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Medicare Eligibility: Who may enroll in Medicare

Medicare Eligibility - Part A and Part B

To be eligible for Medicare Part A and Part 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: You may be automatically enrolled into Medicare Part A (hospital insurance) when you reach age 65 and become eligible for Social Security; but if you want Medicare Part B (medical insurance), you have to enroll in it. Further, if you are already getting benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically get Part A and Part B starting the first day of the month you turn 65. (If your birthday is on the first day of the month, your Part A and Part B coverage starts the first day of the prior month.) But, if you're not receiving retirement benefits from Social Security or the Railroad Retirement Board (for instance, because you're still working), you must sign up for Medicare Part B when you meet the age requirement, as your enrollment isn't automatic.

Be permanently disabled and receive disability benefits for at least two years: You automatically get Part A and Part B after you get disability benefits from Social Security for 24 months or certain disability benefits from the Railroad Retirement Board (RRB) for 24 months.

Have End Stage Renal Disease (ESRD) (permanent kidney failure that requires dialysis treatment or a kidney transplant): You need to sign up for Medicare, as your enrollment isn't automatic.

Have Lou Gehrig's disease (Amyotrophic Lateral Sclerosis, or ALS): You automatically get Part A and Part B the month your disability benefits begin.

Most individuals don't 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). If you're not eligible for premium-free Part A, you will have to pay a monthly premium of up to $426 per month in 2014. In addition, you must also pay the Part B premium each month. Most people pay the standard premium amount, which is $104.90 in 2014; however, individuals with a higher income may have to pay more. Be aware that if you don't sign up for Medicare Part B when you first become eligible, you may have to pay penalty of 10% at the time you do enroll for each 12-month period you could have had it (some exceptions apply).

Medicare Part C Eligibility

Medicare Part C (also called Medicare Advantage is an alternative to Medicare Part A and Part B and is available through private insurers. To be eligible for Medicare Part C, you must already be enrolled in Medicare Part A and Part B, and you must reside within the service area of the Medicare Advantage plan you want. You can get more information about and enroll in a Medicare Advantage (Part C) group plan by contacting one of the following:

  • 1-800-MEDICARE (TTY users 1-877-486-2048), 24 hours a day/7 days a week; or www.medicare.gov
  • The health insurance plan directly
  • Your or your spouse's employer
  • A licensed insurance agent or broker, such as eHealth Medicare Plans

With Medicare Part C coverage, you won't need a Medicare Supplement Plan (Medigap), because Medicare Advantage plans typically cover more than Original Medicare (Part A and Part B).

The Medicare Advantage (Part C) Initial Enrollment Period is generally the same as the Initial Enrollment Period for Medicare Part A and Part B (the seven-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65). Or, you can sign up during the Annual Election Period (AEP) from October 15 to December 7 for coverage effective January 1 of the following year. You can also enroll during a Special Election Period (SEP), if you qualify.

Medicare Part C is optional, and there is no penalty for not signing up. But you must have Medicare Part A and Part B to get Part C, and you must continue making your Part B premiums even if you enroll in a Medicare Part C plan. Monthly rates and plan coverage for Medicare Advantage vary by the insurance company you choose and your specific plan details.

Medicare Part D Eligibility

Medicare Part D covers prescription drugs and, like Medicare Part C, is available through private insurers. To be eligible to enroll in a Medicare prescription drug plan (PDP), you must have Medicare Part A and/or Part B and you must live in the service area for the prescription drug plan in which you want to enroll. To be eligible to enroll in a Medicare Advantage plan with prescription drug coverage (MAPD), you must have Medicare Part A and Part B, and you must live in the service area for the MAPD plan in which you want to enroll.

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