Tuesday, April 9, 2024

Who Can Get Medicare Before Age 65

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Your First Chance To Sign Up

Get Medicare Educated: Working at 65

Generally, when you turn 65. This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65.

Avoid the penaltyIf you miss your 7-month Initial Enrollment Period, you may have to wait to sign up and pay a monthly late enrollment penalty for as long as you have Part B coverage. The penalty goes up the longer you wait. You may also have to pay a penalty if you have to pay a Part A premium, also called Premium-Part A.

Medicare Advantage Eligibility Requirements

  • You must be a U.S. citizen, U.S. national or lawfully present in the United States.
  • You must be enrolled in Medicare Parts A and B.
  • You have to live in the Medicare Advantage plan providers service area.
  • You must not have end-stage renal disease .
  • While regular Medicare Advantage does not cover ESRD, you may qualify for a Medicare Special Needs Plan. SNPs are special types of Advantage plans specifically designed for a particular condition or financial situation.

    You can keep your Medicare Advantage plan if you purchased it before developing ESRD. And you can buy an Advantage plan after being medically determined to no longer have ESRD usually from a successful kidney transplant.

    How To Enroll Early

    A person should contact the SSA with any questions about their work history and eligibility for Medicare by visiting the Contact Us section of their site or calling 1-800-772-1213 .

    If a person receives benefits from the RRB, they can call 1-877-772-5772 to find out more about qualifying for Medicare.

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    Eligibility For People With Als

    People with ALS, or Lou Gehrigs disease, can qualify for Medicare when they are under 65 years of age.

    ALS is a progressive, neurodegenerative disorder that disrupts a persons ability to speak, move, eat, and ultimately breathe. The condition has no cure and is eventually fatal.

    According to the ALS Association, an estimated 16,000 people in the United States have the disorder. A doctor usually diagnoses ALS between the ages of 4070 years.

    Unlike ESRD, those with ALS can receive Medicare Part A benefits in their first month of receiving Social Security or RRB benefits.

    The SSA automatically enrolls a person with ALS in a Medicare plan when they start paying Social Security benefits.

    According to a 2017 review in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, a persons monthly costs with ALS under Medicare can total $10,398 during the month of their diagnosis.

    ALS often progresses rapidly and leads to high healthcare costs. This is why a persons Medicare benefits will usually begin as soon as possible.

    Getting Medicare Under The Age Of 65

    Medicare Part B eligibility: Conditions, exceptions ...

    Many people think of Medicare as a government health-care program for Americans and legal permanent residents who are at least 65 years old. But some people qualify for Medicare before age 65.

    Here are the most common ways you may be eligible for Medicare if youre under age 65:

    • You receive disability benefits from the Social Security Administration or from the Railroad Retirement Board . Youre automatically enrolled in Original Medicare, Part A and Part B, after 24 continuous months of receiving disability benefits.
    • You have Lou Gehrigs disease . Youre automatically enrolled in Medicare the same month that your disability benefits start.
    • You have end-stage renal disease . In this case, you may qualify for Medicare, but youre not automatically enrolled. To enroll, contact Social Security .

    If you have questions about your eligibility for Medicare if youre under 65, or to enroll, you can contact Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. Representatives are available Monday through Friday, from 7AM to 7PM. Or, you can contact Medicare, or a licensed insurance agent at eHealth .

    New To Medicare?

    Becoming eligible for Medicare can be daunting. But dont worry, were here to help you understand Medicare in 15 minutes or less.

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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.

    Can You Enroll In Medicare Before You Turn 65

    You may be eligible for Medicare before age 65 if:

    • Youve received Social Security Disability Insurance for at least 24 months
    • Youll get Medicare Part A and Part B automatically starting the first day of your 25th disability month. You should get your Medicare card in the mail three months before this date.
    • You have Amyotrophic Lateral Sclerosis , or Lou Gehrigs disease
    • Youll get Part A and Part B automatically in the month your SSDI benefits begin.

