Medicare Eligibility & Enrollment: Who Qualifies & When

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If you or your loved ones are nearing a 65^th birthday, you’ve got another reason to celebrate! While it may seem like just another birthday, this is the year you qualify for Medicare.

Did You Know?
When you sign up for Medicare, you can also sign up for Social Security Benefits! Before you apply, locate all necessary documents, such as your Social Security card, birth certificate, proof of U.S. citizenship or lawful immigration status, and any other required documents depending on your specific situation

If you need help with this process, reach out to the team at Midwet Health Insurance Solutions and we will be happy to guide you along the way!

As a general rule, you should sign up for Medicare as soon as you’re eligible. That way, you can avoid late enrollment penalties while receiving maximum coverage. Unfortunately, the enrollment process isn’t always simple.

Don’t want to miss your Medicare eligibility date? Midwest Health Insurance Solutions has you covered! Read on to learn more about Medicare eligibility & enrollment: who qualifies & when.

Who Is Eligible for Medicare?

About 88% of Medicare beneficiaries qualify based on age. However, it’s also possible to qualify based on your disability status.

To qualify under the disability clause, you must have Lou Gehrig’s disease (ALS), end-stage renal disease, or certain other disabilities. As long as you’re receiving Social Security Disability benefits, you’ll be eligible for Medicare as well.

Of course, Medicare coverage can include a variety of different health plans. Here are the Medicare requirements for Parts A, B, C, D, and Medigap.

Part A Eligibility

Medicare Part A covers inpatient care in hospitals. It also covers Medicare benefits like hospice care and skilled nursing facilities. If you’ve been paying Medicare taxes for long enough, you’ll qualify for Part A free of charge.

If you don’t qualify for Part A coverage without premiums, you may still be able to buy it. This requires you to be 65 or older and have access to Medicare Part B. The Part A premium costs either $278 or $505.

Part B Eligibility

Medicare Part B covers medically necessary outpatient care. If you’re eligible for premium-free Medicare Part A, you’re also eligible for Part B. If not, you’ll qualify for Part B if you meet these Medicare eligibility criteria:

You’re a U.S. resident
You’re 65 or older
You’ve lived in the U.S. for 5+ years before applying for Medicare

Part C Eligibility

Medicare Part C is best known as Medicare Advantage. This is simply a bundle of several coverage types, including Medicare Parts A and B. That said, this plan also comes with a few advantages compared to Original Medicare.

Keep in mind that Part C availability can vary by location. Even if you qualify for this plan, you’ll still need to live in its service area to join it. Check the official Medicare website to find plans available in your area.

Part D Eligibility

Part D is Medicare’s drug coverage plan. You can get Plan D coverage by buying it as a stand-alone plan or bundling it with Medicare Advantage. Either way, you’ll need to be a U.S. citizen to be eligible for Part D.

These days, most Medicare Advantage plans include Plan D. In fact, signing up for a stand-alone Part D plan will likely disenroll you from the Advantage plan. The only exceptions are some less common plan types, like PFFS.

Medigap Eligibility

Medigap is additional coverage you can buy from private health insurance companies. It covers some out-of-pocket costs in Original Medicare. As such, you’ll need to have Medicare Parts A and B to be eligible for Medigap.

How to Apply for Medicare

By now, you should (hopefully) know which Medicare plan you’re eligible for. The question is: when and how do you apply for it?

In some cases, this decision will be made for you. If you’re on Social Security, you’ll automatically get Medicare Parts A and B upon turning 65. You may also be able to delay Part B if you have other health coverage.

If you’re not receiving Social Security, you’ll need to apply for Medicare once you’re eligible. Here are the three main Medicare enrollment periods.

Initial Enrollment Period

Unless you qualify for Medicare early due to a disability, the initial period is your first chance to enroll. It lasts for three months before the month you turn 65, your birthday month, and three months after it.

The easiest way to apply is via the official Social Security website. When done this way, your application should take about 10 minutes. After two weeks, you should get your Medicare card in the mail.

Special Enrollment Period

Even if you miss the initial enrollment window, you can still avoid late enrollment fees. To do so, you’ll need to qualify for a special enrollment period. This applies if you’ve encountered one of the following situations:

Loss of Medicaid coverage
Inability to enroll due to a natural disaster
Inability to enroll due to being incarcerated
Inability to enroll due to circumstances outside of your control
Misinformation from your employer or health plan agent

You can also qualify if you have health insurance from your employer. In this case, you can apply for Medicare at any time while you have that coverage. You can also apply up to eight months after the coverage ends.

General Enrollment Period

If you don’t qualify for special enrollment, you’ll have another chance during the general enrollment period. This runs from January 1st to March 31st each year. Your coverage will begin the month after you sign up.

Late Enrollment Costs

If you don’t apply for Medicare on time, you may face late enrollment costs. The exact amount will depend on the plan you want to apply for.

For instance, let’s say you want to apply for Medicare Part A. If you miss the initial period and don’t qualify for special enrollment, you’ll pay a higher monthly fee. The longer you wait to sign up, the bigger the fee.

You may also fail to sign up for Plan B during initial enrollment. If so, your monthly fee will increase by 10% for each year without coverage. This penalty will remain active for as long as you own Part B.

Going without Part D or other prescription drug coverage can also incur fees. This penalty is also permanent and gets recalculated each year.