Is Everyone Eligible For Medicare At 65

When Your Coverage Starts

The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always starts on the first of the month.

If you qualify for Premium-free Part A: Your Part A coverage starts the month you turn 65.

Part B : Coverage starts based on the month you sign up:

Medicare Eligibility At Age 65

• You are at least 65 years old
• You are a U.S. citizen or a legal resident for at least five years

In order to receive premium-free Part A of Medicare, you must meet both of the above requirements and qualify for full Social Security or Railroad Retirement Board benefits, which requires working and paying Social Security taxes for at least 10 full years .

Learn more about Medicare eligibility at and before age 65 by referring to this helpful chart and reading more information below.

I Am Turning 65 Next Year When Can I Sign Up For Medicare

If you are eligible for Medicare, your initial enrollment period for Part A and Part B begins three months before the month of your 65th birthday and ends three months after it. For example, if your 65th birthday is in June, your enrollment period will extend from March 1 through September 30. If you join during one of the 3 months before you turn 65, coverage will begin the first day of the month you turn 65. If you join during the month you turn 65, your coverage will begin the first day of the month after you turn 65. If you join in the month after you turn 65, coverage will begin 2 months later, and if you join 2 or 3 months after you turn 65, coverage will begin 3 months later. A recent change in law limits these gaps in coverage. Starting in 2023, if you enroll in Medicare during the first 3 months after your turn 65, coverage will begin the first day of the month following the month you enroll.

Once you have Part A and Part B, you are then also eligible to enroll in a Medicare Advantage plan and/or a Part D plan. If you are already receiving Social Security benefits when you turn 65, you will automatically be enrolled in Part A and Part B. If you are not already receiving Social Security benefits and you want to enroll in Medicare, you should contact Social Security.

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What If Youre Over 65

Dont worry: You can still sign up for Medicare if you didnt do so at age 65. But you may have to pay a 10% penalty on the monthly premiums for Part B for every 12-month period you didnt opt in for Medicare coverage after becoming eligible.

There is an exception, though: If you have group coverage through your employers plan or were covered through your spouses job and that coverage ends, you qualify for whats called a Special Enrollment Period . This is an 8-month period during which you can sign up for Part A and/or Part B to give you coverage starting when your or your spouses employers coverage ends.

Less commonly, if you didnt work long enough to qualify for premium-free Part A and you didnt sign up at age 65, you may have to pay a penalty for that coverage as well.6

Can You Get Private Insurance Instead Of Medicare

If you have Medicare Part A or Part B, insurers generally arent allowed to sell you a traditional individual health insurance plan .

You can purchase individual health insurance if youve never enrolled in Medicare because you think the overall costs are too high. If youre in the unusual situation of paying for Part A premiums, you can also switch to individual health insurance.

If you develop a medical condition before turning 65 that would qualify you for Medicare, such as ESRD, you can decline to purchase Medicare.

If you decide to purchase private insurance once youre eligible for Medicare unless youre continuing the employer-sponsored insurance that qualifies you for a Special Enrollment Period then youll have to pay the costly late enrollment penalty once you do apply.

If youre nearing the age of 65, then its important you start considering your Medicare coverage.

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Reaching Age 62 Can Affect Your Spouse’s Medicare Premiums

Although reaching age 62 does not qualify you for Medicare, it can carry some significance for your spouse if they receive Medicare benefits.

When one spouse in a couple turns 62 years old, the other spouse who is at least 65 years old may now qualify for premium-free Medicare Part A if they havent yet qualified based on their own work history.

• For example, Gerald is 65 years old, but he doesnt qualify for premium-free Part A because he did not work the minimum number of years required for eligibility. He can still receive Medicare Part A, but he will have to pay a monthly premium for it. In 2020, the Medicare Part A premium can be as high as $458 per month.
• Lets say Geralds wife, Jessica, reaches age 62 and has worked for the required number of years to qualify for premium-free Part A once she turns 65. Because Jessica is now 62 years old and has met the working requirement, Gerald may now receive premium-free Part A.

