Feeling lost? You are not alone. From the mailers to the emails to the TV commercials and more…
People who are new to Medicare often have a difficult time sorting out all of the different options – from coverage and cost to benefits and limits! There are many different parts and plans with similar letters, emails, and commercials – making it hard to figure out what is what – and what is best for YOU.
It is not unusual for those close to 65 to have a whole basket of mail that they have received at home and ask for our help to identify which things should be kept or tossed out…including information from carriers or doctors themselves!
New to Medicare
New to Medicare as Your Primary Insurance
You can find most of the information you need about Medicare planning right here on this website.
Medicare planning can help you avoid penalties and get the most out of your benefits.
First, you need to know that the only parts of Medicare you will enroll in via the Social Security office is your Original Medicare Parts A & B.
All other Parts (C and D), supplemental coverage, or additional insurance enrollments are done outside of the original sign up, through an insurance agent or agency.
If you are already taking Social Security, the government will auto-enroll in both parts of Medicare. Otherwise, you must enroll yourself.
Medicare Eligibility
Who is eligible for Medicare? When can you get Medicare?
Medicare eligibility begins for most people at age 65. Individuals who have been entitled to Social Security disability for at least 24 months also qualify.
Many people confuse their Medicare Eligibility date with their Social Security retirement age. They are different. A person can apply for full retirement income benefits at around age 67. This is considered their retirement age. However, this does not affect the age at which they qualify for Medicare.
There is no such thing as a Medicare retirement age. The normal Medicare eligibility age for Medicare is age 65, whether you have retired or not.
You may also qualify for Medicare coverage at age 65 (or older) if you are a U.S. citizen or a permanent resident and you’ve lived here continuously for 5 years or more.
Medicare Eligibility Under 65
- You can also qualify for Medicare under these circumstances when you are under age 65
- If you are permanently disabled and you have been receiving Social Security disability income benefits for 24 months
- When you have end-stage renal disease, which is kidney failure that requires you to get dialysis or you are waiting for a kidney transplant
- If you have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s disease
-
Eligibility for Medicare Part A
You are eligible for Medicare Part A at age 65 if you or your spouse has legally worked for at least 10 years (40 quarters) in the U.S.
During those working years, you paid taxes toward your Part A hospital benefits. This is why most Americans pay no Part A premiums when they become eligible for Medicare. Part A is focused around your hospital stay.
If you have not worked the required 10 years to qualify for Medicare Part A at no cost, you can purchase Part A by contacting Social Security. In some cases, there are partial premiums for people who have worked over 30 quarters but less than 40 quarters.
You may be automatically enrolled in Part A (and Part B) at the time you turn 65 if you have already enrolled in Social Security income benefits. Your Medicare card will usually arrive in your mailbox about 4 – 6 weeks before you turn 65.
-
Eligibility for Medicare Part B
You are eligible for Medicare Part B at age 65. However, you must pay a monthly premium for Part B. This provides for your outpatient benefits such as doctor visits, lab work, surgery fees, and more.
Some people turning 65 still have health insurance through an employer. They can delay their enrollment into Part B in favor of their group health insurance without fearing a late penalty.
If you delay enrollment into Part B, consult with an insurance agent who specializes in Medicare to be sure you can avoid the enrollment penalty. He or she can explain the special election periods which you must use later on so that you won’t be subject to a late enrollment penalty.
Some Medicare Advantage plans (talked about in the Medicare Part C section) can help reduce the premium for Part B. Additional programs such as LIS (Low Income Subsidy program) can help reduce the premium as well. Reach out to us at 727-266-0355 to learn more about your options to reduce your Part B premium.
-
Eligibility for Medicare Part C
Medicare Part C is another name for the Medicare Advantage program. You can enroll in Part C if you wish to get benefits through a private insurance company instead of Original Medicare. Many of these plans also include prescription drug coverage, which is not included in Original Medicare Part A. To be eligible for Part C, you must first be enrolled in both Medicare Parts A and B. You must also live in the plan’s service area, as they are different per state and county.
Many people think that if they enroll in a Medicare Advantage plan, they can drop their Part B and escape paying Part B premiums. This is NOT the case; however, there are Medicare Advantage plans that can help reduce the premium for Part B.
You must have both A and B to even be eligible to enroll in either a Medicare Advantage plan or Medigap plan (also known as a Medicare Supplement). You must continue to be enrolled in Parts A and B during the entire time that you are enrolled in a Medicare Advantage plan.
Learn more about your personalized options for Medicare Advantage by giving us a call – 727-266-0355.
-
Eligibility for Medicare Part D
Medicare Part D plans consists of your prescription drug coverage. You are eligible for Medicare Part D as long as you are actively enrolled in either Part A and/or B. You must also live in the Part D plans’ service area.
Though Medicare Part D is voluntary, we strongly recommend it if you have no other drug coverage. Part D provides you insurance against future large medication costs. It will also help give you lower copays on covered medications you take now (different for each formulary).
Please note: Be aware that if you do not enroll in Part D and you have no other creditable coverage, you may incur late penalties when you enroll later on.
Frequently Asked Questions
Although Medicare was originally for only people aged 65 and over, that has changed over the years. The following people can now also qualify as stated above:
- Individuals who receive Social Security disability income benefits for at least 24 months
- People who receive Social Security disability income benefits and are diagnosed with Lou Gehrig’s disease are enrolled in Medicare on the first month
- People on kidney dialysis or who are a kidney transplant patient are eligible for Medicare. When those benefits will begin depends on your specific circumstances.
No. You must be a U.S. Citizen or a permanent resident who has lived continuously in the United States for at least 5 years, and be 65 years or older, or in one of the special circumstances listed above.
If you are aging into Medicare, you will qualify at age 65. This is regardless of when you apply for Social Security income benefits. You can apply for Medicare 3 months prior to your 65th birthday.
Not unless they qualify under one of the circumstances discussed in the previous question. Your Medicare eligibility date is not the same as your Social Security eligibility date.
You can apply when you are age 64, as early as 3 months before your 65th birthday month.
No, but if you do not have other creditable health coverage, you will face penalties for delaying your Medicare enrollment. You should also know that when you enroll into Social Security income benefits, you will be automatically enrolled into Medicare Part A.
Medicare is our national health insurance system for people aged 65 and older and people with certain disabilities.
Medicaid is a joint federal and state program to provide benefits for people with low incomes. It is possible to qualify for both Medicare and Medicaid.
You do not need to have Medicare to have Medicaid, and vice versa. Medicaid eligibility does not automatically qualify you for Medicare.
Anyone who is enrolled in either Medicare Part A or Part B (or both) is eligible to enroll in Part D. You must enroll when you are first eligible unless you have other creditable drug coverage. Otherwise, you will be subject to an expensive late penalty for Part D if you choose to enroll at a later time.
Find out about your Medicare Eligibility
Determining your Medicare eligibility can be tricky. We get many questions about when you can collect Medicare, how to qualify for Medicare, what the Medicare requirements are, when to enroll in Medicare, and how to set up Medicare supplement insurance. Though the process may seem overwhelming to you, our experts deal with these processes every day.
We can guide you easily through the process before you reach Medicare age – and recommend setting an initial appointment 3 months before your 65th birthday (or any time you would like a review!).
To book an appointment, please call 727-266-0355.