If you’ve never applied for Medicare before, you might be worried as to whether or not you qualify for it. Luckily, the qualifying factors for Medicare are pretty cut and dry, so you shouldn’t have to read the fine print in order to understand whether or not you are eligible.
Qualifying for Medicare at Age 65 or Older
As long as you are a U.S. citizen or you meet the requirements regarding residency and lawful presence, you should enroll in Medicare when you turn 65 or are getting ready to retire. You can also qualify for Medicare based on the work record of a deceased or divorced spouse.
Even if you carry private insurance, you should still enroll in Medicare because you’ve likely already paid taxes into the program. There are also strict rules about when and how to apply for Medicare, unlike private insurance, which is typically rolling.
With Medicare, you can’t enroll whenever you want. Instead, you must enroll during your Initial Enrollment Period. It’s a fancy way of stating you may enroll three months before you turn 65, the month you turn 65, or in the three months after you have turned 65, but not a day beyond that 90-day period. Essentially, the government gives you 6 full months to sign up for your insurance plan.
If you miss the window, you will have to wait for open enrollment, but it could end up costing you more money.
Most of the time, when you sign up for Medicare you won’t need to pay a premium for Part A. If you decide you want to add Part B, there is an added expense. Your Railroad Retirement, Civil Service Retirement check, or your social security check would then have the funds deducted. You can expect to receive a bill for Part B premium every three months.
Qualifying for Medicare Benefits under Age 65
Some people qualify for Medicare before they hit 65. If you already receive disability from Social Security or the Railroad Retirement Board (RRB) and have for twenty-four months in a row, you may be eligible. Early eligibility is also extended to you if you have Lou Gehrig’s disease or end-stage renal disease (terminal kidney failure).
If any of the instances above apply to your situation, you might receive health insurance through Medicare Part A (hospital insurance) and Part B (medical insurance), otherwise known as Original Medicare. In some cases, enrollment is automatic.
After your enrollment in Original Medicare, you can stick with Medicare Part A and Part B, or you could sign up for a Medicare Advantage plan if you live in a covered area. Private, Medicare-approved insurance companies offer this plan. Exceptions sometimes include those with end-stage renal disease.
If You Do Not Qualify on Your Own or Your Spouse’s Work Record
If you or your spouse’s work record don’t qualify for Medicare benefits, you still have a chance to receive benefits. As a U.S. citizen, or a legal resident for a minimum of five years, there are a few ways you can still receive Medicare benefits if you are 65 years of age or older:
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You can pay the premiums for Medicare Part A (hospital insurance). If you keep working until you gain the required forty credits, you won’t need to pay the premiums.
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If you opt to pay the monthly premiums for Part B, you’ll pay the same as others enrolled in the program. You can also pay the same monthly premium for Medicare Part D (prescription drug coverage) just like everyone else who has enrolled in one of the drug plans.
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Of course, you can skip buying Part A and enroll in Part B, but if you do decide to pay for Part A, you have to enroll in Part B. Are you enrolled in Part A or B? If so, you can opt for Part D too.
Medicare Qualifications Answered
You should have received statements from the Social Security Administration (SSA) regarding your eligibility. If you not yet heard from them, contact them at: (800) 772-1213 to see where you stand when it comes to Medicare benefits. You can also use the helpful Contact Information tool on the Medicare.Gov website in order to figure out who to speak within your state.
