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Who’s Entitled To Medicare

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What Is The Annual Election Period

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The annual election period is the interval in which Medicare beneficiaries can make changes to their coverage. It is also called the annual enrollment period or Medicare open enrollment.

The AEP dates run from October 15 through December 7. During this time, people can change between Original Medicare and Medicare Advantage plans, or between the various Medicare Advantage plans.

Individuals may also change from one Medicare Part D plan to another or enroll in a Part D plan if they did not do so when they were first eligible.

Am I Eligible For Medicare Part A

Generally, youre eligible for Medicare Part A if youre 65 years old and have been a legal resident of the U.S. for at least five years. In fact, the government will automatically enroll you in Medicare Part A at no cost when you reach 65 as long as youre already collecting Social Security or Railroad Retirement benefits.

If youre already receiving Social Security or Railroad Retirement benefits, all you need to do is check your mail for your Medicare card, which should automatically arrive in the mail about three months prior to your 65th birthday . The card will arrive with the option to opt-out of Part B , but opting out of Part B is only a good idea if youre still working and have employer-sponsored coverage that provides the same or better coverage, or if your spouse is still working and you have coverage under their plan.

If youre not already receiving Social Security or Railroad Retirement benefits, youll need to enroll in Medicare during a seven-month open enrollment window that includes the three months before the month you turn 65, the month you turn 65, and the three following months. If you enroll before the month you turn 65, your benefits will start the month you turn 65 . If you enroll in the three months after you turn 65, your coverage could have a delayed effective date.

In addition to turning 65, people can become eligible for Medicare due to a disability , or due to end-stage renal disease or amyotrophic lateral sclerosis .

When You Can Start Receiving Medicare Part A & B Benefits

We have already outlined who is eligible for Medicare, so when can you start receiving the benefits? If you qualify based on age, then you can start receiving benefits the month of your 65th birthday. The time that your benefits actually start depends on when you enroll. We will discuss Medicare enrollment periods more in the next section. But, assuming that you get enrolled in time, your coverage will begin the month that you turn 65.

For individuals receiving Social Security disability benefits, your coverage will begin in your 25th month of SSDI entitlement. Note that you might be considered entitled to SSDI benefits before your payments begin, so your Medicare coverage is based on your entitlement date and not your actual benefit payment start date. You will be automatically enrolled in coverage at this time, and your benefits will start right away. For those on SSDI with ALS, your benefits will start the same month as your SSDI payments. There is no waiting period for Medicare coverage for those individuals. The same is true for those with ESRD, although the initial enrollment period for these individuals varies based on their specific circumstances.

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In General It’s 65 But You Might Be Eligible Sooner

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When you think of Medicare, you probably assume that its for people of retirement age. Thats true, but the program covers more than just those who have worked all their life. You might be eligible right now and not know it. While most beneficiaries are people aged 65 or older, others receive these services at a younger age due to a qualifying disability.

Reasons To Delay Medicare

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If youre thinking about deferring Medicare, discuss the pros and cons with your current insurer, union representative, or employer. Its important to know how or if your current plan will work with Medicare, so you can choose the most comprehensive overage possible.

Some of the common reasons you may want to consider deferring Medicare include:

  • You have a plan through an employer that you want to keep.

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Decide If Delaying Medicare Enrollment Is Right For You

As mentioned earlier, before enrolling in Medicare Advantage plans seniors need to enroll in Medicare Parts A and B. For a small portion of the population, it can be beneficial to delay enrollment in Medicare for a few years. This applies primarily to those who are nearing 65 but who still work . It cannot be stressed enough that enrolling late in Medicare can carry steep, recurring fees for many people, so delaying coverage is only a good option for those who have a fee exemption. Having a fee exemption is most likely, though not guaranteed, for those who fit the profile below.

A senior whos nearing age 65 may have a fee exemption if:

  • The senior receives health coverage through work
  • The workplace includes more than 20 employees
  • The senior plans to work beyond age 65 or the company offers retiree coverage

Essentially, someone in this situation may be able to and may want to delay starting their Medicare coverage because they decide that their work-provided coverage meets all of their needs at a low cost. However, no one should decide this without consulting with their companys benefits manager. When asked, a benefits manager should be able to provide information on whether or not the provided health coverage is considered group coverage by the IRS. Seniors in qualified plans can delay coverage without a late enrollment fee later.

