Medicare Eligibility

Who is eligible for Medicare? Learn about Medicare Part A, Part B, Part C, and Part D eligibility, including age, qualifications, and requirements.

Am I Eligible for Medicare

To be eligible for Medicare, you must first be a U.S. Citizen or a permanent resident who has lived continuously in the United States for at least 5 years.

Most people become eligible for Medicare at age 65. You may also qualify for Medicare before you turn 65 if you have certain health conditions such as ALS (also known as amyotrophic lateral sclerosis, or Lou Gehrig’s disease).

You may also be eligible and even automatically enrolled in Medicare Parts A & B, if you have received disability benefits from Social Security for 24 months, or if you have received certain disability benefits from the Railroad Retirement Board for more than 24 months.

Part A Eligibility

Medicare Part A (Hospital Insurance) is one of the two main components that make up Original Medicare. You can get premium-free Part A if you or a spouse worked and paid Medicare taxes for at least 10 years (or 40 quarters).

If you are eligible to receive Medicare, but do not qualify for premium-free Part A ($0 per month), you can buy Part A. You will expect to pay a monthly premium of either $259 or $471 in 2021 depending on how long you or your spouse worked and paid Medicare taxes. Your cost may be reduced depending on how many quarters you have worked in some states.

Part B Eligibility

Medicare Part B (Medical Insurance) is the other main component of Original Medicare that you become eligible for when you turn 65. You must pay a premium each month to the federal government in order to keep your Part B active. If you don’t sign up for Part B when you first become eligible for Medicare and you don’t have creditable coverage such as employer’s group health insurance, you may be subject to a late-enrollment penalty.

As of 2021, the standard monthly premium for Part B is $148.50 per month. Keep in mind that the Part B monthly premium changes every year. This premium is automatically deducted from your benefit payment if you get benefits from Social Security, Railroad Retirement Board, or Office of Personnel Management. If you don’t get these benefit payments, you will get a bill from Medicare.

Most people will pay the standard premium amount. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). Click here for more detailed information.

Part C Eligibility

Medicare Part C (known as Medicare Advantage) is a type of Medicare health insurance plan offered by private health insurance companies. These plans usually offer an array of benefits ranging from vision, hearing, over-the-counter (OTC), gym memberships, and chiropractic.

To be eligible to enroll in a Medicare Advantage plan, you must have both Part A (Hospital insurance) and Part B (Medical Insurance) and live in the plan’s service area (the ‘service area’ is typically a geographic area like a county). You must continue to keep both Part A and B active by paying the necessary monthly premium to the federal government.

Most part C or Medicare Advantage plans range from having either no or a low monthly premium.

Part D Eligibility

Medicare Part D (Prescription Drug Plan) helps cover and lower the cost of prescription drugs (including many recommended shots and vaccines). Beneficiaries can pay copayments instead of paying the full price of their prescription drugs. Part D plans are offered by private insurance companies that follow rules set by Medicare.

To be eligible to enroll in a Prescription Drug plan, you must be enrolled in either Part A or Part B (or both) and live in the plan’s service area. Keep in mind that many Medicare Advantage plans include prescription drug coverage. If you decide to have your Part D coverage as part of your Medicare Advantage Plan, you keep your Part A and B active by paying the necessary monthly premiums.

If you don’t sign up for Medicare drug coverage (Part D) when you first become eligible for Medicare and you don’t have creditable coverage such as employer’s group health insurance, you may be subject to a late-enrollment penalty. To learn more about the Part D late enrollment penalty, please click here.

The premium Prescription Drug plans do vary based on location and plan. If you have a higher income above a certain limit, you will have to pay an extra amount in addition to your plan premium, which is called Part D-IRMAA (Part D – Income Related Monthly Adjustment Amount). For more explanation about this Part D-IRMAA, please click here.

Frequently Asked Questions

Am I eligible for Medicare once I start collecting my Social Security?

No, withdrawing Social Security doesn’t make you eligible for Medicare. You must be 65 years old unless you have Amyotrophic Lateral Sclerosis (ALS) or End Stage Renal Disease (ESRD) or have been collecting Social Security Disability Income (SSDI) for at least 24 months.

Does my enrollment in Medicaid affect my eligibility for Medicare?

If you have Medicaid, you should sign up for Part B. Medicare will be your primary and your Medicaid will be your secondary. In many states, Medicaid may be able to help pay your Medicare out-of-pocket costs (like deductibles, coinsurances, copayments, and even premiums) depending on the type of Medicaid you are enrolled in.

Am I required to sign up for Medicare when turning 65?

No, you don’t have to. But keep in mind unless you have creditable insurance, for example an employer sponsored health coverage, you will incur a late enrollment penalty that sticks with you for life.

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