What Are My Insurance Options If I Cannot Get Medicare At Age 62
If you dont qualify for Medicare, you may be able to get health insurance coverage through other options:
- Employer-provided insurance
LeRon Moore has guided Medicare beneficiaries and their families as a Medicare professional since 2007. First as a Medicare provider enrollment specialist and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.
Moore holds a bachelors degree from Southern New Hampshire University and is A+ Certified with a Medical Records Clerk Certification and Medical Terminology Certification from Midlands Technical College.
Hes passionate about educating, informing, and resolving issues concerning Medicare and Medicare Advantage Plans, and considers it imperative that he does all he can to educate and inform the senior community as much as possible about Medicare.
You Can Receive Medicare Without Taking Your Social Security Benefits
Medicare and Social Security aid older Americans and their spouses who paid into the programs through FICA taxes during their working years.
Medicare provides both free and cost-effective health insurance coverage for eligible older adults who are 65 years of age or older. Social Security retirement benefits act as a small pension, providing monthly income to those eligible as early as age 62.
Even if you are eligible to start receiving benefits, you do not have to start taking them. In some cases, it may be better to delay or to start taking benefits from one program but not the other.
Will I Be Enrolled In Medicare Automatically
You will generally be automatically enrolled in Medicare if:
- Youâre receiving Social Security retirement benefits when you turn 65.
- Youâre younger than 65 and youâve been getting Social Security disability benefits for 24 months. Youâll typically be enrolled in Medicare in the 25th month of getting these benefits.
- Youâre younger than 65 and have amyotrophic lateral sclerosis , also known as Lou Gehrigâs disease. Youâre automatically signed up for Medicare the same month your Social Security disability benefits start
You typically have to sign up for Medicare yourself if:
- Youâre not yet receiving Social Security retirement benefits when you turn 65.
- Youâre under 65 and have end-stage renal disease, a type of kidney failure. You might qualify for Medicare at any age, but you are not signed up automatically.
- You live in Puerto Rico. You may be automatically enrolled in Medicare Part A when you turn 65, but youâll need to sign up for Part B.
You might have to pay a late enrollment penalty if you donât sign up for Medicare when youâre first eligible. Learn more about the late enrollment penalties.
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Who Is Eligible To Receive Medicare Benefits
Two groups of people are eligible for Medicare benefits: adults aged 65 and older, and people under age 65 with certain disabilities. The program was created in the 1960s to provide health insurance for senior citizens. Older Americans had trouble finding affordable coverage, which spurred the government to create a program specifically for this portion of the population. Its an entitlement program in that the federal government finances it to some degree, but its also supported and financed directly by the very people who use it. Youre eligible for Medicare because you pay for it, in one way or another.
To receive Medicare benefits, you must first:
- Be a U.S. citizen or legal resident of at least five continuous years, and
- Be entitled to receive Social Security benefits.
That means that every U.S. citizen can enroll in Medicare starting at age 65 . When we say Medicare, were referring to original Medicare. This comprises Parts A and B. Part A covers hospital care while Part B covers medical care. There are four parts to the program Part C is a private portion known as Medicare Advantage, and Part D is drug coverage. Please note that throughout this article, we use Medicare as shorthand to refer to Parts A and B specifically.
To qualify for Medicare based on ESRD, you first need to meet the following qualifications:
Who Qualifies For Medicare Part C
Medicare Part C is an alternative way to get your Medicare Part A and Part B benefits. Medicare Advantage plans are available through Medicare-approved private insurers. To be eligible for Medicare Part C, you must already be enrolled in Medicare Part A and Part B, and you must reside within the service area of the Medicare Advantage plan you want. You can get more information about and enroll in a Medicare Advantage plan by contacting a licensed insurance agent or broker, such as eHealth.
The Medicare Advantage plan Initial Coverage Election Period is generally the same as the Initial Enrollment Period for Medicare Part A and Part B . Or, you can sign up during the Annual Election Period from October 15 to December 7 for coverage effective January 1 of the following year. You can also enroll during a Special Election Period , if you qualify.
Please note: If you have end-stage renal disease , hereâs a change you may want to know about. Starting in 2021, you may qualify for a Medicare Advantage plan if you have end-stage renal disease and meet the usual requirements listed below.