In the above example, Jessica has not become eligible for Medicare by turning 62. Her husband Gerald, however, is now eligible to receive his Medicare Part A benefits without paying a monthly premium any longer.

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For California residents, CA-Do Not Sell My Personal Info, .

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.

The purpose of this communication is the solicitation of insurance. Callers will be directed to a licensed insurance agent with TZ Insurance Solutions LLC, TruBridge, Inc. and/or a third-party partner who can provide more information about Medicare Advantage Plans offered by one or several Medicare-contracted carrier. TZ Insurance Solutions LLC, TruBridge, Inc., and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program.

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How To Get Medicare Part A And Part B Coverage

• If you receive SSDI for 24 months, you will automatically be enrolled in Medicare Parts A and B at the beginning of the 25th month.
• If you have ALS, you will automatically be enrolled in Medicare Parts A and B as soon as you receive the first month of SSDI benefits.
• If you have ESRD, you must apply for Medicare benefits. Medicare eligibility depends on a variety of factors, including whether or not you are receiving dialysis, have had a kidney transplant, and/or have paid Medicare taxes sufficiently.

When Do I Apply For Medicare If Im Still Working At 65

What if youre still working when you hit 65? If you qualify for Medicare, but youre not getting Social Security benefits yet, you usually dont get enrolled automatically in Medicare.

Some people decide to:

• Enroll in Medicare Part A as soon as theyre eligible. Even if your employer plan has hospital coverage, Part A is premium-free for most people. If your employer plan has hospital coverage, and you have a hospital stay, your plan and Medicare Part A will coordinate benefits to work out payment of your hospital costs.
• Delay enrollment in Medicare Part B. Theres typically a monthly Part B premium, and if youre covered by an employer plan for now, you may be able to save money by delaying enrollment in Part B.

But youll want to make sure you sign up for Medicare Part B when your employer-based coverage ends. Theres a Part B late enrollment penalty, but you can generally avoid it if you sign up for Part B during a Special Enrollment Period when your other coverage stops.

Its important to be sure about what youre doing so that you can avoid Medicare late enrollment penalties. Contact your employer- or union-based health plan administrator with any questions you have to help ensure a smooth transition to Medicare coverage.

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Who Can Delay Signing Up For Medicare

So, whose insurance remains the primary payer? In a nutshell, if you have coverage through your or your spouse’s current employment, and the employer has 20 or more employees, your insurance plan remains the primary payer.

If you aren’t sure if your employer meets the “group health coverage” criteria, ask your employer’s benefits manager.

If you do qualify, you can delay signing up for Medicare for as long as you are still working. Once the employment or your employer-based health coverage ends, you’ll have eight months to sign up for Medicare Part B without paying a penalty, which is a permanently higher premium.

It’s also important to note that regardless of whether you’re still working or not, if you’ve already signed up for Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. If you don’t want to keep Part B, you’ll need to cancel it .

Who Is Automatically Enrolled For Medicare And Who Needs To Sign Up

Some people will be automatically enrolled in Medicare Part A, which is hospital insurance, and Part B, which is medical insurance, if they meet certain criteria:

• If you’re already getting Social Security benefits or are receiving retirement benefits from the Railroad Retirement Board , you’ll automatically get Part A and Part B on the first day of the month you’ll turn 65.
• If you’ve gotten Social Security or RRB disability benefits for 24 months, you’ll automatically get Part A and Part B.
• If you have ALS , you’ll get Part A and Part B the month your disability benefits begin.

If you’re automatically enrolled, you can expect to get your Medicare card in the mail three months before you’ll be eligible for benefits. On the other hand, if you’re 65 and are not yet receiving Social Security or RRB benefits or if you qualify for Medicare because you have end-stage renal disease, you’ll need to sign up.

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When Do I Apply For Other Kinds Of Medicare Coverage

Are you thinking about signing up for a Medicare Advantage plan, a stand-alone Medicare prescription drug plan, or a Medicare Supplement insurance plan?

No matter what type of Medicare coverage you want, youll generally want to start by signing up for Original Medicare, Part A and Part B. Then, its usually a good idea to sign up for any other type of Medicare coverage you want, promptly.

