Medicare Eligibility Guide: When to Sign Up | GoMedigap

Medicare Eligibility Guide: When to Sign Up

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Medicare Eligibility

When most people near their sixties, they begin wondering when they will become eligible for Medicare, and when they can sign up. When determining Medicare eligibility, incoming seniors must figure out the requirements for enrolling in Medicare Part A, Medicare Part B, and Medicare Part D. After a typical senior meets all of the requirements, they will be able to sign up for Medicare, or in some cases, are automatically enrolled into Medicare.

Medicare Part A Eligibility

At its core, Medicare Part A is the most basic and important part of Medicare. Part A covers all of your inpatient hospital needs. This means that if you were to ever need inpatient hospitalization, Medicare would typically help cover some of the costs associated with your stay.

Most seniors find that their enrollment in Part A is automatic. Medicare Part A eligibility is determined by:

  • Age (you must be 65 or older in most cases)
  • Time in the U.S. (you must be a U.S. citizen/permanent resident of at least 5 years)
  • Benefits (you already receive retirement benefits or disability benefits)
  • End-Stage Renal Disease diagnosis
  • ALS or Lou Gehrig’s disease diagnosis

To receive automatic enrollment into Medicare Part A, you must either:

  • Already be receiving Social Security retirement benefits
  • Receive benefit from the Railroad Retirement Board (RRB)
  • Have worked in the U.S. for at least 10 years or 40 quarters

If you were automatically enrolled in Medicare, your benefits will begin the first day of the month you turn 65. For those who have worked in the U.S. for at least 10 years or 40 quarters, they are eligible for a premium-free Part A. This means that these seniors will not have to pay a monthly payment to receive their Part A benefits.

Medicare Part B Eligibility

Medicare Part B eligibility requirements are similar to those of Part A. If you are at least 65 or older and you are a U.S. citizen or permanent resident of at least 5 years, you are eligible to enroll in Medicare Part B. If you are eligible for the premium-free Part A, you are automatically eligible for Part B.

Some individuals are able to receive automatic enrollment of Part B based on their disability status. For example, if you have ALS or ESRD, you may be able to enroll in Part B before 65. Additionally, receiving Railroad Retirement Benefits and Social Security retirement benefits will allow automatic enrollment in Part B in addition to Part A.

Unlike Part A, all Part B beneficiaries must pay a monthly premium. In 2019, the Medicare Part B premium will be $135.50.

Medicare or the government does not require seniors to enroll in Part B, however, it is highly recommended that all seniors enroll. Part B helps cover your outpatient medical expenses. This includes any or all doctor visits. Without Part B, you might be exposed to hefty out-of-pocket fees.

Medicare Part D Eligibility

If you are eligible for Original Medicare (Parts A and B), you are automatically eligible for Medicare Part D. Medicare Part D eligibility is most likely determined by your Medicare enrollment status. In order to have Part D, you must be enrolled in Original Medicare.

Because of this, your Medicare Part D eligibility has the same requirements as Parts A and B. Like Part B, you must pay a monthly premium for Part D. The Part D premium may vary depending on the plan you choose. When choosing a Part D plan, it is important to include your location, preferred pharmacy, and the medications you are currently taking to most accurately determine your monthly premium. 

Check Medicare Eligibility

Thankfully, Medicare provides an easy-to-use tool for seniors to help determine Medicare eligibility. To use this tool, simply choose “Find out if I’m eligible,” and answer the required questions. If you are interested in finding your potential premiums each month, click on “Calculate my premium.”

This tool is only used to help you determine your eligibility status. It does not sign you up when you enter your information. Additionally, Medicare states on their website that none of the information you enter in this form will be saved. When you close your browser, the information is erased to protect your privacy.

When to Sign Up for Medicare

Once you determine that you are eligible for Medicare, you may wonder when it is time for you to sign up. For those who receive automatic enrollment, you don’t have to worry about this. Medicare will enroll you in Medicare Part A, and sometimes, Medicare Part B depending on your eligibility. You will typically receive your Medicare card in the mail three months before your 65th birthday, or three months before your coverage begins.

For those who do not qualify for automatic enrollment, Medicare offers a seven-month period around your 65th birthday when you can enroll in Medicare without penalty. This period starts three months before you turn 65 and ends three months after your 65th birthday. It is pertinent that you enroll for Medicare during this time to avoid any penalties.

Unlike Parts A and B, Part D has an additional period when you can sign up for a plan. This period is Annual Enrollment Period. You can switch or drop your Part D plans during this time in addition to your Initial Enrollment Period. To help, we have an easy-to-use guide detailing how to sign up for Part D.

With this information, you can successfully and quickly enroll in Medicare for all your health needs.

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