Medicare is not free. While Part A may be premium-free for those who have paid Medicare taxes for at least 40 quarters, Part B requires a monthly premium. Higher-income individuals may pay more due to the Income Related Monthly Adjustment Amount (IRMAA).

What is the Difference Between Original Medicare and Medicare Advantage?

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Medicare Advantage (Part C) is an alternative that replaces Original Medicare with coverage managed by private insurance companies, often including additional benefits like dental and vision.

What Happens If I Delay Medicare Enrollment?

If you delay Medicare enrollment without having creditable coverage, you may face late enrollment penalties. The Part B penalty is 10% for each full 12-month period you were eligible but did not enroll. Part D also has penalties for late enrollment.

Can I Have Medicare and Employer Health Insurance at the Same Time?

Yes, you can have both Medicare and employer-sponsored health insurance. If you are actively employed and your employer has 20 or more employees, your employer coverage is primary, and Medicare is secondary. If your employer has fewer than 20 employees, Medicare is primary.

Does Medicare Cover Long-Term Care?

Medicare does not cover most long-term care services, such as custodial care in a nursing home or assisted living. Medicare may cover short-term skilled nursing care or rehabilitation if it is medically necessary and follows a hospital stay.

Can I Change My Medicare Plan After Enrollment?

Yes, you can change your Medicare plan during specific enrollment periods. The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year, allowing you to switch between Original Medicare, Medicare Advantage, and Part D plans. There are also Special Enrollment Periods for qualifying life events.

Who Is Eligible for Medicare?

Q: Who Qualifies for Medicare Benefits?

To be eligible for Medicare, you must be a U.S. citizen or permanent legal resident. Most people qualify at age 65. However, those under 65 may qualify if they have received Social Security disability benefits for at least 24 months or have been diagnosed with End-Stage Renal Disease (ESRD) or ALS.

Q: Is It Mandatory To Enroll In Medicare When You Turn 65?

No, Medicare enrollment is not mandatory, but there may be financial penalties for not enrolling unless you have creditable alternative health coverage. If you receive Social Security disability benefits, you will be automatically enrolled in Medicare Part A and Part B.

Q: Can I Opt-Out of Medicare?

Yes, you can opt out of Medicare without penalty if you have creditable health insurance coverage, such as an employer group health plan. The employer must have at least 20 employees if you are 65 or older, or at least 100 employees if you are under 65.

Q: Can I Enroll In Part D Prescription Drug Coverage?

To enroll in Medicare Part D, you must be eligible for premium-free Part A. You do not need to have Medicare Part B to enroll in a Part D prescription drug plan.

Q: When Should You Enroll in Medicare?

Most people enroll in Medicare at age 65. Enrollment periods include the Initial Enrollment Period (IEP), General Enrollment Period (GEP), and Special Enrollment Period (SEP). The IEP lasts seven months around your 65th birthday. The GEP runs from January 1 to March 31 each year, and SEP applies to specific life events like losing coverage or relocating.

Home New To Medicare Who Is Eligible for Medicare?

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Key Takeaway:

Medicare is a federal government national health insurance program created to help cover the costs of medical care for U.S citizens and permanent legal resident’s who are age 65 or older, or under and have received Social Security disability income for at least 24-months or have been diagnosed with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease).

Medicare Part A (hospital insurance) is available premium free for those who have paid the Medicare payroll tax for at least 40-quarters and for those starting Medicare while under the age of 65.

Medicare Parts

Medicare medical insurance is composed of four Parts; Part A, Part B, and Part D prescription drug copverage. Medicare Part A (inpatient insurance) and Part B (outpatient insurance) combined is called Original Medicare.

Medicare Part C (aka Medicare Advantage) replaces Medicare Part A & Part B coverage with a privatized version managed by a private insurance company. Many do not consider Medicare Advantage Part C to be a Part of Medicare because it replaces Medicare.

A Medicare Supplement Plan can be added to Original Medicare to improve the insurance coverage. Again, Medicare Advantage plans replace Original Medicare.

In this article, we will discuss who is eligible for Medicare, who can enroll before age 65 using disability benefits, and when is the best time to purchase Medicare.

Medigap Seminars Insurance Agency Reviews.

Who Qualifies for Medicare Benefits?

To be eligible for Medicare requires that you be a U.S. citizen or permanent legal resident to qualify for Medicare benefits. A non-citizen must have resided in the United States and a green card holder for a minimum of 5-years to meet Medicare eligibility requirements and approved for Medicare enrollment.

Most people age into Medicare as they turn 65. However, Medicare is also for people under age 65 who have been receiving social Security disability benefits. Their Medicare will automatically start on the 25th month after their Social Security disability benefits begin.

