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Medicare Eligibility, Age Qualifications And Requirements 2018

Medicare is generally available to Americans 65 or older, younger people with certain disabilities, and people with End-Stage Renal Disease (ESRD). However, different plans have different eligibility requirements. Here is a breakdown of the eligibility requirements for Part A, Part B, Part C, Supplement, and Part D.

Is everyone eligible for Medicare?

To qualify for free Part A (hospital insurance) benefits, you must be at least 65 and a US citizen or permanent legal resident who has been living in the United States for a minimum of five years. You must also meet one of the following two criteria.

  • You or your spouse is eligible for Social Security or Railroad Retirement benefits by earning 40 credits through payroll taxes during approximately 10 years of work.
  • You or your spouse is a current or retired government employee who has paid Medicare payroll taxes while working but has not paid into Social Security. If you qualify through your spouse, they must be at least 62, and you must be at least 65. You may also qualify based on the work record of a divorced or deceased spouse. If you are in a same-sex marriage, you can qualify on your spouse’s work record, regardless of where you live or were married.

Can I apply for Medicare at age 62 or do I have to be 65?

If you are under the typical Medicare qualifications age of 65, you qualify for free Part A benefits if you meet any of the following criteria.

  • You have been receiving Social Security disability benefits for at least 24 months.
  • You receive a disability pension from the Railroad Retirement Board and meet certain criteria.
  • You have Lou Gehrig’s disease (ALS).
  • You have ESRD requiring regular dialysis or a kidney transplant, and you or your spouse has paid Social Security taxes for a length of time that depends on your age.

If you are eligible for Part A at no cost, you can enroll in Part B (medical insurance) by paying a monthly premium. If you don’t receive Part A for free, but instead purchase it, you must also enroll in Part B. However, you can also enroll in Part B without buying Part A if you meet the following two qualifications:

  • You are 65 or older.
  • You are a US citizen or permanent resident who has been here lawfully for a minimum of five years.

If you are 65 years old and don’t qualify on your or your spouse’s work record, you can still get full Medicare benefits. You must be a US citizen or permanent resident for at least five years and do the following three things.

  • Pay premiums for Part A.
  • Pay the same premiums for Part B as other enrollees.
  • Pay the same premiums for Part D (prescription drug coverage) that other enrollees pay.

Generally, you can first enroll during your seven-month Initial Enrollment Period (IEP), which includes the three months before you turn 65, your birthday month, and the three months after.

Medicare eligibility for advantage plans

You are eligible for Part C, or an Advantage Plan, if you fall into these two categories.

  • You are enrolled in both Part A and B.
  • You do not have ESRD.

There are four periods throughout the year when you can enroll in an Advantage Plan.

Generally, you can first enroll during your seven-month Initial Enrollment Period (IEP), which includes the three months before you turn 65, your birthday month, and the three months after.

The Initial Coverage Election Period (ICEP) includes the three months before your eligibility for Part A and B begins, and it concludes either the last day of the month prior to your enrollment in both Parts A and B or the final day of your Initial Enrollment Period for Part B—whichever date is later. Here is an example:

  • You sign up for Part A and Part B in April, the month you turn 65, so your coverage begins April 1. Your ICEP is the seven-month period that includes the three months prior to your birthday month, your birthday month, and the three months following—so it would begin on January 1 and end on July 31. If you enroll in an Advantage Plan, your coverage cannot begin before April 1, when your Part A and Part B coverage begins.

The Annual Election Period (AEP) occurs annually October 15–December 7. During this time, you can change, enroll in, or cancel an Advantage Plan. If you are enrolled in a plan and want to change plans, this is the time. Any new coverage will begin January 1 the next year.

The annual General Enrollment Period allows people who are eligible for Advantage Plans to make one election from January 1 to March 31. Plans might not be open for enrollment, but health insurance companies should honor cancellation requests from people who are enrolled in only a Part C Plan.

There are also Special Election Periods (SEPs) that you may qualify for if your plan is cancelled, you move, or you lose coverage. If you wonder if you qualify for an SEP, call 1-800-MEDICARE.

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Prescription drug coverage eligibility

You are eligible for Part D if you are enrolled in Part A or Part B. Part D is optional coverage that helps cover prescription drug costs, and you must pay a monthly premium for it.

If you choose not to enroll in Part D when you are first eligible, you may be required to pay a penalty to enroll later—a penalty you will have to pay for as long as you are covered by Part D. You can enroll during your Initial Enrollment Period or any other Open Enrollment period.

Medicare eligibility for a Supplement plan

Supplement Plans, also known as Medigap, help cover expenses that Part A and B doesn’t, including copayments, coinsurance, and deductibles. You must meet the following requirements in order to be eligible:

  • You must be enrolled in Part A and Part B.
  • In some states, you must be 65 or older.
  • If you are 65 or older, or eligible due to disability or disease, your eligibility for Supplement coverage may depend on the state you live in.

You can enroll in a Supplement Plan during only the six months following your enrollment in Part B, provided that you are already 65.

  • 5 plans—including Plan F—in most areas
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Some states have additional enrollment periods, but the six months following your 65th birthday and enrollment in Part B is the best time to enroll because you have guaranteed issue rights. This means that during this period, insurance companies cannot deny you coverage or charge additional costs due to your health history.

You can still apply for a Supplement Plan after your Open Enrollment Period ends. However, you won’t have guaranteed issue rights, so there is no guarantee of coverage, and insurance companies can charge you higher rates if you have any existing health conditions.

If you have an Advantage Plan, you cannot also have a Supplement Plan. However, you may be able to cancel your Advantage Plan and apply for a Supplement Plan during an enrollment period—though bear in mind that you can lose guaranteed issue rights in this case. Use our Plan Suggestion tool to help know which plan is best for you.

To learn more about eligibility, please visit our FAQ page.

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