Medicare is a government-run health insurance program that provides Eligibility Requirements for Americans age 65 and older, as well as those who are younger but have certain disabilities. One of the Medicare Eligibility Requirements is, you must meet the program’s age requirements. In this blog post, we will discuss the age qualifications for Medicare and what happens if you do not meet them.
What Are The Basic Qualifications for Medicare?
One of the Eligibility Requirements is you must be a U.S. citizen or permanent legal resident of at least five years, and you must be age 65 or older. If you are under 65, you can still qualify for Medicare if you have certain disabilities, such as end-stage renal disease or amyotrophic lateral sclerosis. You may also qualify if you are a younger person with certain conditions, such as Lou Gehrig’s disease.
What Happens If You Do Not Meet The Qualifications?
If you do not meet the Medicare Eligibility Requirements, such as age or disability requirement, you will not be eligible for coverage. However, you may still be able to get health insurance through other programs, such as Medicaid or the Children’s Health Insurance Program. You can also purchase a health insurance policy on the private market.
What Are The Different Parts of Medicare?
Medicare is made up of four parts: Part A, Part B, Part C, and Part D. A covers hospitalization, while Part B covers outpatient care. Part C, also known as Medicare Advantage, is a private health insurance plan that includes all the benefits of Parts A and B, plus additional coverage like prescription drugs. Part D is a prescription drug benefit that can be added to any of the other plans.
How Do You Enroll in Medicare?
If you’ve received retirement benefits for at least four months before you turn age 65, you are enrolled automatically in Medicare A and B. As you walk through the process, you can tap into helpful tools including an eligibility premium calculator, and find out your potential part premium. You can opt-out of Part B if you are still covered under an employer-sponsored group health plan. If and don’t have group coverage, you may have to pay a penalty.
Government Authority
Social Security Administration (SSA)
Social Security delivers a broad range of services online at socialsecurity.gov and through a nationwide network of over 1,400 offices.
The Social Security Administration (SSA) usually handles Medicare enrollment, but if you worked for the railroad, you enroll in Medicare through the Railroad Retirement Board.
If you have not received retirement benefits, you will need to self-enroll. Sign up for Medicare through Social Security or call (800) 772-1213. If you were a railroad worker, visit the RRB website or call (877) 772-5772.
How Do You Enroll in Medicare Supplement, Medicare Advantage (Part C), and Medicare Prescription Plans?
Medigap, Medicare Part C, and Medicare Prescription Drug plans are administered by private insurance companies approved and regulated by Medicare. The company you choose or a licensed agent can help with your enrollment. During your time working, you pay medicare taxes through your employer. Medicare taxes allow this health insurance coverage to be available.
As for finding plans, you can view options on Medicare.gov, where there is also a premium calculator and you can learn more about different part coverage, as well as, an explanation of each.
This is What is Available
- Medigap: You must have Original Medicare to purchase a Medigap plan. You can enroll during your IEP. If you only have Part A but have not enrolled in Part B yet, you can enroll in a Medigap plan with guaranteed issue rights within six months after you are 65 and have Part B. You cannot have both a Medicare Advantage Plan and a Medigap plan. Suppose you drop your Medicare Advantage Plan. You then return to Original Medicare eligibility, within the first year of having a Medicare Advantage Plan. In that case, you may be able to purchase a Medigap plan. If you wait, you may not be able to purchase a Medigap plan. Also, you may have to pay more based on your health condition.
- Medicare Advantage: You must have Part A and Part B to enroll in a Medicare Advantage Plan. You can join a plan during your IEP or the annual OEP from October 15 through December 7. If you already have a Medicare Advantage Plan, you can make a change during the OEP.
- Prescription Drug Plan (Part D): You must have Part A and Part B to enroll in a Medicare drug plan. This is either through your Medicare Advantage Plan or a stand-alone drug plan. You can enroll during your IEP or during the annual OEP from October 15 through December 7. Suppose you are in a Medicare Advantage Plan with drug coverage. In that case, you can switch to another Medicare coverage. Also, you can switch back to Original Medicare plus a stand-alone drug plan. This can happen one time during the OEP from January 1 to March 31.
If you have any questions about whether you qualify for Medicare eligibility, or which parts of Medicare would be right for you, please contact us. We would be happy to help! Thank you for reading.