How Do I Register A Complaint Against A Doctor

Since the provinces and territories, rather than the federal government, are primarily responsible for the administration and delivery of health care services and the management of health human resources, you should contact your local provincial/territorial Ministry of Health – the phone numbers and websites are located inside the back cover of the current Canada Health Act Annual Report. You can also contact your province or territory’s College of Physicians and Surgeons, which is the organisation that governs physician licensing and conduct. Links to each provincial and territorial medical regulatory authority can be found on the College of Physicians and Surgeons of Canada website.

Canada Health Act Division

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What Is A Special Election Period

A special election period or special enrollment period is when someone can change their Medicare Advantage coverage outside of the official AEP or IEP.

When certain qualifying events happen, such as moving to a new area or losing existing insurance coverage, this triggers an SEP.

There are various rules and approved reasons that affect what changes an individual can make to their Medicare coverage.

The government has a calculator that people can use to determine whether they are eligible for Medicare coverage and, if so, the likely premium.

People can use the calculator at

What About Medigap Plans

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Original Medicare covers a good portion of your care, but its not exhaustive. Theres a wide range of services that Parts A and B dont cover, including dental and vision care. About a third of Medicare enrollees choose the private version of the program Medicare Advantage because it tends to cover more than its original counterpart. But if you like the flexibility of original Medicare and dont need the benefits that Advantage affords, but you still want additional coverage to offset your out-of-pocket costs, then consider adding a Medigap supplemental policy to your plan.

Medigap insurance, as its name suggests, covers some gaps left by original Medicare. Parts A and B require copays, coinsurance and deductibles, which can add up over time. And since Medicare requires Part B enrollees to cover 20 percent of their costs without any caps in place, you may face higher bills without some protection in place. Medigap offers that protection. With a supplemental plan in place, you may have coverage for:

  • Copays and Coinsurance
  • Deductibles for Part A, B or both
  • Medical services while traveling
  • Additional time in the hospital

This is just a sampling of the benefits that Medigap offers. There are 10 plan types, labeled A through N, and each plan type is standardized in all but three states . You can read more about Medigap here or, but were mentioning it in this article because theres a relatively brief window of time to enroll in Medigap with open eligibility.

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Who Is Eligible For Medicare Part A & B

You need to meet at least one of the following criteria for Medicare eligibility:

  • Be age 65 or older and eligible for Social Security: You may be automatically enrolled in Medicare Part A when you reach age 65 and become eligible for Social Security. But, if youâre not receiving retirement benefits from Social Security or the Railroad Retirement Board , you must sign up for Medicare Part B when you meet the age requirement, as your enrollment isnât automatic.
  • Be permanently disabled and receive disability benefits for at least two years: You automatically get Part A and Part B after you get disability benefits from Social Security for 24 months or certain disability benefits from the Railroad Retirement Board for 24 months.
  • Have end-stage renal disease : You need to sign up for Medicare, as your enrollment isnât automatic.
  • Have Lou Gehrigâs disease : You automatically get Part A and Part B the month your disability benefits begin.

Most people donât have to pay a premium for Medicare Part A if they or their spouse paid Medicare taxes while working for at least 10 years . If youâre not eligible for premium-free Part A, you will have to pay a monthly premium of up to $499 in 2022.

What If I Work Past Age 65

You still have a Medicare enrollment decision to make.

If you plan to keep working or you have employer health coverage through a spouse, you have some options to consider when signing up for Medicare. Depending on your situation, you may or may not be able to delay Medicare enrollment.

Your Initial Enrollment Period happens when you’re turning 65 whether you’re still going to work or not. Be sure to know your IEP dates and plan ahead.

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Eligibility For Medicare Part D

You may be eligible for Medicare Part D, which is voluntary. If you have no other drug coverage, we recommend enrolling in the program to protect yourself from future catastrophic medication costs and get lower copays on medications that are covered now. Do not forget to sign up if you dont want any late penalties!

Medicare Eligibility For Part C

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You are qualified for Medicare Advantage if:

  • The plan you want to join is available in your area.
  • You are signed up for Medicare Part A and Part B.
  • You do not have end-stage renal disease .

Private insurance companies handle Medicare Advantage plans, therefore, premiums and coverage vary from one plan to another.

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Medicare Part D Premiums

Medicare Part D is prescription drug coverage. Part D plans have their own different premiums. The national base beneficiary premium sum for Medicare Part D in 2021 is $33.06, however costs can vary. Your Part D Premium will rely upon the plan you pick. Similar to your Part B coverage, you will pay an increased expense on the off chance that you make more than the preset pay level. In 2021, if your pay is more than $88,000 each year, you will pay an IRMAA of $12.30 every month on top of the expense of your Part D premium. IRMAA sums go up from that point at higher levels of pay. This implies that in the event that you make $95,000 each year, and you select a Part D plan with a monthly premium of $36, your complete monthly cost will really be $48.30.

