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Medicare Eligibility: Who may enroll in Medicare
Medicare Eligibility - Parts A and B
To be eligible for Medicare Parts A and B, you must be a U.S. citizen or a permanent legal resident for at least five years. You must also meet at least one of the following criteria for Medicare eligibility:
- Be age 65 or older and eligible for Social Security
- Be permanently disabled (even if under age 65) and receive Social Security disability insurance benefits for at least two years
- Have End Stage Renal Disease (ESRD) (permanent kidney failure that requires dialysis treatment or a kidney transplant)
- Have Lou Gehrig's Disease (Amyotrophic Lateral Sclerosis (ALS))
Once you meet eligibility requirements for Medicare Part A (Hospital Insurance) you may be automatically enrolled. You must sign up for Medicare Part B (Medical Insurance) after you become eligible. Your qualifying event determines when you must enroll: either during the next General Enrollment Period (January 1 through March 31) or within two months of the qualifying event, whichever comes first.
If you don't sign up for Medicare Part B when you become eligible, you may pay penalty of 10 percent for each 12-month period you could have had it. Some exceptions apply.
Most individuals do not have to pay a premium for Medicare Part A if they or their spouse paid Medicare taxes while working for at least 10 years (or 40 quarters). For those not eligible for premium-free Part A, you will have to pay a monthly premium of up to $450.00 per month. In addition, there is a premium of $96.40 per month for Medicare Part B (Most beneficiaries will pay $96.40; however, those new to Medicare in 2011 will pay $115.40 for Part B). High-income individuals may pay more. Low-income individuals may pay less, or can even qualify for no premium.
Medicare Part C Eligibility
Medicare Part C (also called Medicare Advantage) is an alternative to Medicare Parts A and B and is available through private insurers. To be eligible for Medicare Part C, you must already be enrolled in Medicare Parts A and B. You can buy a Medicare Advantage (Part C) group plan through your (or your spouse's) employer or through a qualified insurance agent.
With Medicare Part C coverage, you will not need a Medigap (supplemental) policy. That's because Medicare Advantage plans typically cover more than Original Medicare (Parts A and B).
Medicare Part C General Enrollment Period is the same as Original Medicare (Parts A and B). Or you may sign up within two months of your qualifying event.
Medicare Part C is optional; there is no penalty for not signing up. But you must have Medicare Parts A and B to get Part C. Monthly rates and plan coverage vary by insurance carrier and specific plan design.
Medicare Part D Eligibility
Medicare Part D covers prescription drugs and, like Medicare Part C, is available through private insurers. To be eligible for Medicare Part D, you must have Medicare Parts A and B and you must live in the service area for the prescription drug plan in which you want to enroll.
When you become eligible for Medicare, you must have creditable prescription drug coverage that covers at least as much as Medicare Part D. "Creditable coverage" means you have other prescription drug insurance that generally covers as much as Medicare Part D. You can have this coverage either through a private insurance company or through a Medicare prescription drug plan (for example, a Medicare Advantage plan that includes prescription drug coverage). If you don't have creditable prescription drug coverage when you become eligible for Medicare, you will pay a penalty if you wait to join Medicare Part D later. You will have to pay this penalty for as long as you have Medicare prescription drug coverage.
If you have a Medigap policy, do not assume prescription drugs are covered. Medigap policies no longer include prescription drug coverage. However, some older Medigap policies still do but may not be enough to be considered "creditable." You can request that your older Medigap policy drops the prescription drug benefit so you can enroll in a Medicare Part D plan for creditable coverage.
Low-income individuals may qualify for Extra Help with Medicare prescription drug costs. Extra Help is a program that helps cover the costs for copays, coinsurance, deductibles and all or most of your monthly premium.