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Andrew Smith

Andrew Smith

Medicare Eligibility

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Who is eligible for Medicare?

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Medicare Eligibility: Citizens and legal residents of the United States who have resided in the country for at least 5 years are eligible for Medicare. Medicare is a type of personal insurance. It excludes wives and dependents.

You may be eligible for Medicare benefits if you meet any of the following criteria:

  • You are at least 65 years old.
  • You have a qualifying impairment and are under the age of 65. After 24 months of receiving Social Security disability benefits, you are eligible for Medicare.
  • End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, often known as Lou Gehrig’s Disease) at any age

Before qualifying for Medicare, you must have resided in the United States for at least 5 years in a run to qualify as a legal resident.

Medicare Initial Enrollment Period

You’ll have a seven-month window around your 65th birthday to sign up for Medicare. It’s known as your Initial Enrollment Period or IEP. Your IEP covers the month of your 65th birthday, as well as the three months preceding and following it.

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What if I work past age 65?

32 Medicare Eligibility
You still have to decide whether or not to enroll in Medicare.

You have several alternatives to consider when signing up for Medicare if you want to remain working or if you receive employment health coverage via a spouse. You may or may not be able to postpone Medicare enrollment, depending on your circumstances.

Whether you’re still working or not, your Initial Enrollment Period (IEP) begins when you reach 65. Make a note of your IEP dates and prepare ahead of time.

I'm on disability. When will I be eligible for Medicare?

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If you have a qualifying disability, you may be eligible for Medicare before you turn 65. After you’ve been receiving disability payments for at least 24 months, you’ll be eligible. Parts A and B of Medicare will be automatically enrolled in you. During your IEP, you may make further coverage decisions. The month you get your 25th disability check, as well as the three months before and after, make up your seven-month IEP.

 

What do I need to do when I'm eligible for Medicare?

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It’s time to enroll in Medicare after you’ve become eligible. Before you may enroll in any extra coverage, you must first enroll in Medicare Part A and/or Part B.

When you reach the age of 65, you may be automatically enrolled in Original Medicare (Parts A and B), but this is not the case for everyone.

 

You’ll be automatically enrolled in Original Medicare if:

 

  • When you reach the age of 65, you get Social Security or Railroad Retirement Board payments; or
  • Because of a handicap or a medical condition, you are eligible for Medicare.
If you meet the following criteria, you must enrol in Original Medicare.
  • When you become eligible for Medicare, you are not getting Social Security benefits.

 

You can enrol in Medicare in one of three ways:

 

  1. Online at www.SocialSecurity.gov  .
  2. Monday through Friday, from 7 a.m. to 7 p.m., call Social Security at 1-800-772-1213 (TTY users 1-800-325-0778).
  3. In-person at a Social Security office near you.
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Next steps: Learn about the different Medicare coverage options

Once you’ve registered in Original Medicare Part A and/or Part B, the federal government will begin to cover you. At that point, you can also choose additional coverage from private insurance companies such as a Medicare Advantage plan, Part D prescription drug plan, or Medicare supplement insurance plan.

FAQs

How do you tell if you are eligible for Medicare?

You are eligible for Medicare if you are a US citizen or have been a legal resident for at least 5 years, you are 65 or older, and you or your spouse has worked in Medicare-covered employment for at least 10 years (or 40 quarters).

Are you automatically enrolled in Medicare if you are on Social Security?

Yes. If you are receiving benefits, the Social Security Administration will automatically enroll you in Medicare Parts A and B at the age of 65 if you are eligible. (The government Centers for Medicare & Medicaid Services runs Medicare, but Social Security manages enrollment.)

Can I get Medicare if I never worked?

If you never worked, you can still get Medicare, but it will be more expensive. You will have to pay a monthly premium for Part A unless you have worked and paid Medicare taxes for 10 years — sometimes known as 40 quarters. This may vary based on your spouse and whether or not you worked previously.

Do I automatically get Medicare when I turn 65?

If you’ve received Social Security or Railroad Retirement Benefits for at least 4 months previous to your 65th birthday, Medicare will begin immediately when you turn 65. If you get benefit checks, you’ll be automatically enrolled in both Medicare Part A and Part B when you turn 65.

How do you pay for Medicare Part B if you are not collecting Social Security?

You will receive a bill called a “Notice of Medicare Premium Payment Due” if you have Medicare Part B but are not yet receiving Social Security or Railroad Retirement Board payments (CMS-500). You’ll need to make plans to pay this bill on a monthly basis.

Do I have to pay for Medicare Part A?

The majority of consumers do not pay a monthly Part A premium (sometimes called “premium-free Part A”). In 2022, if you acquire Part A, you’ll spend up to $499 each month. The usual Part A cost is $499 if you haven’t paid Medicare taxes for more than 30 quarters.

Can I change my Medicare plan during my birthday month?

This is because this rule allows residents of California to change their Medigap insurance without having to undergo a medical underwriting. That means you won’t have to answer any inquiries about your health. This can be done up to 30 days after your birthday or up to 30 days before your birthday.

Can you be denied a Medigap policy?

According to a Kaiser Family Foundation report, insurance companies can deny private Medigap insurance coverage to seniors after their first enrollment in Medicare if they have a pre-existing medical condition, such as diabetes or heart disease, save in restricted, qualifying conditions.

Do Medigap premiums increase with age?

Everyone who has a Medigap policy, regardless of age, is charged the same monthly price. Your insurance premium is not determined by your age. Premiums may rise because to inflation and other circumstances, but they will not rise due to your age.

How do I ask Medicare a question?

Do you have any concerns regarding your Medicare benefits? 1-800-MEDICARE (1-800-633-4227) can provide assistance. For TTY users, dial 1-877-486-2048.

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