Medicare Eligibility: Find Out if You Can Enroll This Year

Medicare serves approximately 60 million Americans. Most beneficiaries are age 65 or older, but some younger individuals are also eligible. Here’s how to tell whether you can enroll.

Who Is Eligible for Medicare?

You can qualify for Medicare in one of three ways:

  • You are age 65 or older.
  • You have end stage renal disease.
  • You are disabled. You become eligible for Medicare Part A after receiving Social Security or Railroad Retirement Board disability benefits for 24 months.

Many people are eligible for premium-free Medicare Part A. You will qualify for premium-free Medicare Part A when you turn 65 if you or your spouse paid Medicare taxes for at least 40 quarters. If you do not qualify for premium-free Medicare Part A, you may be able to pay to enroll in both Medicare Part A as long as you also enroll in Medicare Part B.  

If you qualify for premium-free Medicare Part A, you can also enroll in Medicare Part B. Medicare Part B is not free. When you enroll, you will have to pay a monthly premium, and the amount you pay will be based on your income.

If you do not qualify for premium-free Medicare Part A, you can pay to enroll in Medicare Part A and Medicare Part B if you meet both of the following two criteria:

  • You are a U.S. resident.
  • You are a U.S. citizen, or you are a legal resident who has lived in the U.S. for five continuous years before applying for enrollment.

When Can I Enroll?

You may be enrolled in Medicare automatically. If you are receiving Social Security or Railroad Retirement Board benefits, you will automatically be enrolled in Medicare Part A and Medicare Part B when you turn 65. Your coverage will start on the first day of your birthday month, unless your birthday is the first day of the month, in which case your coverage will on the first day of the month before your birthday month.

If you are not automatically enrolled in Medicare, you can enroll in the designated times.

  • Your Initial Enrollment Period: Your initial enrollment period lasts for seven months. It includes the month you turn 65, the three months before, and the three months after. To ensure that coverage starts on the first day of your birthday month, you should enroll during the three months before your birthday month. If you wait until later in the initial enrollment period, your coverage may be delayed. If you do not enroll during the initial enrollment period, you may be charged expensive late penalties.  
  • A Special Enrollment Period: If you receive qualifying employer-based health insurance and the employer has 20 or more employees, you may be able to delay enrollment in Medicare without paying late fees. After the employment or coverage ends, you will have eight months to enroll in Medicare. The end of COBRA continuation coverage does NOT qualify you for a special enrollment period – only group health coverage through active employment does.
  • The General Enrollment Period: If you miss your initial enrollment period and don’t qualify for a special enrollment period, you will have to wait until the general enrollment period. The general enrollment period starts on January 1 and ends on March 31 each year, and coverage starts on July 1. You may be charged an ongoing late penalty for late enrollment.

What About the Open Enrollment Periods?

The fall Open Enrollment Period starts on October 15 and ends on December 7. During this time, current Medicare enrollees can review their coverage and change their plan for the following year. They can switch from Original Medicare to Medicare Advantage, from Medicare Advantage to Original Medicare, or from one Medicare Advantage plan to another. They can also change their Medicare Part D prescription drug coverage.

The Medicare Advantage Open Enrollment Period starts on January 1 and ends on March 31. During this time, Medicare beneficiaries who are currently enrolled in a Medicare Advantage plan can switch to Original Medicare or to a different Medicare Advantage plan. Beneficiaries can also make corresponding changes to their Medicare Part D prescription drug plan. However, people enrolled in Original Medicare cannot switch to Medicare Advantage at this time.

Would you like a licensed agent to guide you through the Medicare Open Enrollment process? Get started by requesting a quote.

Sources
  • https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol/index.html

  • https://www.medicare.gov/index.php/your-medicare-costs/part-a-costs

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