after.
If you sign up during one of the months before your 65th birthday, your coverage will begin on the first day of the month you turn 65 .
Are you eligible for cost-saving Medicare subsidies?
Medicare Eligibility For People Under 62
There are a few exceptions for Medicare age limits that can allow people younger than 65 and under age 62 to enroll in Medicare.
- If you have ALS , you are immediately eligible for Medicare regardless of your age as soon as your Social Security or Railroad Retirement Board disability benefits begin.
- You may also qualify for Medicare if you have kidney failure that requires dialysis or a kidney transplant, which is known as end-stage renal disease .
- You may also qualify for Medicare at age 62 or any age before 65 if you receive disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months.
If you qualify for Medicare under the age of 65 because of a disability, you might also qualify for a Medicare Advantage Special Needs Plan.
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Can I Enroll In Medicare Early Also Will That Affect My Ability To Get Medicare Advantage
- Use GoHealths Medicare Initial Enrollment Tool to see when your dates will be
Once you have enrolled in Original Medicare you have the option to enroll in Medicare Advantage. It doesnt cost you anything to speak with a licensed insurance agent if youre confused about enrollment periods for Medicare. Its important to take the time to understand when your coverage starts, what to do before then, and how to enroll.
Finding The Right Plan For You
Whenshopping for health insurance its important to consider your currenthealthcare needs and any needs you anticipate in the future. Its alsoimportant to consider your budget and what you can afford.
Need help figuring out what coverage is right for you? eHealth is here to help. eHeath is the first and largest online health insurance brokerage, so you can be sure that you will find the best plan for you and your needs with us.
Our online tools are here to not only help save you money but help you keep your doctors when making the switch. eHealths comparison tool allows you to easily compare a large range of health insurance options, so that you can find a plan that fits your budget and coverage needs.
Start shopping for individual and family health insurance now!
And when you turn 65 and are ready for Medicare, let eHealth help you with that transition as well.
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During A Special Enrollment Period
This SEP is available only if you have health insurance from an employer for which you or your spouse actively works. It allows you to delay enrolling in Part B until the employment or the coverage ends whichever occurs first.
The SEP actually lasts throughout the time you have coverage from current employment and for up to eight months after it ends. If you enroll at any point during this time frame, your Medicare coverage will begin on the first day of the following month, and you will not be liable for late penalties regardless of how old you are when you finally sign up.
Be aware that an IEP always trumps an SEP if the two should happen to overlap. For example, if your IEP ends on Aug. 31, and you retire on the same date, you will not be entitled to an SEP. Therefore, if you delayed enrollment until after Aug. 31, you would not be able to sign up until the following general enrollment period and your coverage would not begin until July 1 so you would be left for almost a year without coverage. Even if you signed up during the final months of your IEP, your coverage would still be delayed by two or three months. But, to continue this example, if you retired on Sept. 1, under the rules of the SEP, you could enroll in August and receive Medicare starting Sept. 1 with no loss of coverage.
Two other Medicare enrollment scenarios have different rules.
Medicare Enrollment Can Be Impacted By Social Security Benefits
Depending on your situation, you with either need to enroll in Medicare at age 65 or you may be able to delay. If you continue to work past age 65 and have creditable employer coverage , you can likely delay enrolling in Medicare until you lose that employer coverage. In most cases, people turning 65 will need to get Medicare during their 7-month Initial Enrollment Period to avoid financial penalties for enrolling late. Your IEP begins 3 months before the month of your 65th birthday and ends 3 months after.
Social Security benefits fit in the Medicare enrollment journey in one special way. If you are receiving either Social Security benefits for retirement or for disability, or Railroad Retirement Board benefits, you will be automatically enrolled in Medicare Part A and Part B when you first become eligible.
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Will I Get Medicare At 62 If I Retire Then
No. Even if your spouse is eligible for Medicare when you retire at 62 , youâre not eligible unless you qualify by disability.
if you retire before age 65, you may be able to continue to get medical insurance coverage through your employer, or you can purchase coverage from a private insurance company until you turn 65. While waiting for Medicare enrollment eligibility, you might want to visit healthcare.gov, or your state insurance agency on your stateâs official website, to learn about your options.
Requalifying For Medicare At 65
If you become eligible for Medicare before you turn 65 due to disability or one of the above diagnoses, youll requalify again when you reach age 65. When you do, youll have another Initial Enrollment Period and all the benefits of a newly eligible Medicare recipient, such as a Medicare Supplement Enrollment Period.
