Wednesday, June 19, 2024

Is Everyone Eligible For Medicare

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Reasons To Delay Medicare

LACERS Medicare Requirements

If youre thinking about deferring Medicare, discuss the pros and cons with your current insurer, union representative, or employer. Its important to know how or if your current plan will work with Medicare, so you can choose the most comprehensive overage possible.

Some of the common reasons you may want to consider deferring Medicare include:

  • You have a plan through an employer that you want to keep.

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.

What Is The Medicare Eligibility Age

For just about everyone, the Medicare eligibility age is 65. At that point, youll have access to Medicare Part A and are able to purchase Medicare Part B. For some with disabilities or End Stage Renal Disease, though, eligibility may come at a younger age. Most people are eligible to receive part A without having to pay for it, but there are a few exceptions, which well note in further detail below. For help with healthcare planning and other questions about finances and retirement, consider working with a financial advisor.

Also Check: When Is Open Enrollment For Medicare Supplement Plans

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

Sign Up: Within 8 Months After Your Family Member Stops Working

Who is Eligible for Medicare?
  • If you have Medicare due to a disability or ALS , youll already have Part A .
  • Youll pay a monthly premium for Part B , so you may want to wait to sign up for Part B.

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 until you turn 65. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?

Also Check: Does Medicare Pay For Mens Diapers

Social Security Section 218

Under the Social Security Administration , Section 218 is a provision that allows states to provide retirement and healthcare coverage to local or state employees. This includes either a combination of Social Security and Medicare coverage or just Medicare alone.

So, how do you know if youre eligible for these benefits? The qualifications are based solely on specific job descriptions. You must be a public employee of either a state or local government, which applies to many first responders.

Currently, all 50 states, Puerto Rico, the Virgin Islands, and approximately 60 interstate instrumentalities have a Section 218 agreement with the SSA to provide Medicare coverage.

What Happens If You Enroll In Part D Late

If you dont enroll in Part D when youre first eligible and you didnt have other drug coverage for 63 consecutive days, Medicare may charge a penalty when you enroll, adding it to your monthly premium. Part D premiums vary by plan.

If youre concerned about drug coverage costs, Medicare has a program called Extra Help for people with limited incomes. There is no Part D penalty if you get Extra Help.13

Also Check: What Does Original Medicare Mean

Who Is Eligible For Medicare Part B

Part B medical insurance, the second piece of Original Medicare, covers outpatient services, such as doctors visits, lab work, and preventive care.

Here are the eligibility requirements to enroll in Medicare Part B.

  • If youre entitled to Part A with no monthly premiums, then you qualify for Part B when youre eligible for Part A.
  • If you have to buy Part A, then you can get Part B if:
  • Youre an American citizen who lives in the country or a permanent resident who has lived here for five or more continuous years, and
  • Youre 65 or older or under 65 and qualify for Medicare due to having a disability, ESRD, or ALS.

Your enrollment period for Part B is the same as Part A: during your Initial Enrollment Period when you first qualify for Medicare, or during the General Enrollment Period .

Am I Eligible For Medicare Part A

Medicare and the Health Insurance Marketplace

Generally, youre eligible for Medicare Part A if youre 65 years old and have been a legal resident of the U.S. for at least five years. In fact, the government will automatically enroll you in Medicare Part A at no cost when you reach 65 as long as youre already collecting Social Security or Railroad Retirement benefits.

If youre already receiving Social Security or Railroad Retirement benefits, all you need to do is check your mail for your Medicare card, which should automatically arrive in the mail about three months prior to your 65th birthday . The card will arrive with the option to opt-out of Part B , but opting out of Part B is only a good idea if youre still working and have employer-sponsored coverage that provides the same or better coverage, or if your spouse is still working and you have coverage under their plan.

