If you are new to Medicare, you may be wondering what the Medicare age, eligibility, and qualifications are. This article provides an overview of eligibility for each Original Medicare (Part A and B) as well as Medicare Advantage (Part C), Prescription Coverage (Part D) as well as Medigap (also called Medicare Supplement).
What is Medicare?
Medicare is the primary method for receiving health insurance coverage for most Americans who are 65 and older as well as certain people who qualify under 65 with disabilities.
Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) is the default coverage provided by the federal government. The two parts combined make up what is commonly referred to ‘Original Medicare’.
Medicare coverage also includes Part C (Medicare Advantage), Part D (Prescription Drugs), and Medigap (also known as Medicare Supplement Insurance) which are provided by private insurance companies as either alternative or supplemental coverage to Original Medicare.
Medicare eligibility for those 65 and over
Eligibility for Medicare Part A and B
You are eligible to enroll in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) if you are currently over the age of 65, and:
- Are a U.S. citizen; or
- Are a permanent resident (green card holder) who has been living in the U.S. for the past five (5) years
Enrolling in Medicare
If you are turning 65 and:
- Already receiving Social Security or Railroad Retirement Board (RRB) benefits at least 4 months before turning 65 you are automatically enrolled in Medicare Part A and Part B.
- If you are not yet receiving Social Security or RRB you can proactively enroll with the Social Security Administration during your ‘Initial Enrollment Period’ which is the 7-month period that begins 3 months before the month you turn 65.
If you are still working when you turn 65, you may decide to choose to defer your enrollment, however, you should confirm you are eligible to defer enrollment as you can incur Late Enrollment Penalties.
Eligibility for Premium-free Part A (Hospital Insurance)
You will qualify for premium-free Medicare Part A if you or your spouse have worked and paid Medicare taxes for at least 10 years (40 quarters)
If you (or your spouse) did not pay Medicare taxes for this period but are eligible to enroll in Part A because of your current citizenship or permanent resident status, you can access Part A coverage by purchasing and paying monthly premiums. In 2021:
- If you paid Medicare taxes for less than 30 quarters, the Part A premium is $471 per month.
- If you paid Medicare taxes for 30-39 quarters, the Part A premium is $259 per month.
Regardless if you are receiving Part A coverage for free, everyone who wants to receive Medicare Part B must pay a monthly premium in order to receive coverage. In 2021, the standard monthly premium for Medicare Part B enrollees is $148.50 per month however, if your income from 2 years prior is greater than $88,000 for individuals or $176,000 for those filing a joint tax return then your premium may be higher.
Medicare eligibility for those under 65
Medicare is also available for certain individuals who are under the age of 65 with disabilities, including:
- Individuals who have received Social Security Disability (SSD) benefits for at least 24 months; or
- Individuals that have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or transplant); or
- Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease)
If you are eligible for SSD benefits, there is a 5-month waiting period from the date you apply before your benefits begin. Therefore you will generally need to wait at least 29 months (5 months waiting for period + minimum 24 months receipt of benefits) from the date you apply for SSD to receive Medicare coverage.
For ESRD, you are eligible for Medicare if you have worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee (or you’re the spouse or dependent child of a person who has). Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments. This 4-month waiting period will start even if you haven’t signed up for Medicare.
For ALS, you are eligible to receive Medicare as soon as you become entitled to SSD benefits (so after the 5-month waiting period after applying for SSD benefits).
Eligibility for Part C, Part D, and Medigap
- Part C (Medicare Advantage): Medicare Advantage is an ‘all-in-one’ bundled private alternative to Original Medicare that must provide the same coverage as Original Medicare. These plans often also include additional coverage such as Part D (prescription drugs) as well as extra benefits such as dental, vision, and hearing.
If you are eligible for Part A and Part B, you are generally also eligible to enroll in a Part C (Medicare Advantage) plan. You must already be enrolled in both Medicare Part A and Part B in order to switch into a Medicare Advantage plan.
- Part D (Prescription Drug Coverage): You can receive Part D coverage through a standalone Prescription Drug Plan (PDP) if you are on Original Medicare or through a bundled Medicare Advantage plan (in which case you will have to meet the enrollment requirements for Medicare Advantage).To be eligible to enroll in a PDP, you must at least be entitled to enroll in Medicare Part A (but not necessarily enrolled) or currently enrolled in Medicare Part B. You will be required to pay an additional monthly premium payment and you will also be responsible for any deductibles, co-pays, or co-insurance payments.
- Medigap: Also known as Medicare Supplement Insurance, are provided by private insurance companies to help cover the out-of-pocket cost ‘gaps’ in the Original Medicare. You can therefore only purchase Medigap if you are enrolled in Medicare Part A and B.
You cannot enroll in a Medigap plan while you are enrolled in a Medicare Advantage plan. Medigap coverage will require an additional monthly premium payment and you will also be responsible for any deductibles, co-pays, or co-insurance payments required under the Medigap plan.
Now that you have an understanding of what the Medicare age, eligibility and requirements are make sure to read out articles including What Does Medicare cover?; Medicare Advantage vs. Original Medicare; and Medigap vs. Medicare Advantage
At CoverRight, we’re here to help you find the right coverage that you deserve. Reach out today and start finding the best Medicare plan for you.