A guideline about how and when to enroll in Medicare
WHAT YOU NEED TO KNOW ABOUT ELIGIBILITY
It’s a little bit more complicated than it seems but lets us explain:
The majority of people become eligible for Medicare when they turn 65. However, becoming eligible doesn’t mean you’re automatically enrolled or that all of your health-care necessities are covered. It simply means that you’re allowed to sign up for Medicare. But what really is that you are eligible for? The date you sign up and the state where you live will influence the type of plan you will obtain and its costs.
Eligibility at age 65
Nobody likes to get old, but it is something that nobody can avoid. If you are about to turn 65, then it is time to think about your eligibility for Medicare. When you turn 65, you’ll be automatically eligible for Medicare. But you need to be a citizen of the United States or a legal resident; also have lived in the United States continuously for at least five years.
To qualify for premium-free Part A, you’ll have to meet at least one of the following requirements:
- You are eligible for Social Security (generally, this means you’ve worked and paid Medicare taxes for at least 10 years).
- You or your spouse is an existing or retired government employee who has paid Medicare payroll taxes during their career.
- You or your spouse qualifies for retirement benefits through the Railroad Retirement Board.
- Your husband/wife worked and paid Medicare taxes for a minimum of 10 years and is at least 62 years old.
- Suppose you are divorced, or your spouse is deceased (and you haven’t remarried). In that case, you may also qualify for premium-free or reduced-premium Part A based on your spouse or former spouse’s work history. So even if you haven’t worked, your former spouse’s credits may exempt you from paying a premium for Part A. However, there are restrictions: To qualify for premium-free Part A based on a former spouse’s work history, you must have been married for at least 10 years. To qualify based on a deceased spouse’s work history, you must have been married for a minimum of nine months before his or her death.
- It’s also important to note that Medicare is intended strictly for individuals, unlike private health insurance plans. You cannot add dependents such as children onto your Medicare plan. Even eligible spouses must enroll on their own.
When You’re Eligible to Sign Up
You become eligible to enroll in Medicare three months before your 65th birthday. At that point, the government gives you a seven-month window during which you can sign up for Parts A and B.
This seven-month window, known as your initial enrollment period (IEP), includes:
- The three months before your 65th birthday
- The month of your 65th birthday
- The three months after your 65th birthday
Usually, you’ll want to sign up for Part A as soon as you’re eligible since your coverage will begin based on when you enroll. If you don’t sign up during this period, you’ll pay a late penalty. Also, you won’t be able to enroll until the next general enrollment period, which lasts from January 1 through March 31. That coverage begins July 1.
Suppose you’re still working and have private insurance through your employer. In this case, you can enroll in Part A and delay signing up for Part B until you’re no longer working. This approach lets you put off paying the Part B premium until you retire. However, if you work for a company with fewer than 20 employees, you don’t have this option. In that case, Medicare will become your primary insurer as soon as you turn 65, which means you’ll need to sign up for part B.
Eligibility Before 65
People with specific qualifying disabilities and illnesses are eligible for Medicare before they turn 65.
Some people qualify for Medicare regardless of age, including the following:
- People that have been receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months
- People with ALS (also known as Lou Gehrig’s disease)
- People with end-stage renal disease (ESRD)
Eligibility Beyond Part A
Once you become eligible for Part A, you also automatically become qualified for the other parts of Medicare, including Parts B and D, Medigap, and Medicare Advantage. However, each of these additional parts comes with its own costs. Those who can’t afford these costs may also be eligible for Medicaid. Medicaid provides health insurance for low-income people.
Unlike Medicare, Medicaid is administered by states, so the qualifications will depend on where you live. If you do qualify for Medicaid, it is possible to carry both Medicare and Medicaid simultaneously. In fact, about one in five Medicare recipients is also on Medicaid. Even if you’re not eligible for free Medicaid coverage, you may qualify for a Medicare Savings Program. These programs are based on your income level and can help keep your health-care costs affordable.
In the case that you or your spouse have worked for a minimum of 10 years and paid Medicare taxes, you probably won’t have to pay any premiums for Part A.
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