When Am I Eligible For Medicare?

Most American citizens gain benefits from Medicare. Find out if you are eligible for this coverage.

At the point when you consider Medicare, you likely accept that it’s for individuals who are close to their retirement age. That is valid, however, the program covers something other than the individuals who have worked for their entire life. You may be qualified at the present time and not know it. When am I eligible for Medicare is a question most people often find themselves asking. Research has discovered that while the greater part of recipients, over 80%, are individuals who are 65 years old or more, others get administrations at a young age because of a passing disability.

What age can I get Medicare?

If you are 65 years old or more, you are eligible for full Medicare benefits if:

  • You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years.
  • You are getting Social Security or Railroad Retirement benefits or have worked long enough to be qualified for those benefits but are not yet collecting them.
  • You or your husband/wife is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.

If you are younger than 65, you may still be qualified. You are eligible for full Medicare benefits if you are less than 65 years old if:

  • You have been getting to Social Security Disability benefits for at least 2 years (it is not necessary that they be consecutive)
  • You get a disability pension from the Railroad Retirement Board and meet specific conditions
  • You have Lou Gehrig’s disease, also called amyotrophic lateral sclerosis (ALS), which makes you immediately eligible
  • You have permanent kidney failure for which you need regular dialysis or a kidney transplant — and you or your spouse has paid Social Security taxes for a certain period, based on your age.

What documents do I need to apply for Medicare?

You will have to demonstrate that you are qualified for Medicare when you initially enroll. At times, Medicare may already have this data. In case you are already getting Social Security retirement benefits or Social Security Disability Insurance, you will not have to present any extra documentation. Social Security and Medicare will already have all the data they need to handle your enrollment.

On the off chance that you do not get any sort of Social Security benefits, you will need to give documentation to enroll in Medicare. You can enroll online, via telephone, or face to face at a Social Security office. Regardless of how you apply, you will need to give certain data. Usually, this incorporates:

  • applicant’s date and place of birth
  • applicant’s citizenship status
  • applicant’s Social Security number
  • if you have ever applied for Social Security benefits in the past, or whether anyone has ever applied on your behalf
  • information about any Social Security work credits you’ve earned in another country
  • information about any work you or a spouse has done for the railroad industry
  • information on any federal pension you receive now or will receive in the future
  • the amount of money you have earned in the past 2 years (if you are applying between September and December, you will also need to estimate next year’s earnings)
  • the date and place of any marriages or divorces you have had
  • the dates of any military service you had before 1968
  • the names and ages of any children you have who are less than 18 years old (children up to the age of 19 who are still in high school also need to be mentioned)
  • the names and ages of any children you have who had a disability before age 22
  • the name and address of any employer you have had in the past 2 years
  • the name and Social Security number of your current spouse and any former spouses

Most of this data can be given simply by filling out the application. However, some details will require extra documentation. These documents may include:

  • applicant’s original birth certificate or a copy that has been certified by the issuing agency, for instance, the state you were born in
  • a record of your earnings, such as your Social Security statement
  • if you are not a U.S. citizen, proof of legal residency — including your Permanent Resident Card, often called a green card, along with your admission-departure record, if you have it
  • if you do not have a record of your birth, you will be required to provide other documents to prove your age, for instance, your immunization records, school records, state census records, insurance records, or medical records
  • if you had military service before 1968, a record of your service, such as your discharge papers
  • if you were born outside the United States, you will be required to give a proof of your U.S. citizenship such as your U.S. passport, a Naturalization Certificate, a Certificate of Citizenship, or a U.S. consular report of birth
  • your W-2 or self-employment tax information from the past year

You probably will not require all of these documents, however it is a smart idea to have as many of them prepared as you can. Social Security will tell you what is required and what is not. Any documents you send ought to be originals. Social Security will acknowledge duplicates of W-2s, tax documents, and clinical records, however all the other things should be an original report. Social Security will send the documents back to you after they have been inspected.

