Who Is Eligible For Medicare
Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease . Medicare has two parts, Part A and Part B . You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:
- You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
- You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
- You or your spouse had Medicare-covered government employment.
To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.
If you did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:
- You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
- You are a kidney dialysis or kidney transplant patient.
While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.
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- Most people dont have to pay a premium for Part A . So, you might want to sign up for Part A when you turn 65, even if the active duty service member is still working.
- Youll pay a monthly premium for Part B , so you might 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 for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
Do I Qualify For A Medicare Special Enrollment Period
Perhaps, if you or your spouse is still working and you have health insurance from that employer. The special enrollment period allows you to sign up for Medicare Part B throughout the time you have coverage from your or your spouses employer and for up to eight months after the job or insurance ends, whichever occurs first.
If you enroll at any point during this time, your Medicare coverage will begin the first day of the following month. And you will not be liable for late penalties, no matter how old you are when you finally sign up.
Your decision also depends on the size of your employer and whether the employers plan is first in line to pay your medical bills or second.
Larger companies. If you or your spouse work for a company with 20 or more employees, you can delay signing up for Medicare until the employment ends or the coverage stops, whichever happens first. These large employers must offer you and your spouse the same benefits they offer younger employees and their spouses, which means that the employers coverage can continue to be your primary coverage and pay your medical bills first.
Many people enroll in Medicare Part A at 65 even though they have employer coverage, because its free if they or their spouse has paid 40 or more quarters of Medicare taxes. But they often delay signing up for Part B while theyre still working so they dont have to pay premiums for both Medicare and the employer coverage.
Keep in mind
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Does Having Parts A And B Mean Im Precluded From Coverage Under Part D
If you have only Part A coverage, you may be able to continue that coverage under Medicare Part D. However, if you also have Part B coverage, you will likely be precluded from receiving coverage through Part D. This is because Medicare Part D is a drug plan specifically for seniors and people with disabilities.
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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.
When Would My Medicare Coverage Start
If you enroll during the first three months of your IEP, your Medicare coverage begins on the first day of the month you turn 65 or the first day of the previous month if your birthday falls on the first day of a month.
If you sign up for Part B during the fourth month your birthday month coverage begins the first day of the following month.
If you dont enroll in Part B until later, in the fifth, sixth or seventh month of the IEP, coverage will be delayed by two or three months. However, those rules change in 2023, when the coverage will take effect the next month when you enroll after your birthday month.
You can sign up for premium-free Part A any time after your IEP starts. Your coverage will take effect six months retroactively, but no earlier than the month you turn age 65.
The best way to sign up for Medicare during your initial enrollment period is online at the Social Security website.
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At What Age Can You Get Medicare
You are eligible for Medicare when you turn 65. You may be working, not working or retired. You may or may not be receiving Social Security or other retirement benefits. As far as Medicare eligibility goes, your age is what matters.
Key word your. Medicare is individual insurance. Its your age that counts, not your spouses, even if you are both covered by the same employer insurance when one of you turns 65.
Also, Medicare is separate from Social Security benefits, and there are different eligibility requirements for each. The age for Medicare eligibility is 65. The age for full Social Security benefits depends on what year you were born.
Are You Automatically Enrolled In Medicare
You may be enrolled automatically in Original Medicare if you qualify under these two scenarios:
Contact Medicare by phone three months before your scheduled start date to make sure the correct enrollment options are in process.
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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.
What Is Medicare Advantage Also Known As Medicare Part C
Medicare Advantage is a type of health insurance provided by private insurance companies to U.S. adults ages 65 and up, as well as younger individuals with certain disabilities and health conditions. The federal government pays a flat fee per enrollee to the insurance companies, which then provide the core benefits of Original Medicare, payment to care providers and oftentimes additional benefits.
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When Does Medicare Kick In If You Enroll During The Initial Enrollment Period
For most people, it is best to sign up for Original Medicare during your seven-month Initial Enrollment Period. This enrollment period begins three months before you turn 65 and ends three months following your 65th birthday.
If you enroll in advance, benefits will begin on the first day of the month you turn 65. If you receive Social Security benefits, your coverage will automatically start on the first day of your birth month.
However, if you must enroll yourself, you will need to make sure you apply at least one month before your birth month for coverage to begin on time.
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If you enroll during your birth month or in the three months following, your Medicare will start on the first day of the month following your application.
Once you enroll in Original Medicare, you can sign up for a Medicare Part C or a Medigap plan and Medicare Part D.
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.
Medicare Phone Number: Speaking To A Person At Medicare
Sometimes, it may be preferable to speak with someone at Medicare. The Medicare phone number is 800-MEDICARE, or 800-633-4227. A deaf or partially deaf person may call 877-486-2048.
An individual may call Medicare with questions about coverage, medical records, claims, billing, and expenses.
In addition to speaking with Medicare over the phone, individuals may acquire much of the information they need through two websites.
This article provides an overview of Medicare, explains what to expect when calling Medicare, and discusses alternate contact methods and contact methods for people with specific needs. Lastly, it examines non-Medicare sources for Medicare information.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare is the federal insurance program for individuals who are aged 65 and older, along with some younger people who have specific health conditions. It also provides coverage for a person of any age with end stage renal disease.
Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
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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.
Changing Or Canceling Your Plan
Life is full of twists and turns. You could be faced with new health challenges. Your financial situation could change if you retire or lose your job. Your insurance company could make changes to your plan. All of these things could affect how much prescription drug coverage you need and how much you can afford.
You may need to consider changing your Part D plan. The good new is you are not stuck with the same Part D plan forever. You have choices. The trick is to know when to make those changes.
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Medicare Part B Premiums
For Part B coverage, youll pay a premium each year. Most people will pay the standard premium amount. In 2022, the standard premium is $170.10. However, if you make more than the preset income limits, youll pay more for your premium.
The added premium amount is known as an income-related monthly adjustment amount . The Social Security Administration determines your IRMAA based on the gross income on your tax return. Medicare uses your tax return from 2 years ago.
For example, when you apply for Medicare coverage for 2022, the IRS will provide Medicare with your income from your 2020 tax return. You may pay more depending on your income.
In 2022, higher premium amounts start when individuals make more than $91,000 per year, and it goes up from there. Youll receive an IRMAA letter in the mail from SSA if it is determined you need to pay a higher premium.