Understanding Medicare eligibility and when to apply are just two of the confusing and tricky parts to Medicare. There are a number of factors that can impact your eligibility and enrollment.
If you are 65 or older and a citizen or permanent resident of the United States, you are eligible for all Medicare options. Three months prior to your 65th birthday, you can begin the application process. Applications are accepted through the month of your 65th birthday, and for three months after. If you need assistance navigating the healthcare maze or reviewing options and benefits, contact SENIORx Patient Advocates http://www.seniorpatientadvocates.com/contact/
If you are over 65 and still working or covered with health insurance by a working spouse’s employer but have not taken Medicare benefits yet you are eligible to enroll at almost any time. Anyone who is receiving Social Security Disability Income (SSDI) for 24 months is also eligible for Medicare and will be automatically enrolled into Medicare.
You’re eligible for “Part A” at no cost at age 65 if:
- You receive or are eligible to receive Social Security benefits
- You receive or are eligible to receive railroad retirement benefits
- Your spouse (living or deceased, including divorced spouses) receives or is eligible to receive Social Security or railroad retirement benefits
- You or your spouse worked long enough in a government job through which you paid Medicare taxes
- You are the dependent parent of a fully insured deceased child
If you don’t meet these requirements, you may be able to get Medicare Part A by paying a monthly premium. Usually, you can purchase this coverage only during designated enrollment periods.
Before age 65, you are eligible for Medicare Part A at no cost if:
- You’ve been entitled to Social Security disability benefits for 24 months
- You receive a disability pension from the railroad retirement board and meet certain conditions
- You receive Social Security disability benefits because you have Lou Gehrig’s disease (amyotrophic lateral sclerosis)
- You worked long enough in a government job through which you paid Medicare taxes, and you’ve been entitled to Social Security disability benefits for 24 months
- You’re the child or widow(er) age 50 or older, including a divorced widow(er), of someone who’s worked long enough in a government job through which Medicare taxes were paid, and you meet the requirements of the Social Security disability program
- You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and
- You’re eligible for or receive monthly benefits under Social Security or the railroad retirement system
- You’ve worked long enough in a Medicare-covered government job
- You’re the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job
If you are eligible for Medicare Part A at no cost, you can also enroll in Medicare Part B by paying a monthly premium. Some people with higher incomes will pay a higher monthly Part B premium. If you’re not eligible for Part A at no cost, you can buy Part B, without having to buy Part A, if you’re age 65 or older and you’re:
- A U.S. citizen
- A lawfully admitted non-citizen, who has lived in the United States for at least five years.
If you are eligible to receive Part A and Part B benefits directly from the government you are eligible for Part C plans.
Anyone who has Medicare Part A and/or Part B is eligible for Part D.
Is it Time to Apply?
If you aren’t getting benefits from Social Security (or the Railroad Retirement Board) at least four months before you turn 65, you’ll need to sign up with Social Security to get Parts A and B. However, depending on the size of the employer, you may be able to delay Parts A and B without having to pay a penalty if you enroll later.
You should also investigate your options to consider signing up for Medicare during the seven-month window provided, even if you are working and receiving employer paid benefits. There are strict guidelines as to if and at what point you should sign up based on your unique situation. For example, if you work for a company with fewer than 20 employees, you should sign up for Medicare Part A and B. Medicare will pay before your other coverage. There are also IRS restrictions to be aware of if you fund a Health Savings Account (HSA) if elect Medicare.
You may be required to pay late enrollment penalties and have a gap in coverage if you don’t follow Medicare’s requirements or miss deadlines. Contact SENIORx Patient Advocates to help determine the best time to sign up and start receiving benefits!