Medicare Part C is optional, and there is no penalty for not signing up. But you must have Medicare Part A and Part B to get Part C, and live in the service area of a Medicare Advantage plan.
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Medicare Eligibility At 65 And Older
You can apply for Medicare the year you turn 65, but you generally must meet three eligibility requirements to qualify for full Medicare benefits at this age.
The chief requirement is that you must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years.
In addition, you must 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 you have worked for at least 10 years. You must be eligible for these 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.
If you pay Medicare payroll taxes for 10 full years, 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, and Medicare Part D, which covers prescription drugs. Everyone pays premiums for both regardless of work history.
If you are still working at 65, you dont have to sign up for Medicare but there are benefits to signing up while still employed. Similarly, if you have never worked, you can still get Medicare. It may be more expensive depending on your spouses work history.
Who Qualifies For Medicare Part D
Medicare Part D covers prescription drugs and, like Medicare Part C, is available through private insurers that are approved by Medicare. To be eligible to enroll in a Medicare Part D prescription drug plan , you must have Medicare Part A and/or Part B and you must live in the service area for the prescription drug plan in which you want to enroll. To be eligible to enroll in a Medicare Advantage plan with prescription drug coverage , you must have Medicare Part A and Part B, and you must live in the service area for the MAPD plan youâre considering.
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What If I’m Still Working And I’m Covered Through My Employer’s Health Insurance
In most cases, you don’t have to enroll in Medicare if you’re still working and covered by your employer’s plan. That is, you won’t pay a penalty in the form of higher premiums if you wait until you stop working to enroll in Medicare.
However, because most people pay no premiums for Part A, it costs you nothing to enroll right away, even though you may not need the coverage right away.
If your company has 20 or more employees, your employer coverage is primary that is, it pays claims first. If your company has fewer than 20 employees, Medicare pays first.
When you do stop working, you have 8 months to enroll in Medicare Part B and 63 days to enroll in Medicare Part D after your employment ends. Any later than that and your premiums may be higher when you do enroll.
Note: If you defer your enrollment in Part D, you will need to provide proof that your employer’s prescription drug coverage is “creditable.” To do this, you submit a Creditable Coverage Certificate, which your employer group is required to provide.
Your Medicare Special Enrollment Period
If your employer has at least 20 employees and youre still working and covered under that plan when you turn 65, you can delay your enrollment in Medicare . In that case, youll get an eight-month special enrollment period to sign up for Medicare if and when you leave your job or your employer stops offering coverage. It will start the month after you separate from your employer, or the month after your group health coverage ends whichever happens sooner.
Sign up during those eight months, and you wont have to worry about premium surcharges for being late. And the eight-month special enrollment period is also available if youre delaying Part B enrollment because youre covered under your spouses employer-sponsored plan, assuming their employer has at least 20 employees.
But note that in either case, it has to be a current employer. If youre covered under COBRA or a retiree plan, you wont avoid the Part B late enrollment penalty when you eventually enroll, and you wont have access to a special enrollment period to sign up for Part B youll have to wait for the general enrollment period instead.
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Other Ways To Get Medicare Coverage At Age 65
If you dont qualify for premium-free Medicare Part A coverage, you may be eligible to buy coverage. However, you must still be a U.S. citizen or a permanent resident for at least five years to qualify.
Other Medicare Eligibility Options
- You can pay premiums for Medicare Part A hospital insurance. Premium costs vary based on how long you have worked and paid into Medicare.
- 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. Your premium will be the standard rate and would depend upon 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.
The Part D Donut Hole And Catastrophic Coverage
Once you reach your yearly deductible, your out-pocket-costs for Medicare Part D will be around 25% of drug costs even in the donut hole . Theres a lot of confusion about the donut hole, because many people dont realize that, before the Affordable Care Act passed, Medicare beneficiaries were responsible for 100% of their drug costs while in the donut hole. The passage of ACA included provisions that closed that donut hole, shifting the majority of the drugs cost from the insurance company to the drug manufacturer.