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Tips For Getting Retirement Ready
- A financial advisor can be a big help in figuring out how medical expenses will affect your retirement. Finding the right financial advisor that fits your needs doesnt have to be hard. SmartAssets free financial advisor matching tool matches you with financial advisors in your area in 5 minutes. If youre ready to be matched with local advisors that will help you achieve your financial goals, get started now.
- Medical costs arent the only expenses youll need to grapple with in retirement. Think about where youll want to retire to see how cost of living could impact your lifestyle. SmartAssets cost of living calculator can help you figure out your costs so youll know how much youll need to save. And our retirement calculator can help you see if youre on track with those savings.
What Documents Do I Need To Apply For Medicare
You may be asked for a number of documents when you apply for Medicare, including:
An original birth certificate or other proof of birth
Proof of U.S. citizenship or permanent resident card
Copy of U.S. military service paper
Copy of W-2 forms and latest tax return
The Social Security Administration has a checklist of what you need to apply for Medicare.
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Changing From Employer Or Spouse Coverage
There are two forms that you will need in order to apply for Medicare Part B. Print these forms, get them filled out, and drop them off at your local Social Security office. The first for you need is the Part B enrollment form found here: Medicare Part B enrollment application. Another important form is for your employer to show that you have had coverage since you were first eligible for Medicare at age 65. This is to ensure no penalty is added to your monthly Part B premiums. Here is the form needed for the employer coverage:
What do I need to do if I have Part A, but am losing my group plan coverage?
To sign up for Medicare Part B, you need to fill out application form CMS40B and take or mail it to your local Social Security office. You will also want to send your employer a CMS-L564E form to be filled out and sent in with your CMS40B application. There is an 8-month Special Enrollment Period that begins the month your group coverage ends or when the employment it is based on ends, whichever comes first.
The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medical hospital insurance if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
Learn More About Medicare
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Another type of Medicaid program is Early and Periodic Screening, Diagnostic, and Treatment . This program is available to individuals under the age of 21 who live in households that meet certain financial criteria. This type of Medicaid also has an age restriction and could therefore also be considered age-based.
ABD and EPSDT are required by federal law to be included in all state Medicaid programs. But as long as certain federal requirements are met, state Medicaid programs are free to offer their own Medicaid benefits and eligibility guidelines to people who might not otherwise be eligible for these two programs. Age may or may not play a role, depending on where you live.
For example, Medicaid in North Carolina is only available to those age 65 and over or 21 and under unless you are pregnant, are responsible for a child age 18 and under, disabled or require long-term care.
But in North Dakota, Medicaid is available to all low-income adults, regardless of age.
It could be said that Medicaid is age-based in some states and for some programs, but it is not universally age-based.
Will I Be Enrolled In Medicare Automatically
You will generally be automatically enrolled in Medicare if:
- Youâre receiving Social Security retirement benefits when you turn 65.
- Youâre younger than 65 and youâve been getting Social Security disability benefits for 24 months. Youâll typically be enrolled in Medicare in the 25th month of getting these benefits.
- Youâre younger than 65 and have amyotrophic lateral sclerosis , also known as Lou Gehrigâs disease. Youâre automatically signed up for Medicare the same month your Social Security disability benefits start
You typically have to sign up for Medicare yourself if:
- Youâre not yet receiving Social Security retirement benefits when you turn 65.
- Youâre under 65 and have end-stage renal disease, a type of kidney failure. You might qualify for Medicare at any age, but you are not signed up automatically.
- You live in Puerto Rico. You may be automatically enrolled in Medicare Part A when you turn 65, but youâll need to sign up for Part B.
You might have to pay a late enrollment penalty if you donât sign up for Medicare when youâre first eligible. Learn more about the late enrollment penalties.
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Sign Up: Within 8 Months After You Or Your Spouse Stopped Working
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
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How To Apply Online For Just Medicare
If you are within three months of turning age 65 or older and not ready to start your monthly Social Security benefits yet, you can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses benefits later. It takes less than 10 minutes, and there are no forms to sign and usually no documentation is required.
To find out what documents and information you need to apply, go to the .
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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.
The Proposal For Medicare At 60
Besides a proposal to offer a public health insurance option similar to Medicare, President Biden hopes to lower the Medicare eligibility age to 60. During the presidential race, this was part of his health care platform. Currently, the age at which one becomes Medicare-eligible is 65. Individuals under 65 can obtain Medicare if they collect SSDI for 24 months or are diagnosed with ALS or ESRD.
Lowering the eligibility age five years aims to provide health care to those who retired early, are unemployed, or lack health benefits through their employer. Additionally, qualifying U.S. citizens over 60 would have an extra health care option. As the market is more difficult for older job seekers, the President says its necessary to provide this safety net.
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