Medicare Eligibility

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 $$505 monthly. In some cases, if you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $278.

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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.