Some conditions like a diagnosis of End-Stage Renal Disease (ESRD) permanent kidney failure or amyotrophic lateral sclerosis (ALS aka Lou Gehrig’s disease) automatically qualify a person for disablity benefits and are immidiately eligible for Medicare.

While we often refer to Social Security, we mean either Social Security or railroad retirement board benefits. Some people receive railroad benefits instead of Social security.

You can get more information on the Social Security Disability Insurance program by contacting your local Social Security Administration (SSA) office. If you qualify for the Railroad Retirement benefits, you should contact the Railroad Retirement Board.

Is It Mandatory To Enroll In Medicare When You Turn 65?

Enrollment in Medicare is not mandatory, but there are financial penalties for not doing so unless you have alternative healthcare considered equivalent to Medicare or “creditable”.

You will be automatically enrolled in Medicare if you’ve been receiving Social Security disablity benefits for at least four months before you turned 65. In such a situation, you will automatically be enrolled in Medicare Part A (Hospital Insurance) and Part B (Medicare Insurance) on your twenty-fifth moneth of disability benefits or your Initial Enrollment Period, whichever comes first.

Is Medicare Free?

No, Medicare is not free.

Medicare Part B coverage comes with a monthly premium that will be deducted from you Social Security or railroad retirement board benefits if you are receiving those retirement benefits.

Most people pay the standard Part B monthly premium. Higher income people may pay more than the standard monthly premium, depending on income. This is called the Income Related Monthly Adjustment Amount or IRMAA. if you would like to know more about IRMAA, please read my article and watch the video on IRMAA

If you or your spouse have worked and paid Medicare taxes for a minimum of 40 quarters, your Medicare Part A will be premium free. If neither you nor your spouse have paid the required Medicare taxes, you may purchase Part A by paying a monthly premium. You are required to have or be eligible for your Medicare Part A before enrolling in a Medicare Advantage plan or Medicare supplement

If you are divorced and your ex spouse is eligible for Medicare because they paid Medicare taxes through their payroll deductions, you may use their Medicare eligibility to get your Part A hospital insurance premium free.

Can I Opt-Out of Medicare?

A person who is eligible for Medicare can opt-out of Medicare without penalty as long as they have creditable health insurance coverage like employer group health plan coverage.

For an employer group health plan to be creditable you must be actively employed or using your spouse’s current employment health coverage. In addition, the employer must have a minimum of 20 employees if you are age 65 or older. If you are not yet age 65, the employer must have a minimum of 100 employees.

Medicare’s intent is for you to have full health care coverage, either through Medicare coverage or through another means.

Can I Enroll In Part D Prescription Drug Coverage?

In order to enroll in Part D for prescription drugs you must be eligible for premium free Part A. You do not need to have Medicare Part B. This way you can enroll in Part A even if you have delayed Medicare coverage opting for employer group health plan based insurance.

When Should You Enroll in Medicare?

Most people enroll in Medicare when they first become eligible for Medicare at age 65. It is also common for people to delay Medicare until they reach full Social Security or railroad retirement age. This is the best time to enroll in Medicare. The Medicare enrollment periods are called your Initial Enrollment Period (IEP), General Enrollment Period (GEP or a Special Enrollment Period (SEP).

Initial Enrollment Period (IEP)

Your IEP lasts seven months and begins three months before you turn 65. the earliest your Original Medicare can start is the first day of the month you tun 65. The exception to this rule is when your birthday is on the first of the month. If that is the case, your entire IEP is moved forward by one month.

General Enrollment Period (GEP)

General Enrollment Period is for all of those who did not enroll in Medicare during their IEP. The GEP is from January 1 to March 31 each year. Starting in 2023, people who enroll in Medicare during this time will be able to benefit from their coverage the following month from their enrollment date.

Special Enrollment Period

Special Enrollment Period is for some unexpected life events, like:

changing your permanent residence;
losing your current coverage through no fault of your own;
your current plan changing its contract with Medicare;
the eight-month period after retiring from your employer;
and other circumstances.

You can find all the essential information about special circumstances which qualify you for this enrollment period at Medicare.gov.

Final Thoughts

Enrolling for Medicare as soon as you’re eligible to do so is typically your best option. Anyone at the age of 65 should analyze their current health insurance situation and consider what the best solutions for them and their spouses are.

If you have more questions, you can check our Medigap Seminars site for more valuable resources or find all the essential information about this topic on Medicare.gov.

Learn how to find a trusted Medicare agent near you.

Matthew Claassen

CMT and CEO of Medigap Seminars Insurance Agency.

Medigap Seminars is a top national Medicare Insurance Brokerage, recognized for excellence by major insurers like Mutual of Omaha, Aetna, and Humana. Led by Medicare expert Matthew, whose educational videos have millions of views, the team provides trusted guidance. Matthew, a former financial analyst, also won the 2009 Best Equity Research & Strategy Award.