If you’re looking to enroll in Medicare this year, it’s important to understand the Medicare Part B eligibility requirements.
You’re automatically eligible to enroll in Medicare Part B when you turn 65. You’re also eligible to enroll under special circumstances, such as if you have a diagnosis of a disability or end-stage renal disease.
In this article, we’ll explore who is eligible for Medicare Part B, how to enroll, and important Medicare deadlines to take note of.
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
If you have a disability and are receiving disability payments, you’re eligible to enroll in Medicare Part B even if you’re not 65. 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 end stage renal disease (ESRD)
If you have been given a diagnosed of ESRD, you’re eligible to enroll in Medicare Part B even if you’re not 65. However, it’s important to note that you won’t be eligible to enroll in a Medicare Part C plan.
Medicare is generally reserved for Americans who are age 65 or older. The only exceptions to the eligibility age rules for Medicare Part B are:
- if you have a disability and are receiving Social Security disability payments
- if you have a diagnosis of end stage renal disease
Both qualifications will allow you to enroll in Medicare Part B before your 65th birthday. In most cases, you’ll be automatically enrolled in Medicare parts A and B after you’ve received disability payments for 24 months.
Otherwise, you’ll need to enroll on your own through the Social Security’s website.
To find out more about when you’re personally eligible to enroll in Medicare Part B, you can use Medicare’s Eligibility & Premium Calculator.
Medicare Part B, as part of original Medicare, covers the diagnosis, treatment, and prevention of medical conditions.
This includes medically necessary services or supplies related to diagnosis or treatment of a condition, including visits to the emergency room. It also includes preventive healthcare, such as annual visits to your doctor.
In addition, Medicare Part B also covers:
- medical transportation, such as ambulance services
- durable medical equipment, such as blood sugar strips and crutches
- certain prescription drugs, although this coverage is limited
- mental health services, including inpatient and outpatient services
- clinical research, including clinical trials with experimental treatment options
Medicare Part B doesn’t cover hospital stays, prescription drugs, or additional coverage such as dental or vision.
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, and Medigap.
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 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 won’t need to enroll in Medigap coverage.
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.
- Late enrollment. You can enroll in a Medicare plan or Medicare Advantage plan from January 1st – March 31st 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 1st – June 30th 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 15th – December 7th, 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.
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