Who is eligible for Medicare?

Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).You are eligible for Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. Many people confuse their Medicare Eligibility date with their Social Security date. They are different. A person can apply for full retirement income benefits at age 66. However, this does not affect the age at which they qualify for Medicare.

You can get Part A at age 65 without having to pay premiums if:

  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

To find out if you are eligible and your expected premium, give us a Call and we can determine your eligibility.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

  • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig’s disease, your Medicare benefits begin the first month you get disability benefits.)
  • You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

 

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Eligibility  –  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 in the U.S. During those 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 mainly covers your hospital stays.

In general, you are eligible for Medicare Part A if:

  • You are age 65 or older and a U.S. citizen or permanent legal resident of at least five years in a row.
  • You are already receiving retirement benefits.
  • You are disabled and receiving disability benefits.
  • You have end-stage renal disease (ESRD).
  • You have amyotrophic lateral sclerosis (Lou Gehrig’s disease or ALS).

If you have not worked the required 10 years to qualify for Medicare Part A at no cost, you can purchase Part A. Contact Social Security to find out the cost. If you must purchase Part A, the coverage will cost up to $$437 monthly. In some cases, if you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $240.

 

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Eligibility  –  Part B

You are eligible for Medicare Part B at age 65 as well. However, you must pay a monthly premium for Part B.  This provides for your outpatient benefits such as doctor visits, blood work, outpatient care, medical supplies and preventative services. Check out our Part B page for more on what Part B covers.

Some people turning 65 and are still with their health insurance through an employer 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, give us a Contact Us. We can explain the special election periods which you must use later on so that you won’t be subject to a late enrollment penalty.

If you are still working, you should check with your health benefits administrator to see how your insurance would work with Medicare. If you delay enrollment in Medicare Part B because you already have current employer health coverage, you can sign up later during a Special Enrollment Period without paying a late penalty.

You can enroll in Medicare Part B at any time that you are still covered by a group plan based on current employment. After your employer health coverage ends or your employment ends (whichever comes first), you have an eight-month special enrollment period to sign up for Part B without a late penalty.

Keep in mind that retiree coverage and COBRA are not considered health coverage based on current employment and would not qualify you for a special enrollment period. If you have COBRA after your employer coverage ends, you should not wait until your COBRA coverage ends to sign up for Medicare Part B. Your eight-month Part B special enrollment period begins immediately after your current employment or group plan ends (whichever comes first). This is regardless of whether you get COBRA

 

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Do you need help understanding Medicare coverage? The first step to setting Medicare the right way is knowledge. Let us help you answer your questions and guide you through the Medicare maze. Contact Us Remember, our help is always 100% free.

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. In most cases you’re not eligible if you have end-stage renal disease (although there are exceptions, and some Special Needs Plans may accept you).

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. You must have both A and B to even be eligible to enroll in either a Medicare Advantage plan or Medicare Supplement plan. You must continue to be enrolled in Parts A and B during the entire time that you are enrolled in a Medicare Advantage plan.

 

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Do you need help understanding Medicare coverage? The first step to setting Medicare the right way is knowledge. Let us help you answer your questions and guide you through the Medicare maze. Contact Us Remember, our help is always 100% free.

Eligibility for Medicare Part D is not open to everyone 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. Even though Medicare Part D is voluntary, we strongly recommend it if you have no other drug coverage. Part D provides your insurance against future catastrophic medication costs. It will also help give you lower copays on medications you take now.

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.

You must meet certain criteria to enroll in a Medicare Part D plan. Below are examples of some of the qualifying categories:

  • You are age 65 or older
  • You have a qualifying disability for which you have been receiving Social Security Disability Insurance (SSDI) for more than 24 months1
  • You have been diagnosed with End-Stage Renal Disease (permanent kidney failure requiring a kidney transplant or dialysis)
  • You are entitled to Medicare Part A and/or enrolled in Medicare Part B

Get Free Medicare Help

Do you need help understanding Medicare coverage? The first step to setting Medicare the right way is knowledge. Let us help you answer your questions and guide you through the Medicare maze. Contact Us Remember, our help is always 100% free.

Frequently Asked Questions

When you age into Medicare, you will qualify at age 65. This is regardless of when you apply for Social Security income benefits.

Medicare was originally for only people aged 65 and over but that has changed over the years. The following people can now also qualify:

  • Individuals who receive Social Security disability income benefits for 24 months are automatically enrolled in Medicare on the 25th 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
  • People who receive Social Security disability income benefits and are diagnosed with Lou Gehrig’s disease are enrolled in Medicare on the first month

Your Medicare eligibility date is not the same as your Social Security eligibility date so unless you qualify under one of the circumstances discussed in the previous question the answer is NO.

If you’ve worked at least 10 years (40 quarters) while paying Medicare taxes, there is no monthly premium for your Medicare Part A (hospital insurance) benefits. But if you haven’t worked, or worked less than 10 years, you may qualify for Part A free when your spouse turns 62, if she or he has worked at least 10 years while paying Medicare taxes. However, to be eligible for Medicare, you need to be 65 years old. You also need to be an American citizen or legal permanent resident of at least five continuous years.

Example:

  • Ana is 65 years old. she’s on Medicare, but she pays a monthly premium for her Medicare Part A benefits. She only worked for 6 years and no longer works.
  • Her husband, Mike, has worked for over 30 years.
  • Mike turns 62. Now, Ana no longer has to pay a Medicare Part A monthly premium.
  • Mike still has to wait until age 65 to be eligible for Medicare (unless he qualifies by disability).

If you retire at age 62, you may be able to continue to get medical insurance coverage through your employer, or you can purchase coverage through NevadaHealthlink until you turn 65. Another option is qualifying the Nevada Medicaid.

Your eligibility for Medicare is not based on your work history. However, people with at least 10 years (40 quarters) of paying Medicare payroll taxes will get Part A services without paying premiums once they are eligible.

The age of eligibility for Medicare is still 65 but Congress has discussed changing the age of Medicare eligibility. But so far nothing has been voted and passed into law.

No

You must keep in mind though that 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. You cannot have one without the other.

Medicare is our national health insurance program 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. The coordination of both benefits would be in the following order:

Medicare – Primary

Medicaid – Secondary

Figuring out your Medicare eligibility in the Medicare maze can be overwhelming. We get many questions about how to qualify for Medicare, what the Medicare requirements are, and when to enroll in Medicare.  We deal with these processes every day. We can guide you easily through the process.

Stop the confusion today – let us assist you in making this easier.

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