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Medicare Eligibility

Medicare eligibility primarily depends on the age and tax status of the individual. There are some situations in which exceptions to these eligibility requirements are acknowledged, but those situations are not as common.

Are You Medicare Eligible Video Transcript >

Are you Medicare Eligible?

Hi, i'm Jessica Manion at My Healthcare Direct, and I'm going to be going over what it means to be Medicare eligible, as well as some important information regarding what you're enrolling in, as well as some important information regarding enrollment periods that you should be aware of.

Who is Medicare Eligible?

So, typically to become Medicare eligible, you're put into one of two groups:

The first group is those of you who are either turning 65, or those of you who are retiring that are older than 65 and will be going on to Medicare full-time.

The other group is those of you who are under 65 but you've been on social security disability for at least 24 months or two years. Typically, at that point is when most people become Medicare eligible. 

So, when you become Medicare eligible, there's two things that you typically enroll in.

The first is Part A, which is your hospitalization coverage. For most people - or their spouse - who have worked for 10 years paying into Medicare through their taxes, you get Part A completely free. So, in most cases, most people get Part A for free. 

The second thing you're enrolling in is not free: Part B, which is your outpatient coverage, such as doctor's visits, outpatient surgeries as well as blood work, MRIs, things like that. You do have a monthly premium, and in this year 2021, that premium is 148.50 UDS/month. For most individuals who are on social security already, they will deduct that from your social security check.

Once you become Medicare eligible, regardless of if you're in group one or group two, there's a couple of important enrollment periods that you should know about:

Initial Enrollment Period (IEP)

The first is called your IEP or Initial Enrollment Period, and this really affects those of you that are turning 65. You have a seven month window to enroll in a Medicare plan, whether that's staying with original Medicare and purchasing a separate Medicare supplement and prescription drug policy, or if you enroll in a Medicare Advantage plan. That seven month window starts three months before the month you were born in, includes the month you were born in, and three months after.

So, if you were born May 20th, your Initial Enrollment Period would begin in February. Then you would have February, March, and April, May the month of your birthday, and you will also have the three months after, so June, July, and August. So, from February to August, you have that time where you can enroll in a Medicare plan.

Special Enrollment Period

The second enrollment period to know is the Special Enrollment Period. This typically happens when you're already on Medicare, and it'll be a qualification that you'd have to meet in order to change a plan. For those of you especially on a Medicare advantage plan and, say you move from one state to another, you typically are able to enroll in a separate Medicare advantage plan that is available in the new area that you moved to. So, you want to make sure to keep an eye on, especially if you're on an Advantage Plan, that if you move that you need to make sure that you have a plan that is servicing your area.

Open Enrollment Period

Another enrollment period that you want to be aware of is the Open Enrollment Period, which is not to be confused with the Under-65 Open Enrollment Period that goes on in the Fall. So, the Medicare Open Enrollment Period begins on January 1st and lasts until March 31st. So, during this time, if you're on a Medicare Advantage plan, you can go ahead and switch to a different Medicare Advantage plan, or you can go back to original Medicare and purchase a prescription drug plan.

Annual Election Period (AEP)

Last but certainly not least is the AEP or the Annual Election Period. Anybody on Medicare will definitely recognize these dates I'm about to tell you, because you will see tons of commercials on your tv during this time of year. From October 15th to December 7th, that is your opportunity to make a change, regardless of whether it's a prescription drug plan, a Medicare supplement, which really you could do at any time of the year, or your Medicare Advantage plan to take effect in January 1st.  That is probably one of the important enrollment periods that you're going to want to remember once you are Medicare eligible. 

So, for those of you who are turning 65 or you're already older than 65 but you're going onto Medicare full-time, meaning enrolling in Part B, you can purchase a Medicare supplement plan without any health questions or underwriting. I like to call this the “Golden Ticket to Willy Wonka's Chocolate Factory”: You're going to be automatically approved for your supplement. 

Once you're past that enrollment window - so if you're turning 65, that's that seven month window where you can actually almost enroll up to six months before your birth month, you will automatically be approved and you won't have to go through underwriting. However if you are past that window, then you will have to answer health questions. 

So it's very important to know if you're first going onto Medicare, especially Part B, you will be guaranteed to get on a Medicare supplement with no health questions asked. And finally if you want to enroll in a Medicare Part D prescription drug plan, you must be enrolled in Part A and/or Part B in order to be eligible for a prescription drug plan.

Questions?

If you have any other questions about whether you are Medicare eligible or have any other questions about enrollment periods or what plan you should go with once you are Medicare

eligible, feel free to give our office a call at 888-959-1028. You can also find us on Facebook.

Age

The typical enrollment age for Medicare is 65. This is when the individual’s Initial Enrollment Period will begin and they can make any changes to their Medicare policy. Around this time, beneficiaries will be mailed a packet that will detail their policy and new coverage.

Exceptions to the age requirement are made on the basis of diagnosis. Those with specific diagnoses can enroll in Medicare before their 65th birthday.

Tax history

Tax history is the second important eligibility requirement that must be met in order to be eligible for Medicare. If you or your spouse has paid into Medicare taxes, you’ll most likely be eligible for premium-free Part A.

If you don’t qualify for Medicare because of your tax history, you may still be able to purchase Medicare.

We can help!

Enrollment questions?

Enrolling in Medicare doesn’t have to be complicated or stressful. There are many options available, so our team is here to assist with the enrollment process. If you have any questions or would like to begin enrollment today, make an appointment to speak with one of our professionals.

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