Who Is Eligible For Medicare?
Summary: Medicare eligibility depends on several factors, the most important of which is age. This article covers all you need to know about the eligibility age for Medicare and other factors that determine who qualifies for Medicare.
If you are approaching retirement age, you must start to think about health care coverage and enrolling in Medicare. But how do you know if you’re eligible to enroll?
It’s important to understand the eligibility criteria to ensure you receive the benefits you’re entitled to. How old do you have to be to get Medicare? Who qualifies for Medicare?
This article provides details on Medicare eligibility, including the age requirements and other qualifying conditions.
Qualifications for Original Medicare
Original Medicare consists of two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). In this subsection, we will go over the Original Medicare qualifications.
Medicare Part A: Hospital Insurance
For most people, eligibility for Part A usually comes without a premium, just as long as you or your spouse have paid taxes for at least ten years.
The main requirements for Medicare Part A include:
- Age 65 or above: If you are 65 or older and satisfy US citizenship or residency requirements, you are eligible for Part A. If you are not qualified for Part A, you can still buy into it by paying a premium monthly. The cost can vary based on how long you or your spouse have worked and paid Medicare taxes.
- Younger than 65: You are eligible for Medicare Part A if you qualify for Social Security Disability Insurance (SSDI)* and have been entitled to benefits for 24 months, have Lou Gehrig’s disease, or meet other eligibility requirements1.
- End-stage renal disease (ESRD): Any person of any age with end-stage renal disease (ESRD) who needs dialysis, or a kidney transplant qualifies for Medicare Part A.
*SSDI is a federal program that provides financial assistance to individuals with disabilities to access healthcare coverage through Medicare before they reach the age of 65.
Medicare Part B: Medical Insurance
Usually, everybody who qualifies for Medicare Part A is also qualified for Part B. However, Part B includes monthly premiums, set by the government annually.
Here are some important details to keep in mind while assessing your eligibility for Medicare Part B:
- Automatic enrollment: You are automatically enrolled in both Part A and Part B if you have been receiving Social Security or Railroad Retirement Board benefits since turning 65.
- Enrollment by request: If you are not automatically enrolled, you must sign up for Part B during your first enrollment period, which starts three months before your 65th birthday and ends three months after your 65th birthday.
However, if you have other creditable coverage, such as health insurance through an employer, you may not need to enroll in Part B right away. In this case, you can delay Part B enrollment without penalty, as long as your other coverage is considered creditable by Medicare.
- Disability: If you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for 24 months, you will be automatically registered in Medicare Part B.
- Income-related premiums: Your income will determine your Medicare Part B monthly premium. Higher-earning recipients may pay more, and programs exist to assist those with lower incomes with their premiums.
Eligibility for Medicare Advantage (Part C) and Part D
Medicare Part C, also known as Medicare Advantage, offers all Part A and Part B coverage, often with added benefit including vision, dental, and hearing care.
First, you must be enrolled in both Medicare Part A and Medicare Part B before joining a Medicare Advantage plan. It’s important to note that Medicare Advantage plans are tied to provider networks in specific geographical areas, so you should check to see which providers are covered in your area.
Medicare Advantage includes Special Needs Plans (SNPs) for individuals with specific healthcare needs. These plans provide specialized care and coverage for particular groups as follows:
- Chronic condition SNP (C-SNP): For individuals with certain chronic conditions such as cancer, heart disease, or chronic lung disorders.
- Dual-eligible SNP (D-SNP): For individuals who are eligible for both Medicare and Medicaid.
- Institutional SNP (I-SNP): For individuals who live in institutions like nursing homes or require nursing care at home.
Medicare Part D: Prescription Drug Coverage
Medicare Part D helps provide coverage for most prescription drugs, which helps manage healthcare costs. To join a Part D plan, you must be enrolled in either Medicare Part A or Part B.
