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.
How Do I Become Eligible For Medicare Advantage
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.
Taking Medicare But Not Social Security
It is possible to enroll in Medicare coverage but delay taking your Social Security retirement benefits. For many workers, this strategy is the most financially advantageous.
For most older people, it is a good idea to enroll in all parts of Medicare coverage they plan to use as soon as they are eligible at age 65. If you delay enrolling, Medicare Part D may become more expensive. If you delay signing up for Part B, you may also experience a gap in your coverage or have to pay a late enrollment penalty.
However, if you can afford to, it is often a smart financial decision to delay receiving Social Security benefits until at least your full retirement age in order to increase the benefit you receive. This may mean that there are several years during which you are enrolled and covered by Medicare but not yet receiving your monthly Social Security benefit.
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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.
Who Is Eligible For Medicare And Medicaid
Medicare and Medicaid are two different government-run programs. They are operated and funded by various parts of the government and primarily serve different groups.
- Medicare is a federal program that provides health coverage if you are more than 65 years old or are under 65 and have a disability, regardless of your income.
- Medicaid is a state and federal program that gives health insurance if you have a very low income.
- If you are qualified for both Medicare and Medicaid , you can have both. They will work together to provide you with health coverage and lower your costs.
Moreover, keep in mind that while Medicare and Medicaid are both health insurance programs that are federally supported, there are differences in covered services and cost-sharing. You can call 1-800-MEDICARE or get in touch with your local Medicaid office to learn more about Medicare and Medicaid costs and coverage, especially if you are dual-eligible.
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Younger Than Age : Who Is Eligible For Medicare
As long as you meet the citizenship/legal residence requirements described above, you may be eligible for Medicare when you are younger than age 65 if one of the following circumstances applies to you:
- You have been receiving Social Security disability benefits for at least 24 months in a row
- You have Lou Gehrigs disease
- You have permanent kidney failure requiring regular dialysis or a kidney transplant. This condition is called end-stage renal disease .
Read more details about enrollment in Medicare when youre under 65.
Get Answers To Your Medicare Questions And Enroll In A Plan
If you have further questions about Medicare eligibility, contact a licensed insurance agent today. A licensed agent can help answer your questions and help you compare Medicare Advantage plans that are available where you live.
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About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
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.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare has neither reviewed nor endorsed this information.
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What Are The Medicare Prescription Drug Coverage Options
All Part D and prescription drug plans are offered through private insurance. Availability varies by state.
The right plan for you depends on your budget, medication costs, and what you want to pay for premiums and deductibles. Medicare has a tool to help you compare plans in your area looking ahead to 2020.
- Part D. These plans cover prescription medications for outpatient services. All plans have to offer some basic level of drug coverage based on Medicare rules. Specific plan coverage is based on the plans formulary, or drug list. If your doctor wants a drug covered thats not part of that plans list, theyll need to write a letter of appeal. Each nonformulary medication coverage decision is individual.
- Part C . This type of plan can take care of all your medical needs , including dental and vision coverage. Premiums might be higher and you might have to go to network doctors and pharmacies.
- Medicare supplement .Medigap plans help pay for some or all out-of-pocket costs like deductibles and copays. There are 10 plans available. You can compare the rates and coverage with your original Medicare coverage gap and premiums. Choose the best option to give you maximum benefits at the lowest rates.
New Medigap plans dont cover prescription drug copays or deductibles. Also, you cant buy Medigap insurance if you have a Medicare Advantage plan.
Am I Eligible For Medicare Part B
When you receive notification that youre eligible for Medicare Part A, youll also be notified that youre eligible for Part B coverage, which is optional and has a premium for all enrollees.
Part B costs $148.50/month for most enrollees in 2021, although Part B costs more if your income is more than $88,000 . For 2022, the standard Part B premium is projected to be $158.50/month, and the high-income threshold is projected to increase to $91,000 for a single individual and $182,000 for a couple.
Its important to enroll in both Part A and Part B. You have an enrollment window that runs for seven months . And while you can enroll in the three months following your 65th birthday, its best to enroll in Part B early, or you could have gaps in health coverage. If you wait too long, you could end up locked out of Part B and have to wait until the next general Medicare enrollment period.
If you dont enroll during your initial window, you wont lose eligibility for Part B, but you will be penalized with an increased premium when you eventually enroll, which climbs 10% for each year that youre eligible but dont enroll in Part B . The General Enrollment Period for Medicare A and B runs from January 1 to March 31 each year, for coverage effective July 1 with an increased premium if the late enrollment penalty applies.
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What Age Can I Get Medicare
If you are 65 years old or more, you are eligible 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.
- You are getting Social Security or Railroad Retirement benefits or have worked long enough to be qualified for those benefits but are not yet collecting them.
- You or your husband/wife is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.
