If you’re looking to enroll in Medicare this year, it’s important to understand the Medicare Part B eligibility rules.
You’re eligible to enroll in Medicare Part B in the months leading up to your 65th birthday. You’re also eligible to enroll earlier than that under special circumstances, such as if you have a disability or certain health conditions.
In this article, we’ll explore who is eligible for Medicare Part B, how to enroll, and more.
Medicare Part B is a health insurance option that becomes available for people in the United States once they reach age 65. However, there are some special circumstances under which you may qualify to enroll in Medicare Part B before the age of 65.
Below, you will find the eligibility requirements for enrolling in Medicare Part B.
You’re 65 years old
You automatically qualify for Medicare Part B once you turn 65 years old. Although you’ll need to wait to use your benefits until your 65th birthday, you can enroll:
- 3 months before your 65th birthday
- on your 65th birthday
- 3 months after your 65th birthday
You have a disability
According to the Social Security Administration, qualifying disabilities may include:
- sensory disorders
- cardiovascular and blood disorders
- digestive system disorders
- neurological disorders
- mental disorders
You have ESRD or ALS
Medicare Part B covers the outpatient diagnosis, treatment, and prevention of medical conditions.
Medicare Part B is just one option available to Medicare beneficiaries. However, the best coverage for you will depend entirely on your personal medical and financial situation.
Other coverage options that may be used instead of or in combination with Medicare Part B include:
- Medicare Part C
- Medicare Part D
Medicare Part C
Medicare Part C, also known as Medicare Advantage, is an option offered by private insurance companies for Medicare beneficiaries.
To enroll in Medicare Part C, you must already be enrolled in parts A and B.
Under a Medicare Advantage plan, you’ll generally be covered for:
- hospital services
- medical services
- prescription drugs
- dental, vision, and hearing services
- additional services, such as fitness memberships
If you have a Medicare Part C plan, it takes the place of original Medicare.
Medicare Part D
Medicare Part D is an add-on prescription drug coverage for anyone enrolled in original Medicare.
If you are interested in enrolling in Part D coverage, you’ll want to make sure to do so as soon as possible. If you don’t enroll in either Part C, Part D, or equivalent drug coverage within 63 days of your initial enrollment, you’ll face a permanent late enrollment penalty.
If you’ve enrolled in a Part C plan, you won’t need Medicare Part D.
Medigap is another add-on option for anyone enrolled in original Medicare. Medigap is designed to help cover some costs associated with Medicare, such as premiums, deductibles, and copays.
If you’ve enrolled in a Part C plan, you cannot enroll in Medigap coverage.
If you’re under age 65 and already receiving Social Security or Railroad Retirement Board disability benefits, you’ll be automatically enrolled in Medicare parts A and B when you turn 65. If you don’t wish to have Medicare Part B, you can defer it at that time.
If you’re not currently receiving these benefits, you’ll have to actively enroll in Medicare.
Important Medicare Deadlines
It’s extremely important not to miss any Medicare deadlines, as this can cause you to face late penalties and gaps in your coverage. Here are the Medicare deadlines to pay close attention to:
- Original enrollment. You can enroll in Medicare Part B (and Part A) 3 months before, the month of, and 3 months after your 65th birthday.
- Medigap enrollment. You can enroll in a supplemental Medigap policy for up to 6 months after you turn 65 years old.
- Late enrollment. You can enroll in a Medicare plan or Medicare Advantage plan from January 1–March 31 if you didn’t sign up when you were first eligible.
- Medicare Part D enrollment. You can enroll in a Part D plan from April 1–June 30 if you didn’t sign up when you were first eligible.
- Plan change enrollment. You can enroll in, drop out of, or change your part C or Part D plan from October 15–December 7, during the open enrollment period.
- Special enrollment. Under special circumstances, you may qualify for a special enrollment period of 8 months.
Medicare Part B eligibility begins for most Americans at age 65. Special qualifications, such as disabilities and certain medical conditions, may make you eligible to enroll in Part B early.
If you need more coverage than what Part B offers, additional coverage options include Part C, Part D, and Medigap.
If you’re interested in enrolling in Medicare coverage of any kind, pay close attention to the enrollment deadlines and visit the Social Security website to get started.