Medicare Eligibility
Most people are eligible for Medicare insurance when they turn 65. Whether or not you’ve “retired” doesn’t impact your Medicare eligibility.
You may qualify at 65 (or older) if you’re a United States citizen or a permanent resident, and you’ve lived in the U.S. for five or more continuous years. If you’re new to Medicare, there’s a 7-month window called your Initial Enrollment Period during which you can sign up.
Simple Retirement Benefits is here to answer your questions about Medicare eligibility.
Can You Qualify If You’re Under 65?
Yes, an individual may qualify for Medicare if he or she is under 65 and has one of these conditions:
- A permanent disability and has been getting Social Security disability income for two years.
- End-stage renal disease, aka kidney failure — requiring dialysis or a kidney transplant
- Amyotrophic Lateral Sclerosis (ALS) or “Lou Gehrig’s disease”
We’ll talk about the eligibility criteria for each part of Medicare and supplemental insurance below.
Medicare Part A Eligibility
You’re eligible for Part A (premium-free) when you turn 65 if you or your spouse has worked for at least ten years in the U.S. and paid Medicare taxes. If not, you can contact Social Security to buy Part A.
If you’ve already enrolled in Social Security income benefits, you may be automatically enrolled in Part A at age 65. Your Medicare card normally arrives in the mail about four to six weeks before you turn 65.
Medicare Part B Eligibility
You’re also eligible for Part B when you turn 65. But Part B comes with a monthly premium. If you’re still working at 65 (or older) and you have health coverage through your employer, you can wait to enroll in Medicare Part B — without facing a penalty.
If you delay Part B enrollment, contact an agent at Simple Retirement Benefits. We’ll go over the special enrollment periods for you to use later to avoid a late enrollment fee.
Medicare Part C Eligibility
You’re eligible for Part C (Medicare Advantage) if you’re enrolled in BOTH Parts A and B (Original Medicare). If you drop Part B, you cannot enroll in Part C.
You must also live in the plan’s service area — based on the address Social Security keeps on file for you. Choose a program that operates in that county. Some Advantage plans will be restricted to one or two counties while others may be offered statewide.
Medicare Part D Eligibility
You can sign up for a Part D drug plan if you’re enrolled in EITHER Medicare Part A or Part B — or both — and you’re in the plan’s service area. Important note. If you don’t sign up for Part D and you have no other creditable coverage, you may face late penalties when you register at a later time.
Medigap Eligibility
You can apply for a Medigap or Medicare Supplement plan once you’ve signed up for Parts A and B. Your Medigap benefits get added to your Original Medicare coverage, since it doesn’t pay for everything. Remember: You can’t have a Medicare Advantage plan and a Medigap policy at the same time.
In some states, insurers may sell Medigap plans to folks under 65, although they’re not legally required to do this.
Have More Questions About Medicare Eligibility?
Since everybody’s situation is different, Medicare eligibility can get confusing. No worries. Simple Retirement Benefits can guide you through the process, creating a smooth transition for you and your loved ones. Call 512-432-5414 to see how we can help.
