Medicare Eligibility

Reaching Medicare eligibility can be confusing. Understanding when you become eligible for Medicare and what to do once you are eligible is essential for seniors. Below, you’ll learn everything you need to know about Medicare eligibility, requirements, and more.

Medicare Eligibility Age Chart

Medicare Disability Eligibility Requirements

Typically, you will automatically become enrolled in Medicare at the start of the 25^th month that you collect Social Security Disability checks. However, certain circumstances do not require patients to wait for 24 months.

Those on disability because of ALS automatically start Medicare the same month that disability benefits begin. Medicare isn’t responsible for determining if you qualify for disability. Social Security oversees that decision, as they administer the SSDI checks.

If you become eligible for Medicare due to an end-stage renal disease (ESRD) diagnosis, you will need to enroll yourself in Medicare. You can do so by contacting your local Social Security Administration office.

Premium-Free Medicare Part A Eligibility

Many people believe Medicare is free, but in reality, only Medicare Part A hospital coverage doesn’t include a monthly premium if you or your spouse qualify. You or your spouse must have paid Medicare taxes for at least 40 quarters or ten years to be eligible. If not, you will need to buy into Medicare Part A according to how many quarters you have worked.

Your eligibility for premium-free Medicare Part A is found on your ssa.gov account. This will tell you how many eligible working quarters you have paid Medicare taxes – determining your Medicare Part A premium cost.

Medicare Part B Eligibility

If you do not meet the requirements for Medicare under 65, you will become eligible for Medicare Part B when you reach 65 years of age. Additionally, you must be a resident of the U.S. for at least five years to qualify for Original Medicare (Medicare Part A and Part B).

Unlike Medicare Part A, Medicare Part B involves a monthly premium for everyone who enrolls. This premium is dependent upon the adjusted gross income of the beneficiary.

Low-income earners may qualify for help paying their premium. Further, low-income earners could be eligible for Medicare and Medicaid.

High-income earners, however, may pay more for Medicare Part B and Medicare Part D. This increase in premiums is known as the Income-Related Monthly Adjustment Amount (IRMAA) and is based on your income from two years prior to the current year.

Medicare Part D Eligibility

As of 2006, anyone who has Medicare Part A and Medicare Part B, regardless of health conditions, prescription drug usage, or income, is eligible for prescription drug coverage. The only Part D eligibility requirement is to reside in the service area for the plan in which you wish to enroll.

Medigap and Medicare Advantage Eligibility Requirements

Once you are eligible for Medicare Part A and Part B, you will automatically be eligible for Medigap and Medicare Advantage plans. Private insurance companies offer these plans to provide additional coverage to Original Medicare.

When enrolling in Medicare Advantage plans, you must do so during specific enrollment periods. Likewise, with a Medigap plan, you must apply during your Open Enrollment Period to avoid underwriting health questions.

FAQs

How to Learn About Medicare Eligibility

If you have any questions or concerns regarding your eligibility, please contact a Medicare expert. You can reach a licensed agent to learn more about your coverage options by calling the phone number above or filling out our online rate form.

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