Monday, May 16, 2022

How Old Before You Qualify For Medicare

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You Automatically Get Medicare

Do I Have to Apply for Medicare?
  • You should already have Part A and Part B , because you have ALS and youre already getting disability benefits.
  • We mailed you a welcome package with your Medicare card.

Sign up for Part B if you live in Puerto Rico or outside the U.S.

  • Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.

Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months after your Part A starts, you might have to wait to sign up and pay a monthly late enrollment penalty.

  • Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.

Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.

Review Your Medicare Choices Each Year

Whether you enroll in original Medicare or a Medicare Advantage plan, you generally do not need to renew coverage every year. That being said, plans are sometimes discontinued or their benefits and costs may change to the point that the plan no longer meets your needs. Its not unusual for pharmacy and provider networks to change, for costs to increase, or the list of covered prescription drugs to vary. Thats why its a good idea to review your plan each year and compare it against your current health care needs.

Your health insurer is required to send you an Annual Notice of Change by September 30 each year. The notice outlines any changes in coverage and costs expected to begin the following January. If you decide to change your health care plan after reviewing those updates, you can do so during Medicares open enrollment period. The period runs from October 15 to December 7. During this time, you can switch from original Medicare to Medicare Advantage or vice versa. You can switch from one Medicare Advantage plan to another or from one Medicare Part D plan to another. You can also enroll in Medicare Part D if you have not done so already, although late enrollment penalties may apply.

If you find that the new health care plan is not meeting your needs, you can reverse some plan decisions January 1 to March 31 of the following year. Guidance for the renewal process is offered through the U.S. governments phone line at 1-800-MEDICARE or through your local SHIP.

Medicare Eligibility Before Age 65

If youre under 65 years old, you might be eligible for Medicare:

  • If you receive disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board for at least 24 months in a row
  • If you have amyotrophic lateral sclerosis
  • If you have end-stage renal disease . ESRD is permanent damage to the kidneys that requires regular dialysis or a kidney transplant

If youre eligible for Medicare because of any of these circumstances, you may receive health insurance through Medicare Part A and Medicare Part B , which make up Original Medicare. Your enrollment in Medicare may or may not be automatic, as explained below.

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Do I Receive A Notice About Medicare When I Turn 65

If you are already receiving Social Security benefits, you will get information about Medicare in the mail three months before you turn 65. If you do not receive Social Security benefits, you must actively enroll in Medicare yourself by contacting your local Social Security office. You will not receive a notification in the mail informing you that you qualify for Medicare

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Q: What Should You Do To Prepare For Medicare At Age 64

Medicare Before 65

A: If you take Social Security at age 65, you automatically get put into Medicare. Unfortunately the retirement age is now 66 and if you wait until then to take Social Security, youll likely need to prepare for Medicare at age 64 on your own, and a lot of people dont realize that.

You enroll in Medicare through the Social Security Office. You can either enroll online, on the Social Security website it takes about 10 minutes or you can go to a Social Security office. They recommend calling first to make an appointment, so you wont be waiting there all day. Or, you can enroll over the phone, by calling Social Security. You usually wait on hold for a while, but its another option.

Corinne Lofchie, LICSW, is an Elder Care Advisor at Somerville-Cambridge Elder Services

You can start the process three months before your 65th birthday. That way, your coverage will start the month that you turn 65. Lets say your birthday is January 15. If you enroll in the three-month period before January, your Medicare coverage will begin on January 1. After your birthday month, you have 3 more months to enroll. If you wait, say until January, your coverage will begin on February 1. It always starts the next month, unless you enroll before your birthday month.

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Full Retirement Age By Year

Full retirement age is the age you begin to receive full Social Security benefits. If you start to draw your Social Security benefits before reaching your full retirement age, the payment you receive will be less.

An easy way to think about full benefits and retirement age is this,

  • Social Security will reduce your payments if you choose to receive your benefit before full retirement age. The percentage of reduced amount is highest at age 62 and decreases until you reach full retirement age.
  • If you choose to receive Social Security payments when you reach full retirement, you will get the total amount.
  • Suppose you choose not to receive Social Security payments when you reach full retirement and delay your benefit. In that case, you can increase the amount of your payment by earning delayed retirement credits.

If youre not sure when you reach full retirement age, our table provides the years and months you need to know for full retirement.

The Year You Were BornAge You Reach Full Retirement
Full Retirement Age 1954

If youre looking for the governments Medicare site, please navigate to www.medicare.gov.

