What is Medicare Eligibility

For many Americans, Medicare eligibility often goes hand in hand with becoming age 65, however some people become eligible for Medicare earlier under certain circumstances. Most Medicare beneficiaries receive Medicare Part A without a monthly premium, but some have to pay for it. And some beneficiaries have to pay more than the standard amount for their Medicare Part B and Part D coverage.

We have done the heavy lifting for you and listed our detailed overview of eligibility for all parts of Medicare coverage. In summary:

  • Many Americans become eligible for Medicare when they turn 65.
  • But 14% of all Medicare beneficiaries are under 65, and became eligible after receiving Social Security disability benefits for two years or being diagnosed with ALS or end-stage renal disease.
  • In order to get Medicare Part A without having to pay a monthly premium, you or your spouse must have worked for at least 10 years in the United States, paying Medicare taxes during that time.
  • To enroll in a Medicare Advantage, you must enroll in both Medicare Part A and Part B. Your Medicare Advantage plan will work with and require both parts, and will likely also include Medicare Part D prescription drug coverage.
  • If your income is high, you’ll pay more than other people for your Part B coverage and your Part D coverage. For 2022, “high income” is defined as having had a 2020 income of more than $91,000 for a single person or $182,000 for a couple (here’s how this is indexed each year). The determination is always based on income earned two years prior, but there’s an appeals process you can use if your circumstances have changed significantly since then.
  • You’re automatically eligible to enroll in Medicare Part D as long as you have either Medicare Part A or Part B.
  • If you’re enrolled in both Medicare Part A and Part B (but not a Medicare Advantage or Medicaid yet), you’re eligible to enroll in a Medigap plan to supplement your Medicare coverage. You’ll have a six-month guaranteed-issue window during which you can sign up for any Medigap plan available in your area. In most states and most circumstances, you’ll have to go through medical underwriting if you decide to apply for a Medigap plan after that window ends. You do not need a medical underwriting for any Medicare Advantage Plan.

How to sign up for Medicare

This section walks you through the basics of enrolling in Medicare. But first, you’ll want to read our tips for deciding between Original Medicare plus Medigap and Part D coverage, versus a Medicare Advantage plan.

Enrolling in Original Medicare

If you’re already receiving Social Security or Railroad Retirement Board benefits and you’re a U.S. resident, the federal government automatically enrolls you in both Medicare Part A and Medicare Part B at age 65. You’ll receive your Medicare card in the mail about three months before you turn 65, and your coverage will take effect the first of the month you turn 65. During this time frame you will have the opportunity to enroll into a Medicare Advantage Plan, Medicare Supplement plan or a Stand-Alone Medicare Prescription Plan.

Medicare Part B has a monthly premium, which will be deducted from your Social Security or Railroad Retirement check. The standard Part B premium is $170.10/month for 2022. That’s up from $148.50/month in 2021, and quite a bit higher than initially projected in the Medicare Trustees Report projects. But the Social Security cost-of-living adjustment (COLA) for 2022 is the largest its been in 30 years, and will cover the increase in Part B premiums (for most beneficiaries, the cost of Part B is deducted from Social Security checks; here’s more about how that works). However, the larger-than-expected increase in Part B premiums will eat up a significant portion of the Social Security COLA that many beneficiaries receive.

You can opt out of Part B and avoid the premiums, but it’s generally only a good idea to do that if you’ve got health insurance from your current employer or your spouse’s current employer, and the employer has at least 20 employees.

If you are turning 65, but you’re not yet receiving Social Security or Railroad Retirement benefits, you won’t be automatically enrolled in Original Medicare. Instead, you’ll be able to enroll during a seven-month enrollment period that includes the three months before your birth month, the month you turn 65, and the three following months. So if you’ll be 65 on July 14, your open enrollment period will be April through October.

You’ll enroll through the Social Security Administration. And although your enrollment window is seven months long, you need to enroll during the three months prior to your birthday month in order to have coverage that takes effect the first of the month that you turn 65. If you enroll during your birthday month or one of the three following months, your coverage effective date for Part B will be delayed. If you are looking to enroll in the many benefits of Medicare Advantage start here.

If you’re disabled and receiving Social Security Disability benefits, your Medicare coverage will start automatically in the 25th month that you’re receiving disability benefits. (If you have ALS or end-stage renal disease, you do not have to wait two years to get Medicare.)

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