Youll leave the donut hole and enter the catastrophic coverage phase once your out-of-pocket totals $4,430 in 2022. You can examine the full details here
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Medigap Eligibility In 2021
Eligibility for Medigap lasts for six months, starting from the month you turn 65 and have Medicare Part B in place. In other words, you must be 65 and enrolled in Medicare to sign up for a Medigap policy. Once youre 65 and enrolled in Part B, you have six months to enroll in Medigap without being subject to medical underwriting. During this initial eligibility window, you can:
- Buy any Medigap policy regardless of health history
- Buy a plan knowing that youll pay the same rate as someone without any medical problems
- Buy any Medigap plan available in your state as long as its sold by an approved Medigap seller
Once that 6-month window closes, you can still sign up for Medigap, but the conditions change. Outside of the initial signup window, youre no longer guaranteed coverage if you have medical problems. And if you find a plan at all, it will likely cost much more because itll be based on medical underwriting. The best time to sign up for supplemental coverage through a private Medigap policy is when you first become eligible i.e., when you turn 65 and enroll in Medicare Part B.
What If You Need Help With Other Medicare Costs, Like Prescription Drug Coverage?
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.
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How Much Does Medicare Cost At Age 65
The standard premium for Part B modestly increases year over year. Part A costs also can increase, including the annual deductible and other coinsurance. Known as hospital insurance, Part A doesnt require a monthly premium as long as you have paid Medicare taxes through employment for at least 10 years.
Part B, known as medical insurance, typically pays 80% of the covered cost while you pay the deductible and then 20%.
If I Retire At Age 62 Will I Be Eligible For Medicare At That Time
Medicare is federal health insurance for people 65 or older, some younger people with disabilities, and people with end-stage kidney disease. Most commonly, you are eligible for Medicare when you turn 65, but there are other health insurance options if you are younger and do not have coverage through you or your spouses employer.
What you should know
|1. The typical age requirement for Medicare is 65, unless you qualify because you have a disability.||2. If you retire before 65, you may be eligible for Social Security benefits starting at age 62, but you are not eligible for Medicare.|
|3. You have options for health insurance if you are too young for Medicare. You may obtain it through your employer, or you can purchase from private-sector insurance companies through the health insurance exchange. You may be eligible for Medicaid, which is based on income.||4. If you retire before you are 65, you may be eligible for employer-provided group health insurance under the Consolidated Omnibus Budget Reconciliation Act .|
Medicare was established in 1965 in order to provide health coverage for seniors who would otherwise not be covered by employer-sponsored health insurance plans. If you retire at the age of 62, you may be eligible for retirement benefits through social security, but early retirement will not make you eligible for Medicare.
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D Late Enrollment Penalty
The Part D late enrollment penalty is similar to the Part B late enrollment penalty, in that you have to keep paying it for as long as you have Part D coverage. But its calculated a little differently. For each month that you were eligible but didnt enroll , youll pay an extra 1% of the national base beneficiary amount.
In 2020, the national base beneficiary amount is $32.74/month. Medicare Part D premiums vary significantly from one plan to another, but the penalty amount isnt based on a percentage of your specific planits based instead on a percentage of the national base beneficiary amount. Just as with other parts of Medicare, Part D premiums change from one year to the next, and the national base beneficiary amount generally increases over time.
So a person who delayed Medicare Part D enrollment by 27 months would be paying an extra $8.84/month , on top of their Part D plans monthly premium in 2020. A person who had delayed their Part D enrollment by 52 months would be paying an extra $17.02/month. As time goes by, that amount could increase if the national base beneficiary amount increases . People subject to the Part D late enrollment penalty can pick from among several plans, with varying premiums. But the Part D penalty will continue to be added to their premiums for as long as they have Part D coverage.
How To Enroll In Medicare And When You Should Start Your Research Process
Getting older means making more decisions, from planning for your kids futures to mapping out your retirement years. One of the most important decisions that youll make as you prepare to retire or head into your 60s is what to do about health insurance. If youve been working, then you probably have a plan through your employer. Most people do. But once you turn 65, you become eligible for Medicare, a government-backed program designed specifically for seniors. There are also other reasons that you might be eligible for Medicare, which can muddy the waters when youre researching your options for coverage.
Medicare is administered by the Centers for Medicare and Medicaid Services , but technically speaking, youll enroll via Social Security. In this article, well outline eligibility guidelines so that you can sign up with confidence, and as always, if you have any questions about how to sign up, or what plan might be best for your needs, were always available toll free to answer any questions you might have. Well also highlight the importance of enrolling on time to avoid penalties and delays in coverage. Heres what you need to know about eligibility and Medicare.
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