Who Qualifies For Medicare

If youre 65 or older, you qualify for Medicare. Usually, Medicare starts the first day of the month you turn 65. You must be a U.S. citizen or a permanent resident living in the U.S. for five years in a row.

You or your spouse must pay at least ten years of Medicare taxes to qualify for Premium-free Part A.

Also, those of ANY age on Social Security disability for at least two years are eligible for Medicare.

Those with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis are eligible upon diagnosis.

But, ALS patients get automatic enrollment, whereas ESRD patients must enroll themselves.

Those with either disease dont need to meet the ten-year Medicare tax requirement for premium-free Part A.

Part B costs $148.50 each month, high-income earners may pay more. If youre eligible for Part A, you can get Part B.

Read Also: When Is Open Enrollment For Medicare

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.

How Do I Become Eligible For Medicare Advantage

How to Qualify for Medicare

If youre eligible for Medicare benefits, you have to choose how to receive them either through the government-run Original Medicare program, or through Medicare Advantage. The majority of all Medicare beneficiaries use Original Medicare, but more than four in ten are enrolled in Medicare Advantage plans, and Advantage enrollment has been steadily climbing at a much faster pace than overall Medicare enrollment.

You need to have both Medicare Part A and Part B in order to enroll in Medicare Advantage, and you can select a plan during your Medicare initial enrollment period the seven months surrounding the month you qualify for Medicare .

Most Medicare Advantage plans also include Part D prescription drug coverage if you have a Medicare Advantage plan, you typically receive your Part D coverage together with the health and hospital benefits, in one single package, although the maximum out-of-pocket limits for Medicare Advantage do not include the cost of prescription drugs.

People with end-stage renal disease are eligible for Medicare, but used to be ineligible for most Medicare Advantage plans. This changed as of 2021, however, under the terms of the 21st Century Cures Act. As of 2021, people with ESRD have the same access to Medicare Advantage plans as other Medicare beneficiaries.

Read Also: How To Check Medicare Status Online

Definition Of A Disability

The Social Security Administration has a very strict definition of disability. To be considered disabled:

  • You must be unable to do any substantial work because of your medical condition
  • AND your medical condition must have lasted or be expected to last at least one year, or be expected to result in your death

According to the law, your SSDI payments cannot start until you have been disabled for at least five full months, although a recent law change expedited this process for people with ALS. Your payment will usually start with your sixth month of disability.

How Social Security Affects Early Retirement

While youll become eligible for Social Security at age 62, you wont qualify for your full monthly benefit amount until a few years later.

For those born from 1943-1954, it doesnt happen until age 66.

If you claim your benefits by 62, you only get roughly 75% of the full amount, which is adjusted because youll be getting checks for a longer period of time.

Spousal benefits can also be decreased if you take your benefit early. Specifically, spousal benefits are reduced to 35% of your full retirement amount, compared to 50% if you wait until at least 66.

If you are healthy and likely to live a long time, delaying Social Security until age 70 can help you get the most value from the system youve paid into over your working years.

Recommended Reading: How Old To Be Eligible For Medicare

A Disability And A Long Wait Are Required For Early Medicare Enrollment

Lisa Sullivan, MS, is a nutritionist and a corporate health and wellness educator with nearly 20 years of experience in the healthcare industry.

Medicare isn’t available to most people until age 65, but if you have a long-term disability or have been diagnosed with certain diseases, Medicare is available at any age.

According to Kaiser Family Foundation data, 14% of all Medicare beneficiaries are under age 65. As of April 2021, 63.3 million Americans were enrolled in Medicare. So roughly 9 million of those beneficiaries are under age 65 and eligible for Medicare because of a disability as opposed to age.

What Should I Do As I Am Waiting To Reach The Medicare Eligible Age

Medicare Health Insurance Overview

If you retire at 62, your wait for your Medicare eligible age may only be 3 years. As you wait, you can start researching about Medicare so that you are prepared to make well-informed coverage decisions. For example, you may not know that:

  • Original Medicare doesnt generally cover prescription drugs you take at home. You can get coverage for prescription drugs through Medicare Part D, which is offered by private insurance companies contracted with Medicare.
  • Original Medicare generally doesnt cover routine dental, hearing aids, or eyeglasses. You may be able to get coverage for these benefits through a Medicare Advantage plan offered by a private insurance company. Medicare Advantage plans must cover everything Original Medicare covers, with the exception of hospice care, which is still covered by Part A.
  • Original Medicare has no out-of-pocket maximum. To get help paying for out-of-pocket costs such as copayments, coinsurance, and deductibles, you can get a Medicare Supplement insurance plan, also offered by private insurance companies.