You will have to give the documents recorded above when you enroll in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Together, parts A and B are known as Original Medicare. You will have to enroll in Original Medicare before you can enroll in other Medicare parts. Other parts of Medicare are as follows:

  • Medicare Part C, also known as Medicare Advantage
  • Medicare Part D, which is prescription drug coverage
  • Medicare supplement insurance, also called Medigap

You should not need to submit any extra documentation when you enroll in these other parts. You will only be asked to provide your Medicare number and your Medicare Part A start date. You can find your Medicare number and Part A start date on your Medicare card.

Who is eligible for Medicare and Medicaid?

Medicare and Medicaid are two different government-run programs. They are operated and funded by various parts of the government and primarily serve different groups.

  • Medicare is a federal program that provides health coverage if you are more than 65 years old or are under 65 and have a disability, regardless of your income.
  • Medicaid is a state and federal program that gives health insurance if you have a very low income.
  • If you are qualified for both Medicare and Medicaid (dually eligible), you can have both. They will work together to provide you with health coverage and lower your costs.

Moreover, keep in mind that while Medicare and Medicaid are both health insurance programs that are federally supported, there are differences in covered services and cost-sharing. You can call 1-800-MEDICARE or get in touch with your local Medicaid office to learn more about Medicare and Medicaid costs and coverage, especially if you are dual-eligible.

Medicare

Typically, Medicare is present for people who are 65 years old or more, younger people with disabilities as well as those who have End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are qualified for premium-free Part A if you are 65 years old or more and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at 65 years of age without having to pay premiums if:

  • You are getting retirement benefits from Social Security or the Railroad Retirement Board.
  • You are qualified to receive Social Security or Railroad benefits but you have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

To find out if you are qualified and what your expected premium is, go to the Medicare.gov eligibility tool.

Given that you (or your spouse) did not pay Medicare taxes while you worked, and you are 65 years old or more along with being a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

  • You are a kidney dialysis or kidney transplant patient.
  • You have been getting to Social Security or Railroad Retirement Board disability benefits for 2 years. (Keep in mind that if you have Lou Gehrig’s disease, your Medicare benefits begin the first month you get disability benefits.)

While most people can get a premium-free Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

Am I eligible for Medicare Part A?

Usually, you are qualified for Medicare Part A in case you are 65 years of age and have been a legal resident of the U.S. for at least five years. In fact, the government will automatically enroll you in Medicare Part A free of cost when you reach 65, as long as you are gathering Social Security or Railroad Retirement benefits.

In case you are already getting Social Security or Railroad Retirement benefits, you should simply check your mail for your Medicare card, which ought to automatically arrive in the mail around 90 days (3 months) before your 65th birthday (or the 25th month of a disability, in case you are becoming qualified for Medicare because of disability instead of age). The card will show up with the option to quit Part B, however, quitting Part B is only a smart idea in case you are still actually working and have employer-sponsored coverage that gives the same or better inclusion, or if your spouse is still working and you have inclusion under their plan.

In case you are not already getting Social Security or Railroad Retirement benefits, you will need to enroll in Medicare during a seven-month open enrollment window that incorporates the three months before the month you turn 65, the month you turn 65, and the three months after that. On the off chance that you enroll before the month in which you turn 65, your benefits will begin in the month during which you turn 65 (or the month before that, if your birthday is on the first of the month). In the event that you enroll in the three months after you turn 65, your coverage might have a delayed effective date.

Along with turning 65, individuals can become qualified for Medicare because of a disability (qualification for Medicare begins after you have been getting Social Security or Railroad Retirement Board disability benefits for two years), or because of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). Individuals with ESRD become qualified for Medicare on the fourth month of dialysis treatment, or before that if they participate in a home-dialysis training. Individuals with ALS become qualified for Medicare the same month their disability benefits start (and a five-month waiting period for disability benefits to start after an individual is diagnosed with ALS, is no longer present).

Most people are members of a premium-free or Medicare Part A. You are eligible to receive Part A coverage premium-free if:

  • You are 65 years old and you or your current or former spouse has paid Medicare taxes for at least 10 years.
  • You are not yet 65, but you are disabled and you or your spouse have been paying Medicare taxes for at least 10 years. After you have received Social Security disability benefits or Railroad Retirement Board disability benefits for two years, you will be qualified for Medicare, with a premium-free Part A (the two-year waiting period does not apply for people with ESRD or ALS). In the case of a disabled child, eligibility for Medicare is dependent on a parent’s work history, and this can continue after the child reaches adulthood.

