As your trusted Medicare resource with Licensed Medicare experts, we know that understanding Medicare eligibility and the enrollment process can often overwhelming or confusing. Whether you’re approaching age of 65 or considering retirement, or navigating Medicare eligibility for yourself or a loved one, this guide will help clarify who qualifies for Medicare and how to navigate the enrollment process.
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Who Qualifies for Medicare?
The most common way to qualify for Medicare is by reaching the age of 65. If you or your spouse have worked and paid Medicare taxes for at least 10 years (40 quarters), you’re eligible for premium-free Medicare Part A (hospital insurance). Medicare Part B (medical insurance) is available for a monthly premium based on your adjusted gross income from your tax return income from 2 years prior.
If you’re under 65 but have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, you automatically qualify for Medicare. You’ll receive Medicare Parts A and B, just like someone who qualifies based on age. Based on the health insurance you have access to currently you may or may not accept Part B at that time.
Individuals of any age with End-Stage Renal Disease (ESRD), requiring regular dialysis or a kidney transplant, qualify for Medicare. Coverage usually starts the first month of dialysis if you apply promptly.
If you have ALS, you automatically qualify for Medicare the first month you start receiving SSDI benefits, with no 24-month waiting period.
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How to Apply for Medicare
Already Receiving Social Security: If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. Your Medicare card will arrive in the mail about three months before your 65th birthday. Based on your specific situation if you are working or covered through your spouse you may keep your company coverage or consider Medicare options at this time. If you choose to keep the company coverage you would need to reject your Part B so that the premium for Part B does NOT come out of your social security check. This decision is an important one and our suggestion is to consult with an experienced Medicare advisor to guide you properly to your best course of action at this stage.
If you’re not receiving Social Security benefits, you will need to be proactive in signing up for Medicare on your own when the time is right. You can do this through the Social Security Administration (SSA) website, by phone by scheduling an appointment, or in person at your local SSA office. Consult a medicare expert to ensure you avoid timing and/or penalty issues.
The Initial Enrollment Period is a seven-month window that includes the three months before your 65th birthday, the month of your birthday, and the three months after. This is your first opportunity to sign up for Medicare Parts A and B. This ONLY applies to individuals who are self-employed, unemployed or working for a company of less than 20 employees. This is often a very often misunderstood aspect of Medicare.
If you’re still employed (for a company greater than 20 employees) and covered by an employer’s health plan, you can delay enrolling in Part B without penalty. Once your employment ends, you’ll have an eight-month Special Enrollment Period to sign up for Part B before you would incur a penalty. Each person’s situation is different based on the cost of Cobra for you and your family and the quality and details of coverage your company provides.
Missed Initial Enrollment: If you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you can enroll in Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year. However, a late enrollment penalty may apply.
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Understanding Medicare Parts A and B
Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Medicare Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical supplies.
Understanding these components is crucial for selecting the right coverage and avoiding potential penalties. To learn more, click below to read our blog post on Medicare Parts A and B.
Take Charge of Your Medicare Journey with Emerald Medicare
Navigating Medicare eligibility and enrollment can be overwhelming, but you don’t have to do it alone. Our team of Licensed Medicare experts is here to guide you through every step of the process, ensuring you make informed decisions about your healthcare coverage. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us via the provided phone number or email.
Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com