    Note: Part B isnt automatic if you live in Puerto Rico.4 Youll have to contact Social Security to enroll.

    • You have permanent kidney failure, or end-stage renal disease
    • Youll need to sign up for Medicare yourself. Your coverage usually starts the first day of the fourth month of dialysis treatment or in the month youre admitted to a Medicare-certified hospital for a kidney transplant.5

    A Word of Advice

    If you dont have any other type of health insurance, you should enroll in Medicare Parts A and B when you turn 65.

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    Do I Have To Sign Up For Medicare If I’m 65 Or Older And Still Working

    If you’re age 65 or older, eligible for Medicare, and have insurance through your current job or your spouses current job, you need to make some important Medicare enrollment decisions.

    If you don’t enroll on time, you may have to pay a penalty. Before you make any changes, it’s good to understand how your current coverage works with Medicare about four to five months before you become eligible for Medicare.

    Ask your benefits manager or human resource department how your employer health insurance works with Medicare, and confirm this information with the Social Security Administration and Medicare .

    When you retire or if you lose your employer coverage, you will get a Special Enrollment Period to sign up for Medicare. Be sure to review the rules carefully, so you don’t miss deadlines.

    Note: If you have a Health Savings Account, you and your employer should stop contributing to it 6 months before you sign up for Medicare Part A to avoid an IRS tax penalty. As well, before you enroll in Medicare while still working, check with your employer to see if their employer group health plan coverage for prescription drugs is creditable coverage. If it is not creditable, you could face paying Medicare Part D penalties later on.

    Individual And Family Health Insurance

    Should you enroll in Medicare if you work past age 65?

    In some cases, buying your own health insurance may be your only or best option for finding coverage before you age into Medicare.

    Navigatingthe health insurance marketplace can be difficult, especially if youve onlyreceived health insurance through your employer in the past. But eHealth ishere to guide you through it!

    Youcan enroll in health insurance during the annual openenrollment period,which runs from November 15th through December 15th, inmost states, for coverage starting on January 1st of the followingyear. However, you will likely qualify for a special enrollment period when youretire this 60 day enrollment period allows you to enroll in health insuranceanytime of the year.

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    If I Retire At Age 62 Will I Be Eligible For Medicare

    En español | Nobody can become eligible for Medicare before age 65, unless he or she qualifies at an earlier age on the basis of receiving Social Security disability benefits.

    If you retire at any time before 65, you may be able to get health insurance from any of the following sources:

    • Your spouses current employer, if youre married and the employer provides health care that covers you
    • Your former employer, if youre eligible for retiree health benefits
    • COBRA coverage, which extends your former employers coverage for a certain period of time usually 18 months but requires you to pay the full premiums, including what your employer used to pay toward them
    • Private insurance purchased through marketplaces set up under the Affordable Care Act
    • Private insurance purchased on the open market.

    Medicare Eligibility For People Under 62

    There are a few exceptions for Medicare age limits that can allow people younger than 65 and under age 62 to enroll in Medicare.

    • If you have ALS , you are immediately eligible for Medicare regardless of your age as soon as your Social Security or Railroad Retirement Board disability benefits begin.
    • You may also qualify for Medicare if you have kidney failure that requires dialysis or a kidney transplant, which is known as end-stage renal disease .
    • You may also qualify for Medicare at age 62 or any age before 65 if you receive disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months.

    If you qualify for Medicare under the age of 65 because of a disability, you might also qualify for a Medicare Advantage Special Needs Plan.

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    I Turn 65 In A Few Months When Should I Sign Up For Medicare

    En español | If you already receive Social Security benefits, Social Security will automatically sign you up for Medicare Part A and Part B though you can decline Part B enrollment if you want to. Otherwise, you need to apply for Medicare. The best time to do that depends entirely on your own situation. Broadly, there are two options:

    Working At Age 65 Costs And Penalties

    If you

    People can get Medicare while they are working. However, they may want to consider several factors, including eligibility, and their employers group coverage.

