Medicare Eligibility: Are You Eligible for Medicare?

Who is Eligible for Medicare?

Medicare eligibility is determined by several factors, including age, disability status, and work history. Here are the main criteria:

• Age 65 or Older: Most people become eligible for Medicare when they turn 65.
• Disability: If you have been receiving disability benefits from Social Security or the Railroad Retirement Board for at least 24 months, you may be eligible for Medicare under age 65.
• End-Stage Renal Disease (ESRD): Individuals with ESRD can qualify for Medicare at any age.

Medicare Parts A and B

Medicare is divided into different parts, each covering specific services. Here's a quick overview:

• Part A: Hospital insurance that covers inpatient care, skilled nursing facility care, hospice, and some home health services. Most people don't pay a premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years.
• Part B: Medical insurance that covers doctor's services, outpatient care, medical supplies, and preventive services. Part B requires a monthly premium.

Medicare Part C (Medicare Advantage)

Medicare Advantage Plans (Part C) are an alternative to Original Medicare (Parts A and B). These plans are offered by private insurance companies and often include additional benefits such as dental, vision, and prescription drug coverage. If you are eligible for Medicare Parts A and B, you can choose to enroll in a Medicare Advantage Plan.

Medicare Enrollment Periods

It's important to sign up for Medicare during the correct enrollment period to avoid late penalties and ensure continuous coverage. Here are the key enrollment periods:

• Initial Enrollment Period: This is a 7-month window that starts 3 months before you turn 65, includes your birthday month, and ends 3 months after the month you turn 65.
• Special Enrollment Period: If you or your spouse worked and had group health plan coverage through an employer or union, you may qualify for a Special Enrollment Period to sign up for Part B without a late penalty.
• General Enrollment Period: If you missed your Initial Enrollment Period, you can sign up for Medicare between January 1 and March 31 each year, with coverage starting July 1.

How to Enroll in Medicare

Enrolling in Medicare is a straightforward process, but it requires timely action. Here's how you can get started:

• Automatic Enrollment: If you're already receiving benefits from Social Security or the Railroad Retirement Board, you'll be automatically enrolled in Parts A and B when you turn 65.
• Manual Enrollment: If you're not automatically enrolled, you can apply online at the Social Security website or visit your local Social Security office.
• Medicare Part C and D: To enroll in Medicare Advantage (Part C) or a Prescription Drug Plan (Part D), you'll need to choose a plan and sign up directly with the private insurance company offering the plan.

Medicare Savings Programs

If you're concerned about the costs associated with Medicare, you may be eligible for Medicare Savings Programs. These programs help pay premiums, deductibles, coinsurance, and copayments for eligible individuals. There are different programs based on your income and resources, so it's worth exploring your options.