Who is Eligible for Medicare?

1. Age 65 and Older

The most common way to qualify for Medicare is simply by reaching the age of 65. Once you turn 65, you are eligible for Medicare if you are a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years.

If you’re nearing 65, you can sign up for Medicare during your Initial Enrollment Period (IEP), which starts three months before the month you turn 65, includes the month you turn 65, and ends three months after your birthday month.

2. Younger Individuals with Disabilities

If you are under the age of 65 but have a qualifying disability, you may also be eligible for Medicare. Specifically, if you’ve been receiving Social Security Disability Insurance (SSDI) for 24 months, you will be automatically enrolled in Medicare. This includes people who have been diagnosed with conditions like:

• End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)

• Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease

Once you’re eligible based on disability or ESRD, your Medicare coverage will automatically begin after 24 months of receiving SSDI benefits.

Types of Medicare Coverage

Medicare consists of different parts, each covering specific healthcare services. Understanding what each part offers can help you choose the coverage you need.

Medicare Part A (Hospital Insurance)

• What it covers: Inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services.

• Eligibility: Most people get Part A without a premium because they or their spouse paid Medicare taxes while working.

Medicare Part B (Medical Insurance)

• What it covers: Doctor visits, outpatient hospital services, certain preventive services, and medical supplies.

• Eligibility: Part B requires a monthly premium, which is income-based. If you’re eligible for Medicare, you can choose to enroll in Part B.

Medicare Part D (Prescription Drug Coverage)

• What it covers: Prescription medications.

• Eligibility: Available to everyone with Medicare, and you can sign up for Part D separately or as part of a Medicare Advantage plan.

Medicare Part C (Medicare Advantage)

• What it covers: A combination of Part A, Part B, and often Part D coverage, all bundled into a single plan offered by private insurers. These plans may also provide extra benefits like dental, vision, and hearing coverage.

• Eligibility: You must be eligible for Medicare Parts A and B to join a Medicare Advantage plan.

Special Enrollment Periods (SEPs) for Medicare

Sometimes, you may miss your Initial Enrollment Period, or your situation may change, which allows for other enrollment opportunities.

1. Special Enrollment Period for Those Still Working

If you’re still working at age 65 and have employer-sponsored health insurance, you may delay enrolling in Medicare without penalty. Once you retire or your employer-sponsored insurance ends, you’ll have an 8-month Special Enrollment Period to sign up for Medicare Part B.

2. Special Enrollment Period for Those with Other Life Changes

Other situations that may trigger a Special Enrollment Period include:

• Moving out of your plan’s service area

• Losing other insurance coverage (e.g., employer health insurance)

• Qualifying for Extra Help with prescription drug costs

During these periods, you can enroll in, change, or drop your Medicare coverage without penalty.

How to Apply for Medicare

Most people are automatically enrolled in Medicare when they turn 65 if they are already receiving Social Security benefits. However, if you’re not automatically enrolled, you will need to apply.

Steps to Apply:

1. Online: Visit the official Social Security website to apply.

2. By Phone: Call 1-800-772-1213 to apply by phone.

3. In-Person: Visit your local Social Security office.

If you’re under 65 and qualify due to disability, you will generally be automatically enrolled in Medicare after 24 months of receiving disability benefits.

Key Points to Remember

• Age 65 is the standard age for Medicare eligibility, but younger individuals with disabilities or specific health conditions can qualify earlier.

• It’s important to enroll in Medicare when you’re first eligible to avoid late enrollment penalties.

• Medicare Part A is often free, while Part B, Part C, and Part D come with premiums, which can vary based on your income and plan choices.

• Be aware of Special Enrollment Periods if your circumstances change or if you miss your Initial Enrollment Period.

Conclusion

Medicare eligibility is primarily based on your age or specific health conditions, but understanding the different parts of Medicare, when to enroll, and how to apply can ensure you get the coverage you need. If you are approaching 65 or are dealing with a disability, it’s essential to familiarize yourself with Medicare’s rules to avoid missing out on vital healthcare coverage.

If you’re unsure about which Medicare plan is right for you or need more information, consider reaching out to a Medicare specialist or using resources like the Medicare website to guide you through the process.