New To Medicare?

Becoming eligible for Medicare can be daunting. But dont worry, were here to help you understand Medicare in 15 minutes or less.

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Enrolling Your Newborn Baby

You can enrol your newborn baby by using the Newborn Child Declaration. Youll get the declaration from the hospital. Find out how to enrol your baby.

If youve adopted a child or your child was born overseas, youll need to give us extra documents. Read more about what to do:

Employer Or Military Retiree Coverage

If you or your spouse has an Employer Group Health Plan as retiree health coverage from an employer or the military , you may not need additional insurance. Review the EGHPs costs and benefits and contact your employer benefits representative or SHIIP to learn how your coverage works with Medicare.

Also Check: How To Get Help Paying Your Medicare Premium

Medicare Eligibility At 65 And Older

The year you turn 65, you can apply for Medicare starting three months before your birth month until three months after. You generally have to meet three eligibility requirements to qualify for full Medicare benefits when you turn 65.

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

In addition, you have to 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 youve worked for at least 10 years. You must also be eligible for 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.

Paying Medicare payroll taxes for 10 full years means 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, or Medicare Part D, which covers prescription drugs. But everyone has to pay premiums for both.

You can still get Medicare if you never worked but it may be more expensive depending on your spouse or total work history.

Prepare for Medicare Open Enrollment

Medicaid Or Medicare Savings Programs

Medicare Part D – Details You Need to Know to Before You Enroll

Medicare beneficiaries with limited income or very high medical costs may be eligible to receive assistance from the Medicaid program. There are also Medicare Savings Programs for other limited-income beneficiaries that may help pay for Medicare premiums, deductibles, and coinsurance. There are specified income and resources limits for both programs. Contact your local county Department of Social Services or SHIIP to apply for one of these programs.

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In General It’s 65 But You Might Be Eligible Sooner

    We publish unbiased product reviews our opinions are our own and are not influenced by payment we receive from our advertising partners. Learn more about how we review products and read our advertiser disclosure for how we make money.

    When you think of Medicare, you probably assume that its for people of retirement age. Thats true, but the program covers more than just those who have worked all their life. You might be eligible right now and not know it. Our research has found that while more than 80% of beneficiaries are people aged 65 or older, others receive services at a younger age due to a qualifying disability.

    How Much Does Medicare Cost On Disability

    If you qualify for SSDI, you’ll typically qualify for premium-free Medicare Part A based on your work record. Part B requires a monthly premium , automatically deducted from your Social Security check. You can technically opt out of Part B if you dont want to pay the premiums. Just know that without Part B, youll forego extensive medical coverage. Its usually not a good idea to opt out of Part B unless you have other health insurancelike from an employer.

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    To Qualify For Medicare You Need To Get Disability Benefits From:

    • Social Security
    • Railroad Retirement Board

    Youll automatically get Part A and Part B after you get disability benefits for 24 months. Well mail you a welcome package with your Medicare card.

    If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

    If you live in Puerto Rico or outside the U.S.

    What Are The Typical Age Requirements For Medicare Coverage

    Medicare: Find the right health plan during open enrollment

    The typical Medicare age requirement is 65, or younger if you qualify for disability benefits. In addition to meeting the age requirement of 65, you must also be a U.S. citizen or legal permanent resident before you are eligible for Medicare.

    Most people who are 65 qualify for premium-free Medicare Part A because they have worked for at least ten years and have paid Medicare taxes. Medicare Part A helps cover hospitalization, skilled nursing facility, home health care, and hospice costs. If you are not eligible for premium-free Part A because you have not worked and paid Medicare taxes, but are a citizen with permanent residency and are 65, you can pay premiums to have Part A coverage. If your spouse has worked long enough to qualify for premium-free Part A, your Part A premiums will be free after your spouse turns 62.

    When you meet the requirements for Part A, you also qualify for Medicare Part B which helps cover medical out patient costs such as doctors visits, urgent care, durable medical equipment , some preventive care, and more. If you have Part B, there is a monthly premium you pay, which is $148.50 for 2021, and an annual deductible of $203.

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