Medicare is the United States health insurance program for people aged 65 or older and under 65 in certain circumstances. Medicare helps with healthcare costs but does not cover all medical expenses or most long-term care costs.
To be eligible for Medicare, you must be a United States citizen or a permanent resident who has lived in the United States for five years or more.
If you currently receive Social Security benefits, you’ll get Medicare Part A and Part B automatically when you are eligible and do not need to sign up. Medicare will send you a Welcome packet three months before you turn 65. However, you will still have to adhere to other Medicare deadlines, so thoroughly ensure you read your Welcome packet.
When you reach age of 65 and become eligible for Social Security, you may be automatically enrolled in Medicare Part A. But if you are not receiving retirement benefits from Social Security, enrollment in Medicare Part B is not automatic, you must sign-up when you meet the age requirement.
What qualifies you for Medicare if you are under the age of 65?
If you are under the age of 65, you may be eligible for Medicare if you meet specific criteria:
- You are permanently disabled and have been getting Social Security disability income benefits for 24 months
- You have End-Stage Renal Disease (ESRD) that requires you to get dialysis or are waiting for a kidney transplant
- You have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s disease
Medicare Advantage Eligibility
Medicare Advantage (Part C) is an alternative way to get your Original Medicare benefits. Medicare Advantage plans are available through Medicare-approved private insurance companies. To be eligible for Medicare Advantage you must already be enrolled in Medicare Part A and Part B, and you must reside within the service area of the Medicare Advantage plan you want.
If you have Medicare Advantage, you must continue paying your Part B premium even if you enroll in a Advantage plan. Monthly rates and plan coverage for Medicare Advantage plans vary by the insurance company you choose and your specific plan details. But be aware that Medicare Advantage is optional, and there is no penalty for not signing up.
Medicare Part D Eligibility
Medicare Part D gives prescription drugs coverage and is available as a stand-alone option through private insurance companies that are approved by Medicare or as additional benefit in Part C plan. To be eligible to enroll in a Medicare Part D prescription drug plan, you must have Medicare Part A and/or Part B and you must live in the service area for the prescription drug plan in which you want to enroll. To be eligible to enroll in a Medicare Advantage plan with prescription drug coverage, there are the same criteria as they are for enrolling in Part C, you must have Medicare Part A and Part B, and you must live in the service area for the plan you’re considering.
What you can do once you’re eligible for Medicare
You have choices for how you get your Medicare coverage. If you choose to enroll in Original Medicare coverage, you can buy a Medicare Supplement Insurance policy from a private insurance company.
Medicare Part A provides coverage for inpatient care and limited time at a skilled nursing facility after a hospital stay. It also can cover costs for some home health care and hospice care. To keep it simple, think of Medicare Part A as primarily hospital insurance.
Medicare Part B provides coverage for services from doctors and other healthcare providers. It also covers outpatient care, home healthcare, durable medical equipment, and some preventive services. Think of Part B as medical insurance.
After becoming eligible for Medicare, be sure to learn about Medicare Parts C and D to determine if they are the right fit for you, along with supplement plans that are designed to help cover any gaps in your coverage that you foresee depending on your health and financial situation.
To enroll in Medicare, visit Medicare.gov to start your application immediately. If you need to do this over the course of a few days, you can start your application process, save your information, and log back in at any time to finish.
Once you are officially enrolled in Medicare, visit Medicare.gov to see your first-year checklist. This checklist will ensure that you have all of the necessary information in the right places and make the most of your benefits.
Note that Medicare Eligibility and Social Security retirement ages are different. Individuals can apply for full retirement income benefits at age 67, which is considered their retirement age. This does not affect the age they qualify for Medicare, which is 65.
For all of your eligibility questions, give us a call at 417-633-7200.