If youre not already receiving Social Security or Railroad Retirement benefits, youll need to enroll in Medicare during a seven-month open enrollment window that includes the three months before the month you turn 65, the month you turn 65, and the three following months. If you enroll before the month you turn 65, your benefits will start the month you turn 65 . If you enroll in the three months after you turn 65, your coverage could have a delayed effective date.

In addition to turning 65, people can become eligible for Medicare due to a disability , or due to end-stage renal disease or amyotrophic lateral sclerosis .

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Can First Responders Get Medicare

The term first responder can mean different things to different people. For the purposes of Medicare eligibility and the proposed legislation, a first responder includes people with the following jobs:

  • firefighter
  • emergency medical technician or paramedic

If youre in one of these occupations, you may have specific health concerns, including:

  • exposure to asbestos or other dangerous chemicals or substances
  • lung disease
  • certain cancers

First responders generally receive the same benefits as everyone else while actively employed. But when active employment ends, healthcare coverage ends as well. Plans like COBRA can help for a limited amount of time, but theyre often very expensive.

What If You Worked 10 Years Or Less

Most people will qualify for coverage by paying Medicare and Social Security taxes for 10 years through any combination of employers. Youll need to have spent 10 years doing taxable work to enroll in Medicare Part A for free. If youve worked for less than 10 years in the US, youll need to pay monthly premiums for Medicare Part A.

However, if your spouse who is 62 or older has enough quarterly credits or receives Social Security benefits, then youll still qualify. You may also be able to qualify based on your spouses work record if youre widowed or divorced.

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C Plans Are An Alternative To Original Medicare

Medicare Advantage plans provide Part A and Part B benefits. Most plans have built-in Part D prescription drug coverage. Some also offer other benefits, such as vision and dental coverage. You must continue to pay your Part B premium when you join Medicare Advantage.

There are specific times when you can enroll in Medicare Advantage. These include:

  • Your Initial Enrollment Period , which starts three months before your 65th birthday and ends three months afterward.
  • The annual Open Enrollment Period from October 15 to December 7, when you can switch between Original Medicare and Medicare Advantage.12
  • The Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year. If youre already enrolled in a Medicare Advantage plan, you can switch to a different one or drop your plan and return to Original Medicare.

Medicare Eligibility At 65 And Older

What You Need To Know About Medicare Eligibility at 65

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

Read Also: How Do I Find My Medicare Card Number Online

Things Everyone Should Know About Medicare

Almost all Americans who work pay into the Medicare system, but not everyone knows about the benefits they will become eligible for when they turn 65. Here’s a look at the valuable health insurance you will get in retirement:

Tax rate. Most workers pay 1.45 percent of their earnings into the Medicare trust fund, and companies pay a matching 1.45 percent per employee. Self-employed workers pay 2.9 percent of their earned income into the trust fund. Beginning in 2013, the Affordable Care Act enacted an additional Medicare tax equal to 0.9 percent of earnings over $200,000 for individuals and $250,000 for couples.

Premium costs. Most retirees don’t pay a premium for Medicare Part A hospital insurance. The standard premium amount for Medicare Part B medical insurance is $104.90 per month in 2013, but retirees who earn more than $85,000 pay higher premiums.

Other out-of-pocket expenses. Just as with private health insurance, Medicare has deductibles, copays and coinsurance. The Part B deductible is $147 in 2013, after which Medicare typically pays 80 percent of the Medicare-approved amount of the service. There’s no annual limit on what you might need to pay out-of-pocket.

What is not covered. There are a variety of medical services commonly used by older people that Medicare doesn’t cover, including routine dental or eye care, dentures and hearing aids. Medicare also does not cover extensive long-term care in a nursing home or assisted living facility.

Read more on U.S. News

Other Ways To Get Medicare Coverage At Age 65

If you dont qualify for premium-free Medicare Part A coverage, you may still be eligible to buy coverage.

You still have to be a U.S. citizen or a permanent resident for at least five years.

