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Medicare Eligibility

Medicare is designed for older persons aged 65 and above. It is also made available to people under 65 living with disabilities or certain medical conditions.

Who Is Eligible For Medicare?

Wondering if you are eligible for Medicare? Here's what qualifies you.

You become eligible to sign up for Medicare 3 months before you turn 65. This is due to the Initial Enrollment Period that spans over seven months. These seven months are broken down as follows:

●  Three months before you turn 65

●  The month you turn 65 (your birth month)

●  Three months after the month you turn 65

 

However, the age of 65 is not the only determining factor. You must be aged 65 and fit into these categories to qualify for full Medicare benefits:

●  A U.S. citizen or a permanent legal resident who has lived in the United States for at least five years

●  Receiving (or eligible to receive) benefits from Social Security or Railroad Retirement Board

●  You or your spouse has paid Medicare taxes while working for at least ten years (40 quarters). This means you have earned 40 Social Security Credits.

You get an automatic enrollment into Medicare if you are 65 and already receiving retirement benefits from either Social Security or the Railroad Retirement Board.

 

If you are not drawing your Social Security benefits at age 65 then enrollment into Medicare is not automatic. In this case, you will need to apply for your Medicare benefits and missing the deadline to do so could result in lifetime late enrollment penalties. Learn more about how to apply.

How About Persons Under 65?

People under 65 can also be eligible for Medicare if they:

●  Have end-stage renal disease (ESRD)

●  Have amyotrophic lateral sclerosis (ALS)

●  Have qualified for Social Security retirement benefits and have received Social Security Disability Insurance (SSDI) for at least 24 months (not necessarily consecutive)

●  Have qualified for certain disability benefits from the Railroad Retirement Board for 24 months

●  Have family relationship coverage, when a person's parent or a spouse paid Medicare taxes for a specified period

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Some of these conditions give you automatic enrollment into Medicare. An example is Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS). Aside from automatic enrollment, you do not need a waiting period of two years (after being eligible for or receiving disability benefits) before your Medicare coverage kicks in. Your  Medicare benefits are available immediately after you become eligible.

 

You also get automatic enrollment if you have received SSDI (Social Security Disability Insurance) for at least 24 months. The same benefits apply to persons with ESRD. However, to qualify, you must require regular dialysis or a kidney transplant. Also, you must meet the work requirements for yourself or a family member.

If you need regular dialysis, your Medicare coverage will begin on the first day of the fourth month of your dialysis treatment. For a kidney transplant, your Medicare coverage begins the month you're admitted to the hospital for a kidney transplant. Hence, all healthcare costs you may have incurred within the month (even if they were before your transplant) will be covered.

 

Disability benefits through Social Security are not extended to persons under age 18. In other words, the earliest you can start receiving Medicare benefits due to a disability is age 20 (18 years plus two years waiting period), or age 18 if you have ALS.

Top 5 Medicare Mistakes to Avoid

Avoid Common Pitfalls People Make

If you qualify for Medicare because of a disability, you're eligible for premium-free Medicare Part A without meeting work requirements. And as long as you meet the disability requirements, you can remain covered for more than eight years after returning to work. After that, you may have to start paying for Medicare Part A.

What if I Do Not Meet These Requirements?

Are you aged 65 or older but do not qualify for Medicare? This may be due to your work record or that of your spouse. However, It is not the end of the road, and there's still hope.

 

As long as you are a U.S. citizen or have been a legal resident for at least five years, you can enroll in Medicare and enjoy its coverage benefits. The following are alternative ways to get Medicare benefits:

Buy Medicare Part A And Pay Monthly Premiums

Once you do not qualify for Medicare, you equally do not qualify for a premium-free Part A. However, becoming a Medicare beneficiary is not an impossible mission.

 

As long as you are 65 or above, you can buy Medicare Part A and pay monthly premiums. Your monthly premium depends on how long (in quarters) you've worked and the work credits you've earned.

 

You earn work credits based on your income and when you pay Medicare taxes. In 2022, for every $1,510 you earn, you earn one work credit. If you have worked for less than 30 quarters or earned fewer than 30 work credits, you pay a monthly premium of $499. If you've accrued 30 to 39 credits meaning you've worked and paid Medicare taxes for 30-39 quarters, you pay $274. If you continue working and earn 40 credits, you will no longer pay monthly premiums.

Pay The Standard Monthly Part B Premium

From age 65 and above, you can buy Medicare Part B and pay the same monthly premium that other subscribers pay.

 

In 2023, the standard amount is $164.90. You may pay a higher rate depending on your yearly income due to IRMAA.

Pay The Standard Monthly Part D Premium

From age 65 and above, you can buy a Medicare Part D plan if eligible and pay the same monthly premium that other enrollees in the same plan pay.

 

Note, You must be enrolled in either Part A or B to get Part D. 

 

Also, you must be enrolled in Original Medicare (Part A and B) to purchase a Medicare Advantage plan (Part C) or a Medigap plan.

Top 5 Medicare Mistakes to Avoid! 

Medicare is complicated and making the wrong decision can be costly. We have put together a FREE resource guide covering the Top 5 Medicare mistakes and how to avoid them. Here is what you will learn in this educational resource: 

 

  • Proven Steps to Achieve Medicare Success

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Welcome to Your Local Medicare Help, where we specialize in making Medicare easy to understand and tailored to your needs. Our mission is to provide FREE experienced guidance to all Medicare beneficiaries, ensuring you find the best plan for your unique situation while also helping you access valuable federal and state programs that could save you money and enhance your coverage.

Medicare can be confusing, but you don’t have to navigate it alone. Our dedicated team takes the time to understand your healthcare needs, budget, and preferences. We’ll help you explore your options, including Medicare Supplement Insurance and prescription drug coverage, so you can confidently make informed decisions.

Whether you’re turning 65 or already enrolled and looking to review your plan, we’re here to guide you every step of the way. Contact Your Local Medicare Help today for personalized support—at no cost to you! Let us simplify Medicare so you can focus on your health and well-being.

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*Your Local Medicare Help is an independent insurance brokerage that connects individuals with insurance providers. Your Local Medicare Help is delivering an educational presentation only. Products and services are provided exclusively by the providers. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. We do not offer every plan available in your area. Currently we offer 8 Organizations offering 95 plans. Any information we provide is limited to those plans we do offer in your area. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.” For accommodation of persons with special needs at meetings call 1-877-438-9564. By submitting your phone number, you are giving Your Local Medicare Help permission to communicate with you via live telephone and automatically-sent text message. We are not connected with or endorsed by the United States government or the federal Medicare program.

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