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How do I qualify for Medicare Benefits?

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Summary: Medicare was designed for people age 65 and over. You may also qualify for Medicare if you have a disability or certain disease.

Despite what some politicians are proposing in 2019, Medicare benefits are not currently for all. Medicare was designed for people age 65 and over. Over the years, congress changed the law to expand eligibility beyond retirees; in 1972, disabled people and those with end-stage renal disease became eligible for Medicare benefits. Today, roughly  61 million people are covered by the Medicare program, according to the Centers for Medicare and Medicaid Services (CMS).

Who is eligible for Medicare benefits?

Medicare is more popular than employer-paid health insurance, according to Gallup. People with Medicare benefits report a 77% satisfaction rate, compared to employer plans at only a 69% satisfaction rate.

Any U.S. citizen age 65 or over is eligible for Medicare benefits. Permanent U.S. residents who have lived in the country for at least five consecutive years may also be eligible to enroll.

Individuals on Social Security disability automatically receive Medicare benefits after their 24th disability payment. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (Lou Gehrig’s disease), you don’t have to wait to be on disability for two years before you can enroll in Medicare. Medicare benefits generally kick in on the first day of the 4th month of dialysis treatments for those with ESRD. Lou Gehrig’s disease sufferers qualify for coverage the month they begin receiving disability payments.

When can I apply for Medicare benefits?

If you are receiving Social Security or Railroad Retirement Board benefits, you will automatically be enrolled in Medicare when you turn 65.

If you aren’t receiving retirement benefits when you turn 65, you can enroll in Medicare at any time during your Initial Enrollment Period (IEP), which begins three months before the month you turn 65, includes your birthday month, and extends for three additional months. If you turn 65 in June, you can enroll in Medicare any time between March and August.

If you are a permanent resident and not a U.S. citizen, you may need to apply in person at your local Social Security office. Most people, however, can apply online at SSA.gov.

How do I qualify for premium-free Part A and Part B Medicare benefits?

Most people who are eligible for Medicare benefits qualify for premium-free Part A. However, this depends on your work history. In order to avoid a monthly premium for Part A, you or your spouse must have at least 10 years (or 40 quarters) of work history in which Medicare taxes were withheld from your pay.

If you don’t have a full 40 quarters of qualifying work history, you can still enroll in Medicare, but you will typically pay a monthly premium for Part A. The premium is based on your work history; if you worked fewer than 30 quarters, you pay the full premium. Those with 30 to 39 quarters pay roughly half the full premium.

Everyone pays a standard monthly premium for Part B. Depending on your income, you may also pay an extra amount known as the income-related monthly adjustment amount (IRMAA).

How do I qualify for Part D prescription drug Medicare benefits?

Anyone enrolled in Medicare is eligible to sign up for a Medicare Part D Prescription Drug Plan.

Although enrollment in Part D is entirely voluntary, you must have creditable prescription drug coverage in order to avoid a late enrollment penalty if you decide to enroll after you first become eligible. In other words, you can delay enrolling in Part D if you have prescription drug coverage through an employer or union health insurance plan. When your other coverage ends, you can enroll in Medicare coverage for prescription drugs without paying a monthly penalty.

Are Medicare Supplement Insurance Plans part of my Medicare benefits?

Medicare Supplement Insurance Plans are private insurance plans you can buy to supplement your Medicare benefits under Medicare Part A and Part B. These plans only work with Original Medicare and can’t be used for prescription drugs or with Medicare Advantage plans.

Depending on the plan you choose, it pays some or all of your coinsurance and copayment amounts under Part A and Part B, and your Part A deductible. Beginning January 1, 2020, plans covering your Part B deductible will no longer be available.

Although Medicare Supplement Insurance Plans aren’t a mandatory part of your Medicare benefits, you do have guaranteed issue rights to buy a plan during your Open Enrollment Period. This is the six-month period that begins the month you are both age 65 or over and enrolled in Part B. During that time, you can buy any plan sold in your state and you can’t be charged a higher premium based on your health status.

If you don’t buy during your open enrollment period, you may have to pass medical underwriting and the insurance company can refuse to sell you a plan.

To find a Medicare Advantage, Medicare prescription drug plan, or Medicare Supplement Insurance Plan in your area, enter your ZIP code on this page.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. The product and service descriptions, if any, provided on these Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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