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Original Medicare (Part A and B) Eligibility and Enrollment

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Qualification for and Enrollment in Medicare Parts A and B

Eligibility and enrollment details for Medicare Parts A and B can be found on this website. Visit our Employer Page or I’m 65 and Still Working page for additional information about Medicare for those who are still actively employed.

The following people are eligible for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance):

  • A minimum of 65 years old
  • Disabled
  • Permanent kidney failure (ESRD)
Part A of Medicare (Hospital Insurance)

Some people have to pay a premium to receive Part A, but for the most part it is provided at no cost.

Premium-free Part A is available to persons who are eligible for Medicare due to their own income or the income of a spouse, parent, or child. Applicants receiving Social Security or Railroad Retirement Board (RRB) benefits who meet the required number of quarters of coverage (QCs) will be eligible for premium-free Part A. Whether a person is applying for Medicare Part A due to age, disability, or ESRD determines the exact number of QCs that must be submitted (ESRD). Federal Qualified Retirement Accounts (QCs) are acquired by paying FICA payroll taxes during one’s working years. Since most people already pay the maximum amount into Social Security, their QCs can be utilised to qualify for both monthly payments and premium-free Part A.

NOTE: Some workers in the federal, state, and local governments are exempt from paying the FICA tax on earnings. They can only utilise the QCs they earn to qualify for premium-free Part A; they cannot be used to meet the requirements for regular Social Security payments.

Part A premiums are only available to those who are 65 or older and enrolled in Medicare Part B. There are specific windows of opportunity for enrolling in Medicare’s more expensive Parts A and B. (When someone can enrol is explained under the heading “When Coverage Begins” in the section).

Details on How to Join Part A

Anyone living in the United States (with the exception of Puerto Rico) who has been receiving Social Security or RRB benefits for at least 4 months prior to being eligible for Medicare is enrolled in Parts A and B at no cost to them. In Puerto Rico, residents who meet the requirements for automatic enrollment only receive Part A coverage (no monthly premium required).

Those who are not currently receiving an RRB or Social Security benefit will not be enrolled automatically. Individuals in this category are required to apply through the Social Security Administration.

One’s eligibility for Part B is determined by whether or not they are eligible for premium-free Part A coverage.

Once a person is entitled to premium-free Part A, they are also eligible to enrol in Part B. There are specific windows of opportunity for Part B enrollment.

Part A premium-paying individuals must meet the following criteria in order to enrol in Part B:

  • Be 65 or older;
  • Live in the United States;
  • And either be a citizen of the United States or a lawfully admitted permanent resident alien who has lived in the United States for at least five years prior to the month of applying for Medicare.

Please be aware that a monthly premium must be paid for each month of coverage under Part B, which is a completely optional programme.

Learn More About Part B Enrollment

Anyone living in the United States (with the exception of Puerto Rico) who has been receiving Social Security or RRB benefits for at least 4 months prior to being eligible for Medicare is enrolled in Parts A and B at no cost to them. Those who are eligible for Part B automatically have the option to decline or continue the coverage. Auto-enrolled Puerto Ricans only receive the no-cost Part A coverage for which they qualify; they must opt in to receive Part B coverage.

Those who are not currently receiving an RRB or Social Security benefit will not be enrolled automatically. Only during specific enrollment times are individuals who have previously denied Part B or terminated their Part B enrollment eligible to enrol (or re-enroll) in Part B. If a Medicare Part B (Medical Insurance) enrollee does not sign up within their initial enrollment period, they will typically be required to pay a late enrollment penalty for the duration of their Part B coverage.

For those of you who are 65 and up, here’s how the rules work

You must meet the following age requirements to receive free Medicare Part A:

  • One must be 65 or older and receive either Social Security or Railroad
  • Retirement Board (RRB) cash payments on a monthly basis to qualify.

If you start collecting Social Security or RRB payments at least 4 months before you turn 65, you don’t need to do anything more to qualify for premium-free Part A. At age 65, the person will be automatically enrolled in Part A.

If you are not currently receiving monthly Social Security or RRB payments, you must contact the Social Security Administration in order to apply for Medicare.

