Understanding Medicare Eligibility

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If you fit the following criteria then you are eligible for Medicare:  

  • 65 years of age and older (or younger in the case of disability).

  • Citizen or permanent resident of the U.S. for at least 5 years. 

For those already receiving benefits from Social Security or the Railroad Retirement Board, you will receive a letter from Medicare, notifying you of your eligibility. The letter will be accompanied by informational material on Medicare.

What to know about your Medicare letter: 

  • It will arrive roughly 3 months prior to your 65th birthday.

  • The informational material will explain your Medicare choices and how to act on them. 

  • You have the option to accept Medicare enrollment or postpone it. 

If you aren’t already receiving benefits from Social Security or the Railroad Retirement Board, then you won’t receive a letter from Medicare. In this case, you will need to sign up for Medicare on your own.  

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Be sure to sign up in the 3 months prior to your 65th birthday to avoid any gaps in coverage or late enrollment penalties.

Eligibility for Original Medicare

There are four parts to Medicare coverage, as well as supplemental coverage options. Each part covers different healthcare needs. Once you are eligible for Medicare, you can choose the coverage that you need.

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Parts A and B are known as Original Medicare, which the federal government provides. If you or your spouse paid Medicare taxes (FICA) for at least 10 years, you are eligible for premium-free Part A coverage. 

Also, at this time you are eligible to enroll in Part B, though Part B comes with a monthly premium.

Am I Eligible for Medicare Part A?

You are eligible for Part A if you are 65 years old and a citizen or permanent resident of the U.S. Most individuals receive Part A coverage without a monthly premium

Here are the eligibility criteria for premium-free Part A coverage:

  • You are at least 65 years old.

  • You (or a spouse) have worked and paid Medicare taxes for at least 10 years. 

You are also eligible for premium-free Part A at the age of 65 if:

  • You are currently receiving (or are eligible to receive) benefits from Social Security or the Railroad Retirement Board. 

  • You (or your spouse) had Medicare-covered government employment. 

In the case of disability, you may be eligible for premium-free Part A earlier than 65. The following circumstance apply for early eligibility:

  • You have been entitled to disability benefits from Social Security or the Railroad Retirement Board for 24 months.

  • You have End-Stage Renal Disease. 

  • You have Lou Gehrig's Disease.

Am I Eligible for Medicare Part B?

If you are eligible for Medicare Part A (as listed above), then you are also eligible for Medicare Part B. Part B coverage, however, comes with a monthly premium.

If you are not eligible for premium-free Part A coverage, you may decide that you want to only purchase Part B coverage. Some people take this route, rather than paying two monthly premiums.

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If you would like to check your Medicare Eligibility, Medicare offers free use of their Eligibility & Premium Calculator.

By answering a few questions, you can check your current eligibility status and view an estimation of what your Part B monthly premium will cost. 

It is a straightforward tool to use. The questions should only take a few seconds to answer. Even if you know that you are not yet eligible, you can still check the eligibility calculator to get the exact dates of your upcoming Initial Enrollment Period. 

Eligibility for Additional Medicare Coverage

If you want additional coverage to Parts A and B, you have a few more options to consider. The federal government does not provide additional coverage, rather these plans are offered by private insurance providers.

Am I Eligible for Medicare Part C?

If you are eligible for Original Medicare (Parts A and B), you are eligible to join a Medicare Part C plan, otherwise known as a Medicare Advantage plan. These plans bundle the benefits of Parts A, B, and D (prescription drug coverage). Many plans also provide extra coverage for hearing, dental, and vision care.

Am I Eligible for Medicare Part D?

If you are eligible for Original Medicare (Parts A and B), you are eligible for Medicare Part D, otherwise known as Medicare prescription drug coverage.

For an in-depth look at Medicare Eligibility, check out our

Medicare Eligibility Comprehensive Guide for 2020