You can get Medicare coverage regardless of your income. Keep in mind that:

  • When you hit specific income levels, you will be required to pay higher premium costs.
  • If your pay is more than $88,000, you will get an IRMAA and pay extra expenses for Part B and Part D coverage.
  • You can request for an IRMAA if your circumstances change.
  • If you are in a lower income bracket, you can get assistance in paying for Medicare.
  • You can enroll through your stateâs Medicaid office for special programs and Medicare assistance.

There are various brackets for married couples who file taxes separately. If you file in this manner, you will pay the following amounts for Part B:

Medicare Eligibility: Key Takeaways

For the vast majority of Americans who look forward to receiving Medicare health benefits, eligibility is as uncomplicated as celebrating your 65th birthday.

But your eligibility to receive Medicare coverage without having to pay a premium and your eligibility for other Medicare plans depends on such factors as your work history and your health status. Heres what you need to know:

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Who Is Eligible For Medicare Part C

Now, lets look at Medicare eligibility for Part C, or Medicare Advantage. Youre eligible to enroll if you already have both Part A and Part B.* Coverage is provided through Medicare-approved private insurance companies. Every plan has a service area that you must live in to receive benefits.

*You typically arent eligible for Medicare Advantage if you have ESRD . However, some insurers offer Special Needs Plans that cover ESRD. That will change in 2021 when enrollment restrictions are lifted for enrollees with ESRD.

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1. People are eligible for Medicare for different reasons.

Some are eligible when they turn 65. People under 65 are eligible if they have received Social Security Disability Insurance or certain Railroad Retirement Board disability benefits for at least 24 months. If they have amyotrophic lateral sclerosis , theres no waiting period for Medicare. Some people with End Stage Renal Disease may be eligible for Medicare. Its important to know the different ways that people qualify for Medicare so you can help current and former employees and their dependents anticipate their eligibility for Medicare so they can make timely and appropriate decisions about their enrollment.

2. Some people get Medicare Part A and Part B automatically and some people need to sign up for them.

People living in the United States and U.S. Territories who are already collecting Social Securityeither disability or retirementare automatically enrolled into Part A and Part B when theyre first eligible. These people will get a packet of information a few months before they turn 65 or receive their 25th month of Social Security Disability or Railroad Retirement Board benefits. At that time, they can choose to keep or decline Part B, but cant decline Part A unless they withdraw their original application for Social Security and pay back all Social Security cash benefits.

3. Enrolling in Medicare can only happen at certain times.

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Can I Avoid Penalties

There are some special circumstances in which you can sign up late for Medicare without paying penalties. After the initial enrollment period, you can sign up for optional programs during special enrollment periods.

If you or your spouse continued working past your 65th birthday and had health insurance through your employer, you wont have to pay a penalty for late enrollment in any of the Medicare programs.

Beginning the month after you end your employment, or when your group health plan insurance from that employment ends, you have an 8-month window to sign up for Medicare parts A and B without penalty.

COBRA and retiree health plans are not considered as coverage under current employment and do not qualify you for a special enrollment period or save you from late enrollment penalties.

You can also qualify for a special enrollment period for Medicare parts A and B and avoid late enrollment penalties if you were volunteering in a foreign country during your initial enrollment period.

Who’s Eligible For Medigap

If youre enrolled in both Medicare Part A and Part B, and dont have Medicare Advantage or Medicaid benefits, then youre eligible to apply for a Medigap policy. These plans are standardized, and are designed to cover some or all of the out-of-pocket costs that are incurred when you have a Medicare-covered claim .

You have a federal right to buy a Medigap plan during the six months beginning when youre at least 65 years old and have enrolled in Part B. This is known as your Medigap open enrollment period. After this time runs out, you will have only limited chances to purchase one down the road.

Some states allow people of any age or health status to purchase Medigap coverage at any time without medical underwriting, but most dont. In many states, Medigap plans may not be available for people who have Medicare before age 65. There are 33 states that require Medigap plans to be guaranteed issue in at least some circumstances when an applicant is under age 65, but the rules vary from one state to another you can click on a state on this map to see details about state-based Medigap rules.

If youre enrolling in Medicare due to your age, the primary factor that will affect your ability to purchase a Medigap policy regardless of your health will be whether you enroll during your Medigap Open Enrollment Period.

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