Medicare Eligibility: Everything You Need to Know
To attain Medicare eligibility you must meet a list of qualifications and follow the straight-forward application process. Avoid late penalties by learning your enrollment periods.
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Key Takeaways:
If you are 65 and have paid the Medicare tax for the last 10 years through your payroll taxes, then you are automatically enrolled in Original Medicare (Parts A and B) through your federal retirement benefits.
- If you are younger than 65, you may still be eligible for Medicare if you have a qualifying disability, like ALS or end-stage renal disease.
If you miss your Initial Enrollment Period for Medicare Part A, you are able to join the General Enrollment Period between January 1 through March 31 every year.
Delaying Part B coverage: Once you leave work and retire, or your spouse's healthcare benefits end, you will have an eight-month enrollment period to sign up.
Once you are enrolled, then you can shop for your preferred Medicare Advantage plan, also known as Medicare Part C.
The Initial Enrollment Period is a seven-month time frame that begins three months before the month you turn 65 and ends three months afterward. During this period you can enroll into Medicare Part D.
An Overview of Medicare Eligibility
To qualify for Medicare, you need to be of retirement age or have a qualifying disability. Medicare has four parts and each part has a slightly different eligibility and enrollment process.
Who Is Eligible for Medicare Part A?
The basic requirements for Medicare Part A eligibility include:
You have lived in the US for a minimum of five years
You are 65 years old or older
If you qualify for federal retirement benefits, or receive Social Security, you will be automatically enrolled.
Individuals who are younger than 65 but have a qualifying disability, perhaps requiring regular dialysis, will also be eligible for Medicare Part A.
Special criteria for eligibility include:
You have received Social Security Disability Insurance (SSDI) for 24 months or more, or earned disability benefits from the Railroad Retirement Board (RRB) for 24 months.
You have been diagnosed with Lou Gehrig's disease (ALS).
You have been diagnosed with end-stage renal disease (ESRD), which is kidney failure that requires a kidney transplant or dialysis treatment.
If you are 65 and not automatically enrolled, then you can apply for Medicare Part A during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after your birthday.
Enrollment Periods for Medicare Part A
If you miss your Initial Enrollment Period, you are able to join the General Enrollment Period. This period runs from January 1 through March 31 every year.
There is also a Special Enrollment Period. This is a rolling period and requires a major life-qualifying event such as losing health insurance through your employer.
You can apply for Medicare Part A by visiting your local Social Security office, calling Medicare at 1-800-772-1213 or by filling out a simple application at the Social Security Administration website.
Once you are enrolled in Medicare Part A, you can update your benefit plan during open enrollment. Open enrollment occurs once per year and is only open to those who already have Medicare. The Open Enrollment Period is October 15 through December 7 of every year.
Who Is Eligible for Medicare Part B?
Medicare Part B eligibility requirements are the same as Medicare Part A. Once you qualify for federal retirement benefits, you will be automatically enrolled in Part B. You will qualify for Part B through your federal retirement benefits once you reach your 65th year and have been paying medicare taxes through your payroll taxes for at least 10 years.
Similar to other Medicare parts, you have an Initial and General Enrollment Period to receive Medicare coverage, as well as a Special Enrollment Period for qualifying life-altering events such as a kidney transplant or a change in a spouse's health insurance coverage.
If you are not automatically enrolled, then you can enroll during your Initial Enrollment Period. This period begins three months before your 65th birthday and ends three months after your birthday.
Enrollment Periods for Medicare Part B
If you miss the Initial Enrollment Period, you can enroll during the General Enrollment Period. This occurs between January 1 through March 31 of every year. If you have a life altering event, such as losing health insurance coverage, you can elect to enroll during the rolling Special Enrollment Period.
You can choose to delay your Part B coverage if you are working for a company and have health insurance through their benefits or through your spouse's healthcare insurance. One you leave work and retire, or your spouse's healthcare benefits end, you will have an eight-month enrollment period to sign up for Medicare Part B.
If you do not sign up within this period, you can wait until the General Enrollment Period. Keep in mind a lifetime late penalty fee is tacked on to your monthly Part B premium for each 12-month period you do not enroll into Medicare Part B after you have been deemed eligible to receive Medicare Part B benefits. There are premium-free plans for those that have qualifying incomes.
In order to enroll, you can do one of the three following options:
You can apply by visiting your local Social Security office
You can call Medicare at 1-800-772-1213
You can fill out a simple application at the Social Security Administration website. Please note, if you have Medicare Part A and wish to add Medicare Part B, you will not be able to fill out an online form to do this. You will have to call the above number or visit your local Social Security office.
Once you are enrolled in Medicare Part B, you can update your benefit plan during open enrollment. Open enrollment occurs once per year and is only open to those who already have Medicare. The Open Enrollment Period is October 15 through December 7 of every year.
Who Is Eligible for Medicare Part C?
The first step is to enroll in Medicare Part A and Part B (Original Medicare). If you are 65 and have paid the Medicare tax for the last 10 years through your payroll taxes, then you are automatically enrolled into the Original Medicare through your federal retirement benefits.
If you are 65 and not enrolled into your federal retirement benefits, you will need to enroll into original Medicare through your local Social Security office, calling 1-800-772-1213 or by filling out a form online.
Once you are enrolled, then you can shop for your preferred Medicare Advantage plan, also known as Medicare Part C, through the Medicare website. Depending on the advantage plan you choose, you may need to reside within a specific service area.
Keep in mind there are designated enrollment periods. If you are a new Medicare recipient, you have seven months to enroll beginning three months prior to your 65th birthday. This is known as your Initial Enrollment Period.
After your Initial Enrollment Period, you have two other options.
Option one: The Open Enrollment Period, October 15 through December 7 every year
Option two: The Special Enrollment Period, which occurs after a relocation such as moving to another state or the loss of health coverage
Who Is Eligible for Medicare Part D?
To enroll in Medicare Part D, you must be eligible for Medicare. Medicare Part D includes prescription drug coverage. You are eligible for Medicare if you meet one of the following qualifications:
You are age 65 or older
You have a qualifying disability for which you have received Social Security Disability Insurance (SSDI) for more than 24 months
You have been diagnosed with end-stage renal disease
You are entitled to Medicare Part A and/or enrolled in Medicare Part B
You are eligible for social security benefits
The Initial Enrollment Period is a seven-month time frame that begins three months before the month you turn 65 and ends three months afterward. During this period you can enroll into Medicare Part D. If you miss the Initial Enrollment Period then you can sign up during the General Enrollment Period, which runs every year from January 1 to March 31.
Once you are eligible, the first step to enrolling is to review the private plan offers available in your location. You can call 1-800-MEDICARE or visit the Medicare's Plan Finder tool on medicare.gov to compare plans and enroll. Call the plan you wish to enroll in and a representative can help you.
Danetha Doe is an entrepreneur, journalist, and economist from the San Francisco Bay Area who specializes in writing about finance.
