If you’re approaching retirement, you probably have a lot of questions about Medicare. Understanding how to enroll in this program and what it covers can be confusing. Luckily, you’ve come to the right place.
We’ve rounded up everything you need to know about Medicare age qualification, how to apply, and what is included. Here’s your go-to guide to Medicare qualifications and more.
What is Medicare?
Medicare is the government health insurance program offered to people in the United States who are over the age of 65. Head to this page, for more information on prepping for Medicare.
Certain people with disabilities may also qualify at a younger age. It’s important to note that is federal program is different than Medicaid. Medicaid is the low-income health program that helps to serve people of all ages.
When do I Qualify for Medicare? Medicare Age Qualification Explained
If you are 65 or older and are a citizen of the United States, you are entitled to Medicare benefits. You may also qualify if you’ve been a legal resident for five years. If you’re under 65 and have certain disabilities, you may also qualify for Medicare.
If you’re receiving disability insurance through Social Security, you can qualify for Medicare after a waiting period of two years. People suffering from ALS or permanent kidney failure can qualify for Medicare immediately.
How to Apply for Medicare
When you turn 65 years old, if you’re already getting Social Security benefits, you will be automatically enrolled in the Medicare Part A program. Medicare Part A covers things such as hospital costs. Medicare Part B will cover visits to your doctor. Medicare Part D is a prescription drug program that you’ll need to enroll yourself in. This is not an automatic process.
If you’re already receiving Social Security, the enrollment process is taken care of for you. If you aren’t, you’ll need to sign up yourself. You can apply on the Social Security Administration website.
When you turn 65, you’ll have a seven-month time window to apply. This will start three months before your 65th birthday and run through your birthday month. You’ll then have an additional three months following your birthday.
During this seven-month period of enrollment, you can also sign up for the Medigap or the Medicare Advantage program. It’s important to enroll in these programs during the seven-month enrollment period so that you get the coverage you need.
Those two programs are through private insurance companies and they aren’t required to cover you if you’re out of the enrollment window. They have the right to turn you down after the seven-month period.
Is Medicare Coverage Free?
The Medicare Part A program won’t require you to pay any premiums. You or your spouse would have to have paid your Medicare taxes for a ten-year period or more. If either of you has worked for over ten years, chances are, you’ve paid these. They are taken out of your paycheck automatically.
To check this, you can look at your Social Security statement. If you haven’t paid these taxes, you’ll need to pay your Medicare Part A premiums each month. These are required to cover additional parts of Medicare such as prescriptions and doctors’ visits. The amount will vary slightly each year.
Medicare Part A
Medicare Part A will cover inpatient care at a nursing facility or a hospital. This will not cover long-term care. Medicare Part A may also cover hospice care and some additional health care.
Medicare Part B
Medicare Part B will cover visits to your doctor and other medical services or supplies. This can include preventative care, ambulances, medical equipment, and some outpatient prescriptions. Medicare Part B will require you to pay some monthly premiums as well. This will depend on your adjusted gross income.
The income requirements will change slightly each year. You and your spouse will use your combined income. Medicare Part B will also include a deductible. After you pay this, you’ll only pay for a percentage of the Medicare-approved supplies and services you need.
If you don’t sign up for Medicare Part B when you turn 65, you will pay a penalty for each year you’ve delayed. You will likely pay this penalty for the rest of your life. Very few people will drop Part B once they have enrolled.
The only way to avoid paying this penalty is if you had insurance through an employer when you turned 65. You will have eight months to sign up once your employee coverage ends.
Medicare Part D
Medicare Part D will help cover prescription drug costs. These plans are run through private insurance companies. You will pay a monthly premium that will vary based on your income. The higher your income, the more you’ll pay. You will also pay a penalty if you didn’t sign up during the enrollment window.
Medigap and Medicare Advantage
Not everything is covered through Medicare. This is where some people decide to enroll in Medigap or Medicare Advantage. Medicare Advantage is also known as Medicare Part C. These additional plans will cover things such as dental care, vision, hearing aids, and additional medical supplies.
You can enroll in Medigap programs through a private insurance company. To purchase a policy, you have to be enrolled in Medicare Part A and Part B. You cannot enroll in both Medigap and Medicare Advantage. You will need to choose one or the other.
Medicare 101
The Medicare program is a great resource for older Americans. When it comes to your Medicare age qualification, what the programs cover, and who is eligible, the Medicare website will have the most up to date information.
When you near the age of 65, it’s time to do a little homework and figure out the best care possible. For more great finance and health tips, visit the blog section for additional resources and guides.
