Medicare is the federal government’s health insurance program for older citizens and people with disabilities. If you’re age 65 or older, you qualify for Medicare, but that doesn’t mean that you receive it automatically.
Once you meet certain age benchmarks or other criteria for Medicare, it’s up to you to enroll in the program.
Enrolling in Medicare can be a confusing process. It requires understanding some of the basics of how the program works.
This article will cover what you need to know about:
- what Medicare is
- how to apply
- how to meet important deadlines
- how to figure out if you qualify
The eligibility age for Medicare is 65 years old. This applies whether or not you’re still working at the time of your 65th birthday. You don’t need to be retired to apply for Medicare.
If you have insurance through your employer at the time you apply for Medicare, Medicare will become your secondary insurance.
You can apply for Medicare:
- as early as 3 months before the month you turn age 65
- during the month you turn age 65
- up to 3 months after the month you turn age 65
You have a 7-month window to get enrolled.
There are many exceptions to Medicare’s eligibility age requirement.
If you’re age 65 or younger but you’re receiving Social Security because you have a disability, you may be eligible for Medicare.
After 24 months of receiving Social Security due to having a disability, you become Medicare-eligible.
If you have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s Disease), you’re eligible for Medicare as soon as your Social Security Disability benefits begin. You’re not subject to the 24-month waiting period.
If you have End-Stage Renal Disease (ESRD), you become Medicare eligible after a kidney transplant or 3 months after dialysis treatment begins.
Policymakers and elected officials sometimes discuss changing the age of eligibility for Medicare from 65 to 67 years old.
If this were to happen, it would be a gradually implemented change.
For example, if legislation to change the eligibility requirement passed the year you turned 65, you would still be eligible as you would have been if the law hadn’t changed.
According to the Congressional Budget Office (CBO), the age requirement would most likely increase gradually by 2 months each year until the age was firmly 67 years old.
It would take several years for the age requirement criteria to fully take effect.
There are a few other Medicare eligibility criteria in addition to the age requirement.
- You must be a U.S. citizen or a legal permanent resident who has lived in the United States for at least 5 years.
- You or your spouse must’ve paid into Social Security for what amounts to 10 years or more (also referred to as having earned 40 credits), OR you must’ve paid Medicare tax while you or your spouse was an employee of the federal government.
Important Medicare Deadlines
Every year, the cycle for enrolling in Medicare looks similar. Here are some important deadlines to keep in mind.
- Your 65th birthday. Initial enrollment period. You can apply to enroll in Medicare up to 3 months before, the month of, and 3 months after your 65th birthday.
- January 1–March 31. Annual enrollment period. If you have not applied for Medicare during the 7-month window around your birthday, you can enroll during this time. You can also switch between Original Medicare and Medicare Advantage plans and change your Medicare Part D plan during this period. If you enroll in Medicare Part A or Part B during this time, you will have coverage effective July 1.
- October 15–December 7. Open enrollment period for those who are enrolled in Medicare and wish to switch their plan options. Plans chosen during open enrollment become effective on January 1.
Medicare is a federal health insurance program for people who are age 65 or older, as well as people who have certain health conditions.
Medicare is broken up into different “parts.” The parts are really a way of referring to different policies, products, and benefits connected with Medicare.
Medicare Part A
Medicare Part A is coverage for care in the hospital, as well as hospice, nursing facilities, and some home care services.
If you or your spouse paid Medicare taxes for 10 years or more, you’re eligible for Medicare without any payment or premium once you turn 65 years old.
If you or your spouse worked for less than 10 years, you can still get Medicare Part A, but you may need to pay a premium based on the amount of time that you worked.
Medicare Part B
Medicare Part B covers doctor’s services and preventive care. There’s a monthly premium for Medicare Part B benefits. The premium fluctuates yearly. It’s calculated based on your income.
Medicare Part C
Medicare Part C is also called Medicare Advantage.
Medicare Part C provides all of the benefits of Part A and Part B, and sometimes includes additional benefits, too.
Medicare Part C requires a premium. It’s administered by private insurance companies instead of the federal government.
Medicare Part D
Medicare Part D helps to cover the cost of prescription drugs. Medicare D has its own premium separate from Original Medicare. The cost of these plans varies.
Medicare Part D plans are managed by private insurance companies.
Medigap refers to private insurance plans that require a separate premium. These plans help with the costs of deductibles and co-pays. These plans are designed to help pay for things that Original Medicare doesn’t cover.
The Medicare eligibility age continues to be 65 years old. If that ever changes, you might not be affected, as the change will happen in gradual increments.
Enrolling in Medicare can seem complicated, but there are lots of resources to help simplify the process and to get you enrolled.