Other Medicare Eligibility Options

  • You can pay premiums for Medicare Part A hospital insurance. These vary on how long you have worked and paid into Medicare. If you continue working until youve totaled 10 years of paying into the system, you wont have to pay premiums anymore.
  • 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. This is the same as anyone else would pay depending on 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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Medicare Eligibility Due To A Disability

If you have been receiving SSDI benefits for more than 24 months, often known as the two-year waiting period, you may be eligible for Medicare as a result of your disability. The two-year waiting period begins the month you receive your first SSDI payment. At the start of the 25th month, following the receipt of an SSDI check, you will be automatically enrolled in Medicare.

If you receive SSDI as a result of Amyotrophic Lateral Sclerosis or ALS, Medicare coverage begins the month automatically after your SSDI benefits begin. You do not have to wait two years.

Not Medicare, but Social Security determines whether you qualify for SSDI benefits and runs the program that distributes them. It is recommended that you contact your local Social Security Administration office for additional information about the Social Security Disability Insurance program.

Railroad employees should contact the Railroad Retirement Board for information on disability annuities and eligibility for Medicare.

Medical Conditions And Disabilities

New Primary Care for Adults with Medicare with Oak Street Health’s Laolu Fayanju, MD

If you have certain disabilities, you may be eligible for premium-free Medicare Part A benefits even if youre under 65 years old.

Social Security Disability Insurance recipients

If you have a disability and have been receiving SSDI benefits for at least 24 months , you will automatically be enrolled in premium-free Medicare at the beginning of the 25th month.


If your doctor has diagnosed you with ESRD and youve received a kidney transplant or youre on dialysis, you qualify for Medicare benefits if one of the following criteria applies:

  • you qualify for Social Security retirement benefits
  • you qualify for Railroad Retirement Board benefits
  • your spouse or parent worked long enough to be eligible for Social Security retirement benefits

When you become eligible for Medicare benefits depends on whether you receive dialysis at home or in a treatment facility:

  • If youre receiving dialysis in your home, you can apply for Medicare the first day you begin your dialysis program. You need to be sure to apply before the third month of treatment.
  • If you receive dialysis in a treatment facility, you can apply for Medicare on the first day of the fourth month of your treatment.

If youre scheduled to receive a kidney transplant, you can apply for Medicare on the first day of the month youre admitted to the hospital to start preparing for the transplant. But if your transplant is delayed, your Medicare benefits wont start until 2 months before the month your transplant takes place.

Read Also: When Does Medicare Part D Start

How Do You Receive Your Medicare Benefits When You Meet Medicare Eligibility Requirements At Age 65

If you meet Medicare eligibility requirements and you have received Social Security benefits for at least four months prior to turning age 65, you will typically get Medicare Part A and Part B automatically the first day of the month you turn age 65.

If youre not enrolled in Original Medicare automatically, you may need to file an application with the Social Security Administration. You can enroll in Medicare Part A and Part B during the period that begins three months before your 65th birthday month, includes your birthday month and ends three months after your birthday month.

Note: You have a choice if you want to keep or refuse enrollment in Medicare Part B. If you refuse it, you dont lose your Medicare Part B eligibility. However, you may have to wait for a valid enrollment period before you can enroll. You may also have to pay a late enrollment penalty for as long as you have Medicare Part B coverage.

Do I Automatically Get Medicare When I Turn 65

If you get Social Security and Medicare, you could be eligible for automatic enrollment. Automatic enrollment wont apply to those that buy Part A.

Those that need to buy Part A MUST apply through the Social Security Administration. You may enroll in Medicare for a monthly premium, during an enrollment period.

Your first enrollment period is the Initial Enrollment Period this is the best time to sign up, especially if you dont have coverage.

If you have an employer group plan, you may delay enrollment. First, talk to the benefits administrator where you work to be sure Medicare isnt primary at age 65.

When you miss your enrollment period and dont qualify for the Special Enrollment Period, youll apply for Medicare during the General Enrollment Period.

Those that get Part B during the General Enrollment Period will likely face a late enrollment penalty.

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