Medicare Eligibility: Who is Eligible?

Medicare Eligibility

When most people enter retirement age, they wonder about next steps regarding their health coverage. In this conversation lies the question: When am I eligible for Medicare? While learning the ins-and-outs of Medicare, a person must learn the requirements for Medicare Part A, Medicare Part B, and Medicare Part D. Once a senior meets all the requirements to sign up for Medicare, it is important that they sign up as soon as possible. In some cases, some seniors are automatically enrolled in Medicare.

Medicare Eligibility: Part A

Medicare Part A is considered the base level, and one of the most important parts of Medicare. Part A covers your inpatient hospital needs. For example, if you were ever to need to stay overnight in the hospital as an admitted patient, Medicare will typically cover 80% of the costs associated with your hospital stay.

Most seniors receive automatic enrollment into Medicare Part A. This typically happens when:

  • You worked at least 10 years (40 quarters) in the United States
  • You’re already receiving Social Security retirement benefits
  • You receive benefits from the Railroad Retirement Board (RRB)

For those who receive automatic enrollment into Part A, benefits will begin the first day of the month you turn 65. Seniors who worked at least 10 years (40 quarters) in the United States are eligible for a premium-free Part A. You paid your Medicare taxes while you were working, so you will not have to pay for this part of Medicare to receive coverage benefits.

If you do not receive automatic enrollment, you will have to ensure that you are eligible for Medicare Part A. The following determines Part A eligibility:

  • Time in the United States (citizen or permanent resident for at least 5 years)
  • Benefits received (retirement or disability)
  • An ALS or Lou Gehrig’s disease diagnosis
  • Your age (must be 65 or older in most scenarios)
  • An End-Stage Renal Disease diagnosis

Medicare Eligibility: Part B

You must meet similar requirements as Part A to qualify for Medicare Part B. To qualify for Medicare Part B, you must be:

  • 65 or older (in most cases)
  • A United States Citizen or permanent resident of at least 5 years

For those who were eligible for the premium-free Medicare Part A, you are automatically eligible for Medicare Part B.

Some people can qualify for automatic enrollment in Part B based on their disability status. For example, those with ALS or End-Stage Renal Disease may be able to enroll in Part B before they turn 65. Receiving Railroad Retirement Benefits and Social Security retirement benefits can also qualify you for automatic enrollment in Part B.

While Part A can come premium-free, you must pay a monthly premium for Medicare Part B. In 2019, the Medicare Part B premium is $135.50.

No entity requires any senior to enroll in Part B. It is, however, highly recommended that you enroll in Part B. Medicare Part B covers your outpatient medical expenses, typically at 80%. An example of these outpatient medical expenses includes any doctor visits or preventative services. Without Medicare Part B, you would typically have to pay for all of these expenses out-of-pocket. 

Medicare Eligibility: Part D

If you have or are eligible for Medicare Part A or Part B, you will automatically be eligible for Medicare Part D. Part D is your prescription drug coverage. This helps protect you from the high costs of any prescription drugs you might need to take. Your eligibility for Part D is often determined by your Medicare enrollment status. To clarify, in order to have Part D, you must first be enrolled in Original Medicare Parts A and B.

Because having Medicare Parts A and B is a prerequisite to enrolling in Part D, you must meet all of the same eligibility requirements as needed for Medicare Parts A and B. In addition to the Medicare Part B premium, you will also need to pay a monthly premium for Part D. Typically, these premiums come at a low cost to the beneficiary. To lower these costs as much as possible, it is important to give specific, detailed information while signing up for Part D. This information includes all of the medications you are currently taking, your location, your preferred pharmacy, and any other information needed.

Medicare Eligibility Status

To make this process as easy as possible, Medicare created a tool for seniors to use to determine their eligibility. When using the tool, choose “Find out if I’m eligible” and answer the prompted questions. If you know you are eligible and you are more interested in seeing a rough estimate of what you will be paying each month for Medicare, choose the option that reads “Calculate my premium.”

This tool does not sign you up for Medicare. It is simply used to help you determine your eligibility status. The information that you enter is not saved on any database, and when you close your browser, Medicare erases the information to protect your privacy.

Medicare Supplement Plans

A Medicare supplement plan can help cover the remaining 20% of costs that Medicare does not cover in Medicare Parts A or B. Depending on the plan, it could mean that you would be free of any out-of-pocket costs, copayments, deductibles, or more. If you are interested in signing up for a Medicare supplement plan while you are enrolling in Medicare, feel free to call one of our licensed agents at (800) 310-2550 or get your free quote online.

Compare Your Medicare Supplement Rates Immediately!

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.