If an individual applies to Part A (or for Social Security or RRB benefits) within 6 months of the month in which he or she turns 65, coverage under Part A will begin in that individual’s birthday month. Part A coverage will be retroactive for 6 months if an application is submitted more than 6 months after the applicant turns age 65.

In the case that your 65th birthday falls on the 1st of the month, your Part A coverage will begin on the 1st of the month before your actual birthday. If your birthday is on December 1 and you’re starting Part A on November 1, here’s what you need to know.

More Information for

Those 65 and Older Who Have to Pay the Part A Premium

Medicare Part A enrollees who are required to make monthly premium payments are not automatically enrolled in the programme upon reaching age 65. What they must do is:

  • Contact the Social Security Administration to submit an enrollment application;
  • Sign up for Medicare during a qualifying enrollment period; and
  • enrol in, or be enrolled in, Medicare Part B.

The individual must maintain enrollment in Part B and continue to pay the required monthly premiums in order to keep their premium Part A coverage. This means that the individual’s Part B and Part A premiums must be paid in a timely manner in order to maintain coverage.

Exquisite Component A person’s coverage will begin on the first day of the month following the enrollment period in which they enrol.

Medicaid for People With Disabilities

After receiving Social Security or Railroad Retirement Board (RRB) disability payments for 24 months, an individual is eligible for Part A. After being disabled for 29 months, an employee of the federal, state, or local government who is not receiving monthly Social Security or RRB benefits may be declared entitled to disability benefits and automatically entitled to Part A.

Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) Exceptional Regulations

Part A coverage begins the month after an individual first becomes eligible for Social Security or RRB disability cash payments due to Amyotrophic Lateral Sclerosis (ALS). This has no requisite lag time.

Special Requirement for Individuals Seeking Disability Benefits on Behalf of a Child The Social Security Administration does not permit disability benefits for children to begin until they turn 18. Thus, a person’s eligibility for Part A based on a child’s disability benefit entitlement cannot commence before the month in which he or she becomes 20 (or 18 in the case of ALS).

Medicare for Patients With Kidney Failure (ESRD)

Regular dialysis patients and kidney transplant recipients who have applied for Medicare and meet 1 of the following criteria are eligible for premium-free Part A coverage:

  • Have accumulated sufficient qualifying service under Social Security, the Railroad Retirement Board (RRB), or federal service; or.
  • receive or qualify for RRB or Social Security payments; or
  • Are the spouse or dependent child of someone receiving Social Security or RRB payments, or who has worked the necessary number of years under Social Security or the RRB, or who is a government employee.

As we launch into Part A, we will cover:

  • The third month after the first month of a regular dialysis course; the first month of a regular dialysis course if the patient engages in self-dialysis training; the month of the kidney transplant; the two months prior to the month of transplant if the patient was hospitalised during those months in preparation for the transplant.
Periods of Eligibility and the Activation of Coverage

Those who meet the requirements for premium-free Part A coverage can sign up for it at any time after becoming eligible.

In order to qualify for premium coverage for Medicare Parts A and/or B, individuals must enrol within the designated enrollment periods. The following times are open for signing up for Part A and Part B premiums:

  • Time of first enrollment.
  • Open enrollment, and more generally.
  • Limited enrollment time for active-duty military, federal civilian employees, and those with disabilities who are employed
Initial Sign-Up Window (IEP)

An individual’s Initial Eligibility Period (IEP) lasts for a total of 7 months, starting 3 months prior to the month in which they turn 65 and ending 3 months after their 65th birthday. To qualify for Medicare at age 65, you must have been disabled for at least 24 months. IEPs for these persons begin three months before to the month in which they become eligible for disability benefits and continue for an additional three months afterward. Individualized education programmes (IEPs) for those who suffer from ESRD and ALS are tailored to each patient’s specific needs.

When you enrol in the IEP determines when your coverage will begin. Coverage will begin in the month that the individual becomes eligible for Medicare if they enrol during the first three months of the IEP. Those who wait until a later month to enrol in the IEP will have to wait longer for coverage to kick in. Individuals who have been receiving Social Security disability payments for at least 24 months are enrolled in Medicare Parts A and B automatically.

