People are eligible for Medicare beginning at the age of 65, but benefits aren’t necessarily only for those who have worked all their lives and are now at the age to receive retirement benefits. This government-funded system can benefit many individuals who may not even know they qualify.
Table of Contents
- 1 Factors in Medicare Eligibility
- 2 At What Age Can You Get On Medicare?
- 3 Requalifying at Age 65
- 4 Automatic Enrollment and Applying
- 5 More Resources for Medicare Beneficiaries
Factors in Medicare Eligibility
There are several ways that individuals can qualify for medicare.
- Certain Illnesses
Age is the top factor in determining eligibility for medicare. For most people, Medicare eligibility age begins at 65.
Some people qualify for Medicare before age 65 if they have a disability. These individuals qualify during their 25th month of receiving social security disability benefits. For those qualifying for medicare due to a disability, this period, when a person can begin applying for benefits, begins in the 22nd month of receiving social security disability benefits.
If this applies to your situation, you can follow this link to learn more about how to qualify for Social Security Disability.
There are some medical conditions that allow an individual to qualify for medical before reaching the age of 65. Those include end stage renal disease and amyotrophic lateral sclerosis, also known as Lou Gehrig’s Disease. Those with end stage renal disease will qualify if they are in need of regular dialysis or a kidney transplant. Those with the terminal Lou Gehrig’s Disease automatically qualify as well.
At What Age Can You Get On Medicare?
While most people assume that Medicare is reserved for those who have reached retirement age, that isn’t necessarily true. Medicare coverage can also benefit others in certain circumstances. However, those who qualify before age 65 should be aware that they will need to reapply when they do reach age 65.
Medicare Before Retirement Age
For some, benefits can start before the age of 65. This includes the categories of people above, including those who have a disability and those who have certain illnesses. At age 65, both those who are retired and those who are still working qualify for health insurance through Medicare enrollment.
Alternatively, Medicaid is a U.S. public assistance program for U.S. citizens of all ages.
Find out more about the differences between Medicare and Medicaid.
Benefits Received Before 65
For those who do qualify for benefits before age 65, there are restrictions. People in these categories qualify for free Part A benefits. According to medicare.gov, this is what Part A covers:
- Inpatient care in a hospital
- Skilled nursing facility care
- Inpatient care in a skilled nursing facility
- Hospice care
- Home health care
Most people qualify to not pay a monthly premium for Part A. This is true for those who have worked and paid Medicare taxes for at least ten years.
Requalifying at Age 65
An individual who qualified for benefits before age 65 will qualify again at age 65. At this point, there will be another Initial Enrollment Period. During that period, the person will need to apply for benefits again.
Adding Part B Benefits
When qualifying for benefits at the age of 65, a person will get the benefits of Part A, along with Part B. Part A and Part B combined are known as Original Medicare. We’ve covered Part A, now we’ll look at the two areas covered with Part B. Again, these are defined by Medicare.gov.
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventative services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
Unlike Part A, there is a Part B premium that most people will have to pay. However, the standard premium is minimal, currently $135.50. Those with an income below $85,000 will pay the standard Medicare premiums.
Adding Medicare Part C and Part D Plans
Medicare health plans are offered by private companies and provide additional benefits to those with Medicare Part A and Medicare Part B.
Part C is the Medicare Advantage plan. To qualify for this plan, the individual must first qualify for Part A and Part B and must pay premiums, if applicable. In most cases, those with end-stage renal disease will not qualify.
Medicare Part D is prescription drug coverage. To qualify for this prescription drug plan, a person must first qualify for Part A and Part B and must pay premiums, if applicable.
Automatic Enrollment and Applying
Those who are already qualified for Social Security benefits or Railroad Retirement Board benefits will typically be automatically enrolled for Medicare.
Those who have not qualified for those benefits will have to fill out paperwork to be enrolled. Don’t let the process of applying for a government-funded program scare you. The process for enrolling is pretty simple, and you can start it seven months before you become eligible. This seven month period is called your Initial Enrollment Period (IEP).
As mentioned above, the Initial Enrollment Period can change based on circumstances. For those qualifying due to a disability, the IEP begins in the 22nd month of receiving social security benefits. For those who qualified before age 65 and are requalifying at age 65, there is a second IEP that begins seven months before that birthday.
More Resources for Medicare Beneficiaries
When approaching the age to qualify for Medicare benefits, visit the official Social Security Administration Medicare website to determine your eligibility and calculate your premium. In the meantime, read more about when and how to apply for Medicare and visit medicare.gov to prepare for when that time comes.