Medicare Eligibility
Who is eligible for Medicare anyway? Medicare eligibility begins for most people at age 65. Individuals who have been entitled to Social Security disability for at least 24 months also qualify.
Many people confuse their Medicare Eligibility date with their Social Security date. They are different. A person can apply for full retirement income benefits at age 66. However, this does not affect the age at which they qualify for Medicare. Everyone who has worked at least 40 quarters (10 years) in the United States during their lifetime can qualify for Medicare at age 65.
Eligibility for Medicare Part A
Medicare Eligibility begins at age 65 for most people.
You are eligible for Medicare Part A at age 65 if you or your spouse has legally worked (and paid taxes) for at least 10 years in the U.S. During those years, you paid taxes toward your Part A hospital benefits. This is why most Americans pay no Part A premiums when they become eligible for Medicare. Part A mainly covers your hospital stays. If you have worked and paid taxes in the US, then you will be issued Medicare Part A automatically. Even if you are employed with a company with over 20 employees it makes perfect sense to have this benefit.
If you have not worked and paid taxes the required 10 years, Part A may be available for you to purchase. You can call Social Security at 1-800-772-1213, or visit your local Social Security office for more information about buying Part A.
Eligibility for Medicare Part B
You are eligible for Medicare Part B at age 65 as well. However, you must pay a monthly premium for Part B. This provides for your outpatient benefits such as doctor visits, lab work, surgery fees, and more. Check out our Part B page for more on what Part B covers. Our “Ultimate Medicare Quick Reference Guide” (see at bottom of this page) goes over the costs for Medicare Part B which is based on income.
Generally, if you are taking Social Security early you will automatically be enrolled in Medicare Part B unless you specifically ask Social Security NOT to enroll you.
If you are not taking Social Security, then the situation is murkier. For those who were born in the US, you can almost always enroll by either going online Medicare.gov, enrolling over the phone with Social Security, or asking us to enroll you. The same generally applies for US Citizens and Permanent Residents who’ve been in the US for a very long time. If one of the self-enrollment techniques fails to work, then you’ll likely need to go to a local social security office to apply.
Should that occur, please call us first so we can ensure you bring the proper paperwork and don’t have to wait in line multiple times.
Some people turning 65 still health insurance through an employer. They can delay their enrollment into Part B in favor of their group health insurance without fearing a late penalty if their employer has more than 20 employees. If you work for a smaller company, you must have both Medicare Part A and Part B to be covered by your company plan. In that case, you might need to evaluate whether the company plan makes sense for you or not.
If you delay enrollment into Part B, consult with a local insurance agent who specializes in Florida Medicare. He or she can explain the special election periods which you must use later on so that you won’t be subject to a late enrollment penalty.
This is confusing and that is one of the values we bring at Fl Medicare Agency. We know the rules and can take a great deal of stress out of the equation for you.
Eligibility for Medicare Part C
Medicare Part C is another name for the Medicare Advantage program which is issued by private insurance companies instead of Original Medicare. You can get them from an agent, broker, or the company directly. Usually, these plans have smaller networks than Medicare, but some of them include built-in Part D coverage.
To be eligible for Part C, you must first be enrolled in both Medicare Parts A and B. You must also live in the plan’s service area.
Many people think that if they enroll in a Medicare Advantage plan, they can drop their Part B and escape paying Part B premiums. This is NOT the case. You must have both A and B to even be eligible to enroll in either a Medicare Advantage plan or Medigap plan. You must continue to be enrolled in Parts A and B during the entire time that you are enrolled in a Medicare Advantage plan.
Learn more about Part C Advantage plans here.
Eligibility for Medicare Part D
You are eligible for Medicare Part D as long as you are actively enrolled in either Part A and/or B. You must also live in the Part D plans’ service area. Though Medicare Part D is voluntary, we strongly recommend it if you have no other drug coverage. Part D provides your insurance against future catastrophic medication costs. It will also help give you lower copays on medications you take now. Unlike Medicare Part B you only have sixty days from the time you are enrolled in either Medicare Part A or Medicare Part B to have credible drug coverage. This can be from a company plan, VA or TRICOR benefit, a retiree plan, a Medicare Advantage Plan with Drug Benefits, or a stand-alone Medicare PDP Part D Plan.
Remember if you don’t have credible coverage, you will be subject to penalties and like the penalties on Medicare Part B, these penalties follow you for the remainder of your life.
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