ALERT: A late enrollment penalty applies if a person does not enrol in Medicare Part B or premium Part A when first eligible. As long as they remain a Part B participant, the penalty will be applied.

Occurrence of Open Enrollment (GEP)

Each year, the GEP runs from January 1st to March 31st. On July 1 of that year, both Part B and Part A Premium coverage will commence.

For those of Working Age and Working Disability, a Special Enrollment Period (SEP) is available.

During the SEP, newly eligible Medicare beneficiaries can sign up for Part B or premium Part A if they did not do so when initially eligible because they were covered by a group health plan due to their own or a spouse’s current employment (or the current employment of a family member, if disabled). Individuals are eligible to enrol at any time throughout their employment and group health plan coverage, as well as for 8 months after their employment or plan coverage ends, whichever comes first.

WARNING: People who have end-stage renal disease (ESRD) cannot enrol during the SEP.

International Volunteers Have a Unique Sign-Up Window (SEP)

During this SEP, individuals who were not enrolled in Medicare when first eligible because they were serving as volunteers abroad for a tax-exempt organisation for at least 12 months and had health insurance that provided coverage for the period of the volunteer service may do so.

The rules governing the timing of volunteer recruitment

The volunteer’s SEP begins on the earlier of the first day of the month following the month for which the:

One or more of the following conditions has been met: the individual’s overseas volunteer service has ended; the organization’s tax-exempt status has lapsed; the individual’s health insurance policy no longer provides coverage abroad.

It is not possible to enrol in Medicare Part B or Medicare Part A with a premium until the IEP is complete.

Abandonment from the Program

People who are eligible for premium-free Part A coverage are not allowed to voluntarily discontinue their Part A coverage. The law expressly forbids such conduct. The following causes an end to premium-free Part A coverage:

  • Benefit reductions from the Social Security Administration or the Railroad Retirement Board;

  • Death.

People with ESRD have their premium-free period of Part A finish at a different time than the general population.

Due to the necessity of paying premiums, Medicare Parts A and B might be voluntarily cancelled. Premiums for Medicare Parts A and B are no longer covered because:

    • Request to be removed from the enrollment rolls voluntarily (effective immediately);

    • Inability to pay required premiums;
      For people under 65 who are incapacitated or have end-stage renal disease (Part B ends when Part A does); or

    • Death.

Premiums

Medicare Parts A and B both have premiums that must be paid on a regular basis.

IRMAA (Income-Related Monthly Adjustment Amount) (Income-Related Monthly Adjustment Amount)

An additional amount is added to the Part B premium for those with incomes over $85,000 and to the Part D premium for those with incomes over $170,000 (for a married couple). An income-related monthly adjustment amount is the name given to this supplementary payment. Less than 5 percent of people with Medicare are affected, thus most people will not pay a higher premium.

Premium Part A late enrollment penalty

Those who wait to sign up for Medicare Part A premium may have to pay a higher monthly premium if they do so. Part A monthly premiums could go up by as much as 10%. The higher premium will apply for twice as many years as the person was eligible for Part A but did not enrol in it.

For instance, if a person is eligible for Medicare Part A for 2 years but opts out of enrolling, the higher premium will apply for 4 years.

Part B late enrollment penalty

Individuals who did not enrol in Medicare Part B when first eligible may be required to do so in the future and pay a late enrollment penalty for the duration of their Medicare coverage. Every full year that an individual is eligible for Part B but does not enrol, their monthly premium may increase by 10%.

For illustration purposes, let’s say that Ms. Green’s IO terminated on September 30, 2009. She waited until the March 2013 Open Enrollment Period to sign up for Medicare Part B. For Ms. Green, the Part B penalty is 20%. (Although it took Ms. Green a total of 30 months, only 2 full years passed before she finally signed up.)

To enrol in Medicare Part A and/or Part B during a SEP without incurring a penalty, a person must meet certain criteria.

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Original Medicare (Part A and B) Eligibility and Enrollment

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