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.
Can I Get Medicare Younger Than 65
The Medicare age requirement of 65 is usually waived for people in three categories:
While most people with disabilities have to wait two years to qualify or Medicare, people with ALS and ESRD dont have the same waiting periods.
People with ALS get Medicare benefits the first month of getting disability benefits.
If you have ESRD, you Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments.
To qualify as disabled for SSDI you must be unable to engage in substantial gainful activity because of a physical or mental health problem.
Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.
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More than 125 House lawmakers introduced legislation Friday that lowers the Medicare eligibility age to 60 from 65.
The Improving Medicare Coverage Act led by Reps. Pramila Jayapal, D-Wash. Conor Lamb, D-Pa. Joe Neguse, D-Colo. and Susan Wild, D-Pa. Haley Stevens, D-Mich. and Debbie Dingell, D-Mich. would expand Medicare to at least 23 million people, the lawmakers said in a statement.
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When Should I Sign Up For Medicare
Generally, we advise people to file for Medicare benefits 3 months before age 65. Remember, Medicare benefits can begin no earlier than age 65. If you are already receiving Social Security, you will automatically be enrolled in Medicare Parts A and B without an additional application. However, because you must pay a premium for Part B coverage, you have the option of turning it down. You will receive a Medicare card about two months before age 65. If you would like to file for Medicare only, you can apply by calling 1-800-772-1213. Our representatives there can make an appointment for you at any convenient Social Security office and advise you what to bring with you. When you apply for Medicare, we often also take an application for monthly benefits. You can apply for retirement benefits online.
If you didnt sign up when you were first eligible for Medicare, you can sign up during the General Enrollment Period between January 1 and March 31 each year, unless you are eligible for a Special Enrollment Period.
What Are The Differences Between Medicare And Medicaid
Medicare is a federal health insurance program open to Americans aged 65 and older, and those with specific disabilities who are under the age of 65. Medicaid, a combined state and federal program, is a state-specific health insurance program for low-income individuals with limited financial means, regardless of their age.
Medicare, generally speaking, offers the same benefits to all eligible participants. However, coverage is divided into Medicare Part A, Part B, and Part D. Medicare Part A is for hospice care, skilled nursing facility care, and inpatient hospital care. Medicare Part B is for outpatient care, durable medical equipment, and home health care. Part D is for prescription coverage. Not all persons will elect to have coverage in all three areas. In addition, some persons choose to get their Medicare benefits via Medicare Advantage plans, also called Medicare Part C. These plans are available via private insurance companies and include the same benefits as Medicare Part A and Part B, as well as some additional ones, such as dental, vision, and hearing. Many Medicare Advantage plans also include Medicare Part D.
Medicaid is more comprehensive in its coverage, but the benefits are specific to the age group. Children have different eligibility requirements and receive different benefits from low-income adults and from elderly or disabled persons.
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Eligibility For Medicare Part C
Medicare Part C is another name for the Medicare Advantage program which is issued by private insurance companies instead of Original Medicare. You can get them from an agent, broker, or the company directly. Usually, these plans have smaller networks than Medicare, but some of them include built-in Part D coverage.
To be eligible for Part C, you must first be enrolled in both Medicare Parts A and B. You must also live in the plans service area.
Many people think that if they enroll in a Medicare Advantage plan, they can drop their Part B and escape paying Part B premiums. This is NOT the case. You must have both A and B to even be eligible to enroll in either a Medicare Advantage plan or Medigap plan. You must continue to be enrolled in Parts A and B during the entire time that you are enrolled in a Medicare Advantage plan.
When Are You Eligible To Enroll In Medicare
You can apply for Medicare during several enrollment periods.
The first, Initial Enrollment Period , includes the three months before your 65th birthday, the month of your 65th birthday and the three months after your 65th birthday.4
If you didnt apply for Medicare within the seven months surrounding your 65th birthday, the window to apply opens again at the beginning of each year, from January 1 to March 31 . But keep in mind that if you enroll during the GEP, your actual Medicare coverage wont begin until July of that year.5
If you or your spouse paid Medicare taxes for 10 years or more, youre eligible for premium-free Medicare Part A . If, though, you or your spouse worked for less than a decade, you will still qualify for Medicare but you may need to pay a monthly premium for Part A, which will be based on how long you or your spouse worked.
Everyone who enrolls in Medicare Part B is required to pay a monthly premium. The standard premium for 2021 is $148.50, those who are considered higher-income beneficiaries will pay more.
And if you opt for Medicare Part D , you may pay a premium, depending on how you get the coverage. This can be through a standalone drug plan or as part of a Medicare Advantage that includes drug coverage.
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What You Need To Know
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
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Almost everyone knows that youre eligible for Medicare after age 65, but whats not so well known is how to actually enroll and start receiving benefits. However, getting Medicare benefits doesnt have to be stressful or difficult. These steps and rules will help you navigate the Medicare enrollment experience and get the care you need.
Eligibility For Medicare Part A
Medicare Eligibility begins at age 65 for most people.
You are eligible for Medicare Part A at age 65 if you or your spouse has legally worked for at least 10 years in the U.S. During those years, you paid taxes toward your Part A hospital benefits. This is why most Americans pay no Part A premiums when they become eligible for Medicare. Part A mainly covers your hospital stays. If you have worked and paid taxes in the US then you will be issued Medicare Part A automatically. Even if you are employed with a company with over 20 employees it makes perfect sense to have this benefit.
