Medicare Eligibility
Medicare insures you for a long and happy retirement. But when do you become eligible, and how do you navigate eligibility and enrollment?
Medicare Defined
To understand Medicare eligibility, you need to understand Medicare itself first. Original Medicare is the base standard — you must enroll in it before you can enroll in other Medicare plans like Medicare Advantage, Part D, or Medicare Supplement.
Original Medicare includes Part A and Part B. Part A covers short-term hospital and nursing home care, and Part B covers general medically necessary and preventive care.
How Eligibility Works
The most common way to become eligible for Medicare is by age. People 65 years or older who are U.S. citizens are eligible for Original Medicare, and that includes you.
If you are under 65 and unable to work due to a disability (such as from an accident, surgery, etc.), you can eventually qualify for Medicare.
Note: To be eligible while under 65, you have to first be eligible for and receive Social Security Disability Insurance (SSDI) for at least 24 months, which means you have to meet these requirements:
- You cannot do work and engage in substantial gainful activity (SGA) because of your medical condition.
- You cannot do the work you did previously or adjust to other work because of your medical condition.
- Your condition has lasted or is expected to last for at least one year or to result in death.
You’re also eligible under age 65 if you’re diagnosed with Lou Gehrig’s Disease (ALS) or End-Stage Renal Disease (ESRD) requiring dialysis.
Eligibility and Enrollment
Eligibility and enrollment go hand-in-hand for Medicare. If you become eligible for Medicare based on age, it’s very important to enroll within a specific window called your Initial Enrollment Period (IEP).
Your IEP will begin 3 months before your 65th birthday and will end 3 months after. During this period, you are eligible for and can enroll in Original Medicare, as well as any other Medicare plan of your choosing. If you’re already retired when your IEP begins, you will be automatically enrolled.
Why is it so important to enroll as soon as you’re eligible? If you miss your IEP, you may be faced with late enrollment penalties. This will be added to your Part B and Part D premiums permanently once you enroll. If you’re working, you don’t have to enroll within your IEP — instead, it’ll start once your employer health insurance ends.
The Easiest Way To Get Your Medicare Coverage
Taking the time to understand your Medicare eligibility is better with help. To get started, call 626-966-1098, or email info@priorityhealthins.com.