If you (or your spouse) have not been paying Medicare (FICA) taxes for at least 10 years, you will still be qualified to purchase Part A inclusion. However, you will be required to pay a premium, which varies depending on your work history. Your premium in 2021 will be $471 a month if you have paid into Medicare less than 7.5 years, and $259 a month if you have paid FICA taxes for at least 7.5 years but less than 10 years.

Am I eligible for Medicare Part B?

At the point when you get a notification that you are qualified for Medicare Part A, you will likewise be informed that you are qualified for Part B inclusion, which is optional and has a charge for all enrollees. Part B costs $148.50/month for most enrollees in 2021, albeit Part B costs more if your pay is more than $88,000 (or $176,000 for a married couple; keep in mind that these sums were filed for inflation beginning in 2020).

Enroll in both Part A and Part B. You have an enrollment window that runs for seven months (generally, starting three months before the month you turn 65 and proceeding for 3months after that). And keeping in mind that you can enroll in the three months following your 65th birthday, it is ideal to enroll in Part B early, or you could have gaps in your health coverage. If you wait excessively long, you could wind up locked out of Part B and would have to until the following general Medicare enrollment period.

In the event that you do not enroll during your initial window, you will not lose qualification for Part B, yet you will be punished with an increased premium when you finally enroll, which climbs 10% for every year that you were qualified but did not enroll in Part B (note that there is no punishment on the off chance that you delay Part B since you are covered by a current employers’ plan, either your own or your spouse’s). The General Enrollment Period (GEP) for Medicare A and B runs from January 1 to March 31 every year, for coverage effective July 1 — with an increased premium if the late enrollment penalty applies.

Am I eligible for Medicare Part C?

In case you are qualified for Medicare benefits, you need to pick how to get them – either through the federally run Original Medicare program, or through Medicare Advantage. Most Medicare recipients utilize Original Medicare, yet around four out of every ten are enrolled in Medicare Advantage plans and Advantage enrollment has been consistently moving at a much quicker speed than overall Medicare enrollment.

You need to have (or be qualified for) both Medicare Part A and Part B to enroll in Medicare Advantage, and you can choose a plan during your Medicare initial enrollment period — the seven months surrounding the month you become eligible for Medicare (keep in mind that there are some rural areas of the nation where Medicare Advantage plans are not accessible; you need to live in a region where Advantage plans are offered in order to enroll in one).

Most Medicare Advantage plans additionally incorporate Part D prescription drug inclusion; if you have a Medicare Advantage plan, you usually get your Part D inclusion along with the health and hospital benefits, in one single bundle, albeit the maximum out-of-pocket limits for Medicare Advantage (around $7,550 in 2021) exclude the cost of prescription drugs. Individuals with end-stage renal disease (ESRD) are qualified for Medicare, however, they used to be ineligible for most Medicare Advantage plans. This changed starting in 2021, however, under the conditions of the 21st Century Cures Act. As of 2021, individuals with ESRD have the same access to Medicare Advantage plans as other Medicare recipients.

Am I eligible for Medicare Part D?

To be qualified for Medicare Part D prescription medication inclusion, you should have either Medicare Part A or Part B, or both. You can enroll in Medicare Part D at the same time you sign up for Medicare Part A and B.

As mentioned previously, the vast majority who select Medicare Advantage should get their Part D prescription benefits as part of that same Medicare Advantage plan (89% of all Medicare Advantage plans incorporate Part D inclusion in 2021). Medicare Savings Account (MSA) plans exclude Part D inclusion, as do some Private Fee-for-Service (PFFS) Medicare plans. In the event that you have a MSA or a PFFS and it does not have Part D inclusion included, you are permitted to buy an independent Part D plan to enhance it.

Similarly as with Part B, you are still qualified for Part D prescription drug inclusion on the off chance that you do not enroll when you are first qualified, however you might pay higher premiums in the event that you enroll later on, except if you had creditable inclusion from another plan during the time that you delayed enrollment in Part D.