If you are younger than 65, you may still be qualified. You are eligible for full Medicare benefits if you are less than 65 years old if:
- You have been getting to Social Security Disability benefits for at least 2 years
- You get a disability pension from the Railroad Retirement Board and meet specific conditions
- You have Lou Gehrigs disease, also called amyotrophic lateral sclerosis , which makes you immediately eligible
- You have permanent kidney failure for which you need regular dialysis or a kidney transplant and you or your spouse has paid Social Security taxes for a certain period, based on your age.
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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Preparing As The Eligibility Age Nears
If a person already receives benefits from the Social Security Administration, the Administration will automatically enroll them in Medicare parts A and B.
The person will receive a âWelcome to Medicareâ packet 3 months before their 65th birthday, with instructions on how to sign up.
A person does not have to be retired to receive Medicare. If a person is not currently receiving Social Security benefits, they can apply for Medicare benefits as early as 3 months before their 65th birthday.
For example, if a person turns 65 years of age in April, they can apply for Medicare benefits in January of the same year.
Applying for Medicare benefits as early as possible may help the Social Security office process the paperwork in time for the personâs 65th birthday.
People who apply too late may face a premium 10% higher than that of those who apply on time. This premium would apply for double the time a person has been eligible but did not apply.
A person can apply for Medicare during their birth month or up to 3 months after their birth month without having to pay penalties for Medicare coverage.
However, their benefits will not begin until the Centers for Medicare and Medicaid Services process their request.
Medicaid The Underinsured The Uninsured
Having health insurance does not always mean you can afford to use it. There may be expensive deductibles to pay out of pocket before your insurance coverage kicks in. When insurance does pay for services, you could still be left to pay copays or coinsurance .
Not everyone is fortunate enough to afford health insurance. As many as 17% of adults between 60 and 64 are on Medicaid, and 8% are uninsured. States where Medicaid expansion did not occur tend to have higher rates of uninsured people.
Unfortunately, many people delay care due to concerns over cost. In 2019, 9.1% of people delayed getting the care they needed, and 8.3% chose not to get care at all. When it came to people who did not have insurance, those rates increased to 32.2% and 30.4%, respectively.
A study in the journal Cancerlooked at a national database of cancer diagnoses from 2014 to 2016. The researchers focused on uninsured adults between 61 and 64 years old and compared them to insured adults on Medicare from 65 to 69 years old.
Interestingly, there was a significant rise in cancer diagnoses at 65 years old, especially for colon cancer and lung cancer. The implication is that people delayed care until they qualified for Medicare.
Medicare at 60 could be an option for Americans who do not qualify for Medicaid or who cannot otherwise access affordable health care.
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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.
What Else Should I Do At 65
You may have Medicare Part A and Part B automatically, but thismay not be the only coverage you want or need.
Basic Medicare has no out-of-pocket maximum and comes with copayments, coinsurance, and deductibles that could reach thousands or tens of thousands of dollars if you get very sick.
You dont get coverage for most prescription drugs through Medicare Part A and Part B. Fortunately, additional coverage is available through private insurance companies. This includes:
- Medicare Part D prescription drug coverage: you can get a stand-alone plan to go alongside Original Medicare Part A and Part B or you can get a Medicare Advantage plan that includes prescription drug coverage.
- Medicare Advantage: an all-in-one plan that includes hospital, medical, and usually prescription drug coverage. Medicare Advantage may also include extra benefits such as routine dental, routine hearing, routine vision, medical and non-medical transportation, and fitness benefits.
- Medicare Supplement : helps cover copayments, coinsurance and deductibles not covered by basic Medicare. Some Medicare Supplement plans also have out-of-pocket maximums.
You may be able to enroll in or switch Medicare Advantage plans every year. However, Medicare Supplement has only one open enrollment period in your lifetime, which is the period surrounding your 65th birthday.
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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:
If you sign up:
1 month after you turn 65
2 months after you sign up
2 or 3 months after you turn 65
3 months after you sign up
When Am I Eligible For Medicare If I Have End
If you are eligible for Medicare because you have end stage renal disease and youre on dialysis, your Medicare coverage usually will begin on the first day of the fourth month of your dialysis treatment. Your Medicare coverage may start on the first month of dialysis under certain conditions.
When you become eligible for Medicare because of ESRD you also usually can sign up for Medicare Part D prescription drug coverage. However, you may not be eligible for Medicare Advantage or Medicare Supplement . Medicare Advantage plans generally exclude people with ESRD and Medicare Supplement plans generally exclude people under 65. If you miss your Medicare Initial Enrollment Period, you can usually sign up for Medicare Part D in the Medicare Open Enrollment Period, which is October 15-December 7 each year.
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Am I Eligible For Medicare Part D
If youre eligible for Original Medicare , then youre also eligible for Medicare Part D, otherwise known as Medicare prescription drug coverage. If you choose to enroll in Part D coverage, you cannot also enroll in a Medicare Advantage Plan .
You have the option to enroll in Medicare Part D during your Initial Enrollment Period, which is when you first become eligible for Original Medicare.
However, you can also enroll later during the annual Open Enrollment Period . If you dont enroll when first eligible, however, you may have to pay a late enrollment penalty.