If you have not worked and paid taxes the required 10 years, Part A may be available for you to purchase. You can call Social Security at 1-800-772-1213, or visit your local Social Security office for more information about buying Part A.
Find out about your Medicare Eligibility
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Medicare Vs Medicaid Compare Benefits
In the context of long term care for the elderly, Medicares benefits are very limited. Medicare does not pay for personal care . Medicare will pay for a very limited number of days of skilled nursing . Medicare will also pay for some home health care, provided it is medical in nature. Starting in 2019, some Medicare Advantage plans started offering long term care benefits. These services and supports are plan specific. But they may include:
- Adult day care
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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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.
Compare Medicare Advantage plans in your area
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
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.
Three Approaches To Reform
The NASI study bit.ly/2K4Aya7 offers a fascinating in-depth look at three approaches to expanding Medicare eligibility: lowering the eligibility age, establishing Medicare for All, and creating a Medicare buy-in. The report was created by a study panel made up of 27 experts from a broad range of perspectives, such as economics, health policy, political science, sociology, medicine and law.
The report draws some surprising conclusions about the practicality of actually executing these approaches. Yes, Medicare for All might be the toughest putt from a political standpoint – but the optional buy-in – which sounded great rolling off the tongues of moderate candidates like Pete Buttigieg – actually is the most difficult to execute.
A lot of people think that Medicare for All sounds nice, but that it is aspirational and very difficult, if not impossible to do in practice, said Moon. And the buy-in just sounds like its not a big change. But we quickly realized that the buy-in was very complicated, because you take a complicated program like Medicare, which has a lot of moving parts, and then the even more complex Affordable Care Act structure and you try to marry the two in some way. Its very difficult to do.
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Signing Up For Premium
You can sign up for Part A any time after you turn 65. Your Part A coverage starts 6 months back from when you sign up or when you apply for benefits from Social Security . Coverage cant start earlier than the month you turned 65.
After your Initial Enrollment Period ends, you can only sign up for Part B and Premium-Part A during one of the other enrollment periods.
Can A 62 Year Old Get Medicaid
Yes. Medicaid qualification is based on income, not age. While Medicaid eligibility differs from one state to another, it is typically available to people of lower incomes and resources including pregnant women, the disabled, the elderly and children.
Learn more about the difference between Medicare and Medicaid.
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Whathappens When A Qualifying Spouse Is Younger
A person is eligible for Medicare Part A if they or their spouse have paid Medicare taxes for at least 40 quarters of work.
This might become more challenging when an older adult with a younger spouse did not work 40 quarters but their spouse did.
If a younger spouse worked for 40 quarters, they can qualify their partner for Medicare coverage once they reach 62 years of age and the older, nonworking spouse reaches 65 years of age.
If a person reaches 65 years of age, did not pay Medicare taxes for 40 quarters, and has a spouse under the age of 62 years, they may have to pay for their Medicare Part A benefits until their qualifying spouse reaches 62 years of age.
Automatic Enrollment: Who Gets It
While most people have to apply for Medicare, if you already receive Social Security or Railroad Retirement Board benefits, you will be automatically enrolled in Medicare Parts A and B. It will go into effect on the first day of the month of your 65th birthday . Your Medicare card should be sent to you three months before your birthday, and the only action you should take is to stick your card into your wallet or purse unless you wish to enroll in Parts C or D as well. Other information on decisions you need to make will be mailed to you in a package.
People under the age of of 65 who have had a disability that qualifies them Social Security or Railroad Retirement benefits for 24 months or more are automatically enrolled in Parts A and B of Medicare, with coverage beginning on the 25th month of eligibility and your card arriving in the mail three months before that. People with Lou Gehrigs disease get their benefits on the same month that Social Security or Railroad Retirement benefits begin.
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Medicare Eligibility For Medicare Advantage Before 65
After youre enrolled in Original Medicare, you may choose to remain with Original Medicare or consider enrollment in a Medicare Advantage plan offered by a private, Medicare-approved insurance company.
Medicare eligibility for Medicare Part C works a little differently. Youre eligible for Medicare Advantage plans if you have Part A and Part B and live in the service area of a Medicare Advantage plan. If you have End Stage Renal Disease , you usually cant enroll in a Medicare Advantage plan, but there may be some exceptions, such as a Medicare Advantage plan offered by the same insurance company as your employer-based health plan, or a Medicare Special Needs Plan .
When you enroll in a Medicare Advantage plan, youre still in the Medicare program and need to pay your monthly Medicare Part B premium and any premium the plan charges. The Medicare Advantage program offers an alternative way of receiving Original Medicare coverage but may offer additional benefits. For example, Original Medicare doesnt include prescription drug coverage or routine dental/vision care, but a Medicare Advantage plan may include these benefits and more. Benefits, availability and plan costs vary among plans.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
Medicare At Age 60 Dems Debate A Major Change
Democrats are reportedly debating the possibility of lowering the eligibility age for Medicare as part of their $3.5 trillion spending package currently under construction in Congress.
Lowering the Medicare eligibility age to 60 was not included in the budget blueprint Democrats released last week, although the idea was endorsed by then-presidential candidate Joe Biden in the spring of 2020. Progressive lawmakers, including Senate Budget Committee Chair Bernie Sanders , have long supported the proposal.
Adding the age change would increase the cost of the overall spending package by about $200 billion, Axioss Hans Nichols reports, which could force lawmakers to find new sources of revenue or cuts in other programs.
Determining the final cost will be difficult, though, until lawmakers provide additional details, including how long they plan to fund the program.
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