Medicare Part A and Part B Eligibility – Do You Qualify?
Who is eligible for Medicare Part A and Part B?
If you are an American citizen or legal permanent resident of at least five consecutive years. You must also pass at least one of the following requirements for Medicare eligibility:
- Are you permanently disabled and have been receiving disability benefits for at least two years? If yes, then you automatically get Part A and Part B after you get disability benefits from Social Security for 24 months. You will also get it if you have been on certain disability benefits from the Railroad Retirement Board (RRB) for 24 months.
- Are you at least age 65 or older and eligible for Social Security? Well if you meet this requirement then you may be automatically enrolled in Medicare Part A (hospital insurance). Furthermore, let’s say you are already getting benefits from Social Security or the Railroad Retirement Board (RRB). Then, you will automatically get Medicare 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 preceding month.) If, for example, you’re still working and you’re not receiving retirement benefits from Social Security or the Railroad Retirement Board. Then you must sign up for Medicare Part B when you meet the age requirement as your enrollment is not automatic
- Do you have Lou Gehrigh’s disease (Amyotrophic Lateral Sclerosis, or ALS)? Then you automatically will get Part A and Part B the month your disability benefits begin.
- Do you have end-stage renal disease (ESRD)? Then you need to sign up for Medicare, as your enrollment is not automatic.
Most beneficiaries don’t have to pay a premium for Medicare Part A. If you or your spouse paid Medicare taxes while working for at least 10 years (or 40 quarters) then you may be eligible for premium-free Medicare Part A. If you’re not eligible for premium free Part A, then you will have to pay a monthly premium of up to $458 in 2020.
Additionally, you must pay $144.60 for Part B premium, which is the standard amount, each month in 2020.
Individuals with a higher income may have to pay more for their Part B premium. Note that there is a penalty if you don’t sign up for Medicare Part B when you first become eligible. If you don’t sign up right away, you may have to pay a 10% penalty (added to your monthly premium) for each 12-month period you could have had it but didn’t (some exceptions apply).
Medicare Part C eligibility (or Medicare Advantage) – How can you qualify?
Another way to your Medicare Part A and Part B benefits is through Medicare Part C (also called Medicare Advantage). If you want these Medicare Advantage Plans, they are available through private insurers. You must already be enrolled in Medicare Part A and Part B to be eligible for Medicare Part C. You must also live within the service area of the Medicare Advantage plan that you want. If you want more information about enrolling in a Medicare Advantage plan then contact one of the following:
- 1–800-MEDICARE (1–800–633–4227; TTY users 1–877–486–2048), 24 hours a day/7 days a week; or www.medicare.gov
- A licensed insurance broker or agent.
Medicare Part C (The Medical Advantage) has a seven-month Initial Enrollment period (IEP). This period starts 3 months before the month you turn 65, as well as the month you turn 65, and ends 3 months after the month you turn 65. (This is generally the same as the Initial Enrollment Period for Medicare Part A and Part B). Another option is to sign up during the Annual Election Period (AEP) from October 15 to December 7 for coverage effective until January 1 of the next year. If you qualify, you can also enroll during a Special Election Period (SEP).
You might not qualify for a Medicare Advantage plan if you have end-stage renal disease (ESRD) in most cases. However, if you are someone with ESRD, there’s one type of Medicare Advantage plan especially meant for you.
There is no penalty for not signing up to Medicare Part C as it is optional. But, in order to get Part C, you must live in the service area of a Medicare Advantage plan and have Medicare Part A and Part B. Generally, you cannot have end-stage renal disease as well (with a few exceptions).
Medicare Part C does not exempt you from paying your Part B premium so you must continue to pay it. Medicare Advantage plans vary by the insurance company you choose as well as the monthly rates and plan coverage.
Medicare Part D (Prescription Drugs) eligibility – How can you qualify?
Like Medicare Part C, Medicare Part D (prescription drugs) is available through private insurers. These private insurers must be Medicare approved to have a Medicare prescription drug plan (PDP).
How can you be eligible to enroll in a Medicare prescription drug plan (Medicare Part D)? 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.
How can you be eligible to enroll in a Medicare Advantage plan with prescription drug coverage (MAPD)? You must live in the service area for the MAPD plan you’re considering and you must have Medicare Part A and Part B.