Heres a quick rundown on the main Medicare coverage options you have besides Original Medicare and when to sign up.

• Medicare Advantage this program gives you an alternative way to get your Medicare Part A and Part B benefits . You need Part A and Part B to qualify, and then the plan manages those benefits for you. If you dont enroll during your Medicare Initial Enrollment Period , you might have to wait to sign up. Learn about Medicare Advantage enrollment periods.
• Stand-alone Medicare prescription drug plan you might want this type of plan if you need prescription drug coverage. You need Part A or Part B to qualify. If you dont enroll during your Medicare Initial Enrollment Period , you might have to wait to sign up. Learn about Medicare Part D enrollment periods.

Be aware that if you have a Medicare Advantage plan, it might include prescription drug coverage, so you wouldnt need a stand-alone plan. In fact, you generally cant have both a Medicare Advantage prescription drug plan and a stand-alone Part D prescription drug plan.

New To Medicare?

Getting Medicare Under The Age Of 65

Many people think of Medicare as a government health-care program for Americans and legal permanent residents who are at least 65 years old. But some people qualify for Medicare before age 65.

Here are the most common ways you may be eligible for Medicare if youre under age 65:

• You receive disability benefits from the Social Security Administration or from the Railroad Retirement Board . Youre automatically enrolled in Original Medicare, Part A and Part B, after 24 continuous months of receiving disability benefits.
• You have Lou Gehrigs disease . Youre automatically enrolled in Medicare the same month that your disability benefits start.
• You have end-stage renal disease . In this case, you may qualify for Medicare, but youre not automatically enrolled. To enroll, contact Social Security .

If you have questions about your eligibility for Medicare if youre under 65, or to enroll, you can contact Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. Representatives are available Monday through Friday, from 7AM to 7PM. Or, you can contact Medicare, or a licensed insurance agent at eHealth .

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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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

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.

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Get Someone On Your Side With Medicare

If youre able to answer the questions above, you will be equipped with the knowledge to answer whether it is mandatory to sign up for Medicare at age 65.

Medicare brings up many ifs, ands, and buts. Its easy to get lost in the chaos of it all. Thats why beginning the Medicare process is so frustrating to most.

Instead of doing a cannonball into the pool of Medicare, test the waters. Take it one step at a time and get the help of an experienced Medicare broker like Boomer Benefits. Our help is free.

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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.

How Does Medicare Work With My Job

Keep in mind that:

• Most people qualify to get Part A without paying a monthly premium. If you qualify, you can sign up for Part A coverage starting 3 months before you turn 65 and any time after you turn 65 Part A coverage starts up to 6 months back from when you sign up or apply to get benefits from Social Security .
• If you have a Health Savings Account, you and your employer should stop contributing to it 6 months before you sign up for Part A to avoid a tax penalty.

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Is Part B Of Medicare Mandatory

Medicare Part B is optional, and it covers qualified outpatient care, certain preventive care services and durable medical equipment .

Most beneficiaries pay the standard Part B premium of $170.10 per month in 2022. Some higher income-earners will pay more for their Part B coverage. This higher amount is called the Income-Related Monthly Adjustment Amount, or IRMAA.

Although Part B is optional, it is mandatory to have Medicare Part A and Medicare Part B in order to enroll in a Medicare Advantage plan or a Medicare Supplement Insurance plan.

How Do I Get Full Medicare Benefits

If youve worked at least 10 years while paying Medicare taxes, there is no monthly premium for your Medicare Part A benefits. But if you havent worked, or worked less than 10 years, you may qualify for premium-free Part A when your spouse turns 62, if she or he has worked at least 10 years while paying Medicare taxes. However, to be eligible for Medicare, you need to be 65 years old. You also need to be an American citizen or legal permanent resident of at least five continuous years.

So, to summarize with an example:

• Bob is 65 years old. Hes on Medicare, but he pays a monthly premium for his Medicare Part A benefits. He only worked for seven years and no longer works.
• His wife, Mary, has worked for over 30 years.

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