Who is eligible for Medicare Part A and B?

If you are turning 65 or are already 65 years old, you may be wondering when you can begin enrolling in Original Medicare – Part A and B. Medicare Part A is basically hospital insurance and Medicare Part B is basically medical insurance. Before enrollment can begin, you need to know a few requirements that you are first required to meet:

  • Those who qualify for Medicare must be United States citizen or permanent resident who has lived in the United States for no less than five years.
  • To be automatically enrolled, you must be currently receiving Social Security or Railroad Retirement Board benefits.

After the previously mentioned requirements are met, you can proceed to the eligibility criteria:

  • you are 65 years old or older; or
  • you are receiving Social Security disability benefits for at least 24 months in a row
  • you have been diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)

If you do not qualify for automatic enrollment through Social Security, you can enroll during your Initial Enrollment Period, which starts three months before your 65th birthday and ends three months after your 65th birthday.

You can also receive premium-free Medicare Part A if you have legally worked in the U.S. while paying Medicare taxes for ten years or more. However, regardless if you’re eligible for premium-free Part A, you will have to pay a premium for Part B.

What if I’m younger than 65?

If you are younger than 65, you may be eligible to enroll in Original Medicare, but you do have to meet certain criteria to do so:

  • You are permanently disabled and have been getting Social Security disability income benefits for 24 months
  • You have End-Stage Renal Disease that requires you to get dialysis or have permanent kidney failure and wait for a kidney transplant
  • You have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig`s disease

Signing up for Original Medicare

Keep in mind that if you don’t receive premium-free Part A, you can purchase Part B without having to purchase Part A. However, you have to be:

  • 65 or older
  • A U.S. citizen or permanent resident who has continuously lived in the U.S. for at least five years

If you are not eligible for premium-free Part A or enrolled automatically and choose not to enroll when you become eligible for Medicare, your Part A premium will go up 10 percent. This is considered as the late enrollment penalty. You will be expected to pay this higher premium for double the amount you went without having Part A coverage. For example, if you were eligible for Part A for three years but did not enroll, you will be required to pay a higher premium for six years. However, with Part B, you will be expected to pay a higher monthly premium for as long as you have Part B coverage.

Medicare Enrollment Periods

  • Initial enrollment period – starts three months before the month of your 65th birthday, and extends to the three months after your birthday month, in total this is a 7-month period. During this period you are obligated to enroll in Medicare. Otherwise, you will be exposed to a late enrollment penalty. 
  • Special Enrollment Period – Individuals who are still getting health coverage through their employer can use a Special Enrollment Period. The Special Enrollment Period lasts eight months and starts the month after employment or the employee health coverage ends. Those who are eligible for Special Enrollment are not exposed to the late enrollment penalty.
  • Open Enrollment Period – starts on October 15 and lasts until December 7. It is designed only for changes in the current plans you own. In this period you are able to change from Medicare to Medicare Advantage plans, as well as you are able to enroll in a new Medicare Advantage plan or only a stand-alone Part D plan. 

For any Medicare eligibility questions, you may have, give Temmen Insurance a call at 417-633-7200.

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