    This article describes the circumstances in which a working person may want to consider signing up for Medicare, some limitations, and possible penalties. It also discusses the different parts of Medicare and the enrollment periods.

    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.

    According to Medicare, most people should enroll in Medicare Part A, which is hospital insurance, when they first become eligible, which is generally when a person turns 65. Most people do not pay a premium for Part A because they paid sufficient taxes.

    If a working person has group health insurance through their employer, they can delay enrolling in Medicare Part B. However, an individual might consider getting Part B to cover some costs not included in the group health plan.

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    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:

  • Fax or mail your CMS-40B, CMS-L564, and secondary evidence to your local Social Security office .
  • Note: When completing the forms CMS-40B and CMS-L564

    • 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 .

    You’re Eligible For Medicare

    Medicare eligibility begins at age 65, and you can even sign up for coverage beginning three months before the month of your 65th birthday. It pays to enroll in Medicare on time, because if you don’t, you could end up subject to costly penalties that make your Part B premiums more expensive.

    If you’ll be signing up for original Medicare , you’ll need a Part D plan for prescription drug coverage as well. Medicare Part A will cover your hospital care and Part B will cover outpatient care, but drug coverage is separate.

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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.

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    Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.

    How Do I Apply For Traditional Medicare

    What to Know About Medicare Part D When Still Working

    If youre not automatically enrolled in Medicare Part A and Part B, you need to sign up. You should enroll during your IEP, or a Special Enrollment Period if you qualify for one. As mentioned above, one example of a Special Enrollment Period might be if you delayed enrollment in Medicare Part A and/or Part B because you had employer coverage.

    You typically sign up for Medicare through the Social Security Administration . You can go to the website at ssa.gov. Or, go in person to a Social Security office. You can reach the SSA at 1-800-772-1213 . Representatives are available Monday through Friday, from 7AM to 7PM, in all U.S. time zones.

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    Retirees And Those Still Working

    If you paid into a retirement system that didnt withhold Social Security or Medicare premiums, youre probably still eligible for Medicareeither through your retirement system or through your spouse. To receive full Medicare coverage at 65, you must have earned enough credits to be eligible for Social Security.

    Each $1,470 you earn annually equals one credit, but you can only earn a maximum of four credits each year. You will receive Social Security benefits at retirement if you have earned 40 credits10 years of work if you earned at least $5,880 in each of those years. If you continue to work beyond age 65, things get a bit more complicated. You will have to file for Medicare, but you may be able to keep your companys health insurance policy as your primary insurer. Or, your company-sponsored insurance plan might force you to make Medicare primary, or other conditions may apply to you.

    Theres a lot to consider that makes it prudent to talk to a person knowledgeable in Medicare about your specific choices. This could be your Human Resources department or a Medicare representative.

    If you continue to work beyond 65, theres a lot to consider that makes it prudent to talk to a Medicare expert about your choices.

    Medicare Part D And Group Coverage

    Medicare Part D helps cover prescription drug costs, which is not a benefit offered by Original Medicare.

    Medicare Part D requires you to pay a monthly premium in addition to your Part B premium.

    If you do not enroll in a Part D plan when youre first eligible and do not have confirmation of creditable coverage, you may have to pay late enrollment penalties if you decide to enroll in a Part D plan later.

    If you have another source of creditable drug coverage you can choose not to enroll in a Medicare Prescription Drug Plan and will not face late enrollment penalties if you decide to enroll in a Medicare drug plan once you retire.

    Note: Many Medicare Advantage plans include coverage for prescription drugs. If youre enrolled in a Medicare Advantage plan that covers prescription drugs, you cannot enroll in a Medicare Part D plan.

    You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online in as little as 10 minutes when you visit MyRxPlans.com.1

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