Medicare Eligibility

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Medicare Part A Eligibility

You are eligible for Medicare Part A when you turn 65. If you or your spouse legally worked at least 10 years in the U.S., you will receive Medicare Part A benefits free. While working, you paid for Medicare benefits through payroll deductions.

If you worked less than 10 years, you may be able to purchase Part A benefits. However, if you worked more than 30 quarters (7.5 years), but less than 40 quarters (10 years), there are partial premiums available.

Medicare Part B Eligibility

You are eligible for Medicare Part B when you turn 65, however, there is a monthly premium. This coverage pays for outpatient benefits such as doctor visits, lab work, surgery fees, etc.

If you are turning 65 and still receive health insurance through your employer, you can delay your enrollment in Part B without a late penalty. Check with an insurance agent to find out more about delaying enrollment into Part B.

If you have a spouse, you will each purchase your own Part B policy. Social Security will determine the amount you pay based on your married income, but the Part B policy is individual.

Medicare Part C Eligibility

Another name for Medicare Part C is the Medicare Advantage plan. If you would rather get your benefits through a private insurance company instead of Original Medicare, you can enroll in Medicare Advantage.

To be eligible for Part C, you must be enrolled in both Medicare Parts A and B and live in a plan’s service area.

Many people think if they enroll in a Medicare Advantage plan, they can drop their Part B coverage and avoid the premium. This is NOT true. You must be enrolled in both Parts A and B, and remain enrolled in both parts, to enroll in either a Medicare Advantage plan or a Medicare Supplemental plan.

Medicare Part D Eligibility

Medicare Part D Eligibility

Medicare Part D is coverage for prescription drugs and is optional insurance. You must be enrolled in either Part A and/or Part B to be eligible for Part D and you must live in the plan’s service area.

Even though Part D is optional, we recommend it if you don’t have any other prescription drug coverage. Part D protects against catastrophic medication costs and helps you pay lower copays on medication now.

If you do not enroll in Part D and you don’t have any other creditable coverage, you may incur late penalties when you enroll later.

Frequently Asked Questions

Who is eligible for Medicare under age 65?

  • Individuals who receive Social Security disability income for 24 months
  • People receiving Social Security disability income AND are diagnosed with Lou Gehrig’s disease
  • People on kidney dialysis or who are kidney transplant patients. The benefits depend on your specific circumstances.

How long do you have to work to be eligible for Medicare?

Eligibility for Medicare isn’t based on work history, however, people who worked at least 10 years (40 quarters) and paid Medicare through payroll taxes will get Part A services for free.

Can a person get Medicare at age 62?

Not unless they qualify for the special circumstances described above. Eligibility for Medicare and for Social Security are not the same.

Is the Medicare eligibility age changing to 67?

The Medicare eligibility age is still 65. Some younger people can enroll in Medicare (see above). Congress discussed changing the Medicare eligibility age, but no change has been voted into law.

Is it mandatory to sign up for Medicare at 65?

No, but without other creditable health coverage, you will incur penalties for delaying your Medicare enrollment. When you enroll in Social Security income benefits, you are automatically enrolled in Medicare Part A. You can’t have one without the other.

What is the difference between Medicare and Medicaid?

Medicare is the national health insurance system for anyone age 65 and older, and people with certain disabilities. Medicaid is a joint federal/state program providing benefits for people with low incomes. You might qualify for both Medicare and Medicaid. Medicare would be primary coverage and Medicaid secondary coverage.

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