Medicare is the federal government's health insurance program for older citizens and people with disabilities. If you're age 65 or older, you qualify for Medicare, but that doesn't mean that you receive it automatically.
Once you meet certain age benchmarks or other criteria for Medicare, it's up to you to enroll in the program.
Enrolling in Medicare can be a confusing process. It requires understanding some of the basics of how the program works.
This article will cover what you need to know about:
- what Medicare is
- how to apply
- how to meet important deadlines
- how to figure out if you qualify
The eligibility age for Medicare is 65 years old. This applies whether or not you're still working at the time of your 65th birthday. You don't need to be retired to apply for Medicare.
If you have insurance through your employer at the time you apply for Medicare, Medicare will become your secondary insurance.
You can apply for Medicare:
- as early as 3 months before the month you turn age 65
- during the month you turn age 65
- up to 3 months after the month you turn age 65
This time frame around your 65th birthday provides a total of 7 months to get enrolled.
There are many exceptions to Medicare's eligibility age requirement, including:
- disability. If you're younger than age 65 but you're receiving Social Security due to a disability, you may be eligible for Medicare. After 24 months of receiving Social Security, you become Medicare-eligible.
- ALS. If you have amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease), you're eligible for Medicare as soon as your Social Security disability benefits begin. You're not subject to the 24-month waiting period.
- ESRD. If you have end stage renal disease (ESRD), you become Medicare eligible after a kidney transplant or 3 months after dialysis treatment begins.
There are a few other Medicare eligibility criteria in addition to the age requirement.
- You must be a U.S. citizen or a legal permanent resident who has lived in the United States for at least 5 years.
- You or your spouse must've paid into Social Security for what amounts to 10 years or more (also referred to as having earned 40 credits), OR you must've paid Medicare tax while you or your spouse was an employee of the federal government.
Important Medicare Deadlines
Every year, the cycle for enrolling in Medicare looks similar. Here are some important deadlines to keep in mind:
- Your 65th birthday. Initial enrollment period. You can apply to enroll in Medicare up to 3 months before, the month of, and 3 months after your 65th birthday.
- January 1–March 31. Annual enrollment period. If you have not applied for Medicare during the 7-month window around your birthday, you can enroll during this time. You can also switch between Original Medicare and Medicare Advantage plans and change your Medicare Part D plan during this period. If you enroll in Medicare Part A or Part B during this time, you will have coverage effective July 1.
- October 15–December 7. Open enrollment period for those who are enrolled in Medicare and wish to switch their plan options. Plans chosen during open enrollment become effective on January 1.
Medicare is broken up into different “parts.” The parts are really a way of referring to different policies, products, and benefits connected with Medicare.
- Medicare Part A. Medicare Part A is hospital insurance. It covers you during short-term inpatient stays in hospitals and for services like hospice. It also provides limited coverage for skilled nursing facility care and select in-home services.
- Medicare Part B. Medicare Part B is medical insurance that covers everyday care needs like doctor's appointments, therapist visits, medical equipment, and urgent care visits.
- Medicare Part C. Medicare Part C is also called Medicare Advantage. These plans combine the coverage of parts A and B into a single plan. Medicare Advantage plans are offered by private insurance companies and are overseen by Medicare.
- Medicare Part D. Medicare Part D is prescription drug coverage. Part D plans are stand-alone plans that cover only prescriptions. These plans are also provided through private insurance companies.
- Medigap. Medigap is also known as Medicare supplement insurance. Medigap plans help cover the out-of-pocket costs of Medicare, like deductibles, copayments, and coinsurance amounts.
The Medicare eligibility age continues to be 65 years old. If that ever changes, you might not be affected, as the change will happen in gradual increments.
Enrolling in Medicare can seem complicated, but there are lots of resources to help simplify the process and to get you enrolled.
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