Part D plans are provided by private insurers. When evaluating plans from different carriers, keep in mind that each plan typically has a pharmacy network. You’ll want to make sure that your preferred pharmacies are included in that network.
How to Check Eligibility
Review the Medicare eligibility criteria provided in this article to see whether you are eligible for the program. Most civil service retirees will automatically receive information regarding Medicare benefits as they approach the eligibility age, usually 65.
If you meet this requirement, you can enroll in Medicare during the Initial Enrollment Period, which starts three months before you turn 65 and extends three months after your 65th birthday.
For those who have worked for the federal government and received a civil service retirement pension, Medicare eligibility follows the same basic rules as that of other retirees.
For further information, you can use the Medicare calculator to estimate your eligibility. Alternatively, call the Railroad Retirement Board or the Social Security Medicare telephone number.
So You’re Eligible for Medicare. What’s Next?
Once you’ve confirmed your Medicare eligibility, the next thing you need to do is enroll.
As a reminder, you will be automatically enrolled in both Part A and Part B Medicare if you have been receiving Social Security or Railroad Retirement Board benefits for at least four months prior to turning 65.
Your Initial Enrollment Period begins three months before you turn 65 and extends for three months after your 65th birthday. It’s important to complete your Medicare eligibility check during this window. If you delay enrolling, you may face a late enrollment penalty, which results in higher monthly premiums.
If you’ve decided you’d like additional coverage, consider learning more about Medicare supplement insurance plans and Medicare Advantage plans. Not sure if you’re eligible or if one is right for you? Visit Mutual of Omaha to learn more about the basics of Medicare.
FAQs
Q1. What are the 3 important eligibility criteria for Medicare?
These are the three important eligibility criteria for Medicare:
- You must be 65 or older.
- You need to be a US citizen or permanent legal resident for at least five years.
- You or your spouse must have paid Medicare taxes for at least 10 years.
If you’re younger than 65 and eligible for SSDI benefits, you may also qualify for Medicare.
Q2. Can you get Medicare at age 62?
No, the standard age to qualify for Medicare is 65. However, you may be eligible earlier if you have certain disabilities or conditions, like ALS or end-stage renal disease (ESRD).
Q3. Do I automatically get Medicare when I turn 65?
As you turn 65, you will automatically be enrolled in Medicare Parts A and B. If not, you need to sign up. You automatically qualify to receive Medicare benefits if you have received Social Security benefits for at least 4 months prior to turning 65.
Q4. Who is not eligible for Medicare?
Those who haven’t worked or paid taxes for at least 10 years and do not qualify through a spouse, as well as certain non-US citizens or recent immigrants, are not automatically eligible for Medicare enrolment. Also, people with disabilities and younger than age 65 who have received SSDI benefits for less than two years are not eligible. They may need to meet additional requirements before being eligible for Medicare.
Q5. Can I get Medicare if I never worked but my spouse did?
Yes, you can be eligible for Medicare based on your spouse’s work record if your spouse is eligible, you are at least 65 years old, or you have certain medical conditions or disabilities.
Q6. Is Medicare free at age 65 for seniors?
Medicare Part A is generally premium-free if you or your spouse have paid taxes for 10 years. But if you’re wondering, “Can I get Medicare Part B for free?” Medicare Part B includes a monthly premium which is typically deducted from your Social Security benefits.
Q7. Is the Medicare age changing to 67?
As of now, Medicare age eligibility remains 65.
Q8. What kind of insurance can you get if you retire at age 62?
If you retire at 62, you can consider private health insurance, Medicaid, the health insurance marketplace, health share plans, or other options until you reach the Medicare eligibility age.
Q9. Can I delay enrolling in Medicare Part B?
It may make sense to delay enrollment in Medicare Part B if you’re still working and have health insurance through your employer.
1Original Medicare (Part A and B) Eligibility and Enrollment,
https://www.cms.gov/medicare/enrollment-renewal/original-part-a-b
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