Medicaid

You may be eligible for free or low-cost care through Medicaid depending on income and family size. In all states, Medicaid gives health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states the program provides coverage for all low-income adults who fall below a certain level of earning.

  • First, figure out if your state is extending Medicaid and learn what that means for you.
  • If your state is extending Medicaid, find out what you may qualify for depending on your income and family size.

Even if you were told that you are not eligible for Medicaid in the past, you may qualify under the new rules. There are 2 ways whether you qualify for Medicaid or not:

  • Fill out an application in the Health Insurance Marketplace. When you complete the application, you will be told which programs you and your family are eligible for. If it looks like anyone is qualified for Medicaid and/or CHIP, the state agency will be notified so that you can enroll.
  • Go to your state’s Medicaid website. Using the drop-down menu at the top of this page, choose your state. You can apply right now and find out if you are eligible. If you qualify, inclusion will start immediately.

What is the maximum income to qualify for Medicare?

  • A Qualified Disabled and Working Individuals (QDWI) policy assists in paying for your Medicare Part A premium (if you pay this premium). To be eligible, your monthly income cannot be more than $4,045 for an individual or $5,425 for a married couple. Your resource limits are $4,000 for one person and $6,000 for a married couple. You may be qualified for this only if
  • you are a working disabled individual under 65;
  • you lost your premium-free Part A when you returned to work;
  • you are not getting state medical assistance;
  • you meet the income and resource requirements set by your state
  • A Qualified Medicare Beneficiary (QMB) policy helps cover your Medicare Part A and Part B premiums, as well as other expenses such as copayments, coinsurance, and deductibles. To be eligible, your monthly income can be no more than $1,010 for an individual or $1,355 for a married couple. Your resource limits are $7,280 for one person and $10,930 for a married couple.
  • A Qualifying Individual (QI) policy helps paying for your Medicare Part B premium. To be eligible, your monthly income can be no more than $1,357 for an individual or $1,823 for a married couple. Your resource limits are $7,280 for one person and $10,930 for a married couple.
  • A Specified Low-Income Medicare Beneficiary (SLMB) policy helps cover your Medicare Part B premium. To be eligible, your monthly income can be no more than $1,208 for an individual or $1,622 for a married couple. Your resource limits are $7,280 for one person and $10,930 for a married couple.

How long before you turn 65 do you apply for Medicare?

When you are first qualified for Medicare, you have a 7-month Initial Enrollment Period to enroll Part A and/or Part B. If you are qualified for Medicare when you turn 65 years old, you can sign up during the 7-month period that:

  • Starts 3 months before the month you turn 65
  • Includes the month you turn 65
  • Finishes 3 months after the month you turn 65

If you wait until the month in which you turn 65 years old (or the 3 months after you turn 65) to sign up, your Part B coverage will be delayed. This could create a gap in your coverage. In most situations, if you do not enroll in Medicare Part B when you are first eligible, you will have to pay a late enrollment penalty. Moreover, you will have to pay this penalty for as long as you have Part B and you could have a gap in your health coverage.

Conclusion

Medicare benefits start once you are 65 years of age (except if you qualify by disability). You are automatically enrolled at age 65 in case you are getting Social Security or Railroad Retirement Board benefits. To check whether you fit the bill for benefits, go to Medicare.gov’s eligibility and premium calculator. That is where you can check your eligibility for benefits and get an estimate of your monthly premium. In the event that your individual circumstance is not shrouded in the calculator, contact Social Security to examine your case and get the help you need. Social Security agents will assist you with understanding your specific situation and guide you through the subsequent stages.

Sandra Johnson

Sandra Johnson

Sandra Johnson was a few years out of school and took a job as a life insurance agent in California, selling coverage door-to-door for Prudential. The experience taught her about the technical components of insurance and its benefits for individuals and society, as well as the misunderstandings people often have about insurance. She has over ten years’ experience in the insurance industry, having worked as both a Broker and Underwriter, assisting clients across a broad range of industries. At Insurance Noon, Sarah diligently gathers all the required information and curates up pieces to provide meaningful insurance solutions. Her personal value proposition is to demonstrate a genuine interest in always adding value for clients.Her determined approach to guiding clients has turned her into a platinum adviser to multiple insurers.