Who Qualifies for Medicare?

Medicare permits enrollment for people who:

  • Recently turned or are about to turn 65
  • Are under age 65 with a qualifying disability
  • Were diagnosed with End-Stage Renal Disease or ALS

What Does Medicare Include?

Medicare health insurance comes in several parts. Medicare Part A (hospitalization) and Part B (medical insurance) are also referred to as Original Medicare. They only cover 80% of your medical costs, so consider buying supplemental Medicare insurance.

There are two types of extra Medicare coverage:

  • Medicare supplements
  • Medicare Advantage

A Medicare Supplement works in conjunction with Original Medicare to close the coverage gaps. There is a separate monthly fee. You would also buy a standalone Medicare Part D (medications) plan.

Medicare Advantage plans bundle Part A and Part B into a single plan, and often include Part D (prescription drug coverage). Some of these plans also include dental, vision, and hearing services, with a $0 monthly premium.

You can have either a supplement or Advantage plan, but not both.

When Can I Enroll in Medicare?

65th Birthday – Initial Enrollment Period

You first become eligible for Medicare in a 7-month window around your 65th birthday. You would sign up for Medicare Part A and/or Part B.

It starts 3 months before the month of your 65th birthday. Of course, it includes the month you turn 65. Then, the window ends 3 months after the month you turned 65.

For example, if your birthday is June 14, you can enroll between March 1 and September 30.

Medicare refers to the 7-month window as the Initial Enrollment Period.

Qualifying Disability

If you have a qualifying disability, your Medicare coverage beings 24 months after you begin receiving Social Security or Railroad Retirement Board disability benefits.

If you join within the 3 months before you become eligible for Medicare, your coverage begins on Day 1 of your 25th month of disability payments.

If you join during your 25th month of receiving disability payments, your coverage begins in the following month on the first day.

If you join within the 3 months after receiving your 25th month of disability payments, your coverage begins on the first day of the month after you sign up with Medicare.

End-Stage Renal Disease

You are eligible for Medicare at any age if

  • Your kidneys no longer work; and
  • Require frequent dialysis or had a kidney transplant; and
  • You worked the required time under Social Security, the Railroad Retirement Board or as a government employee; or
  • You already receive Social Security or RRB benefits; or
  • You are the spouse or dependent child of a person who meets the above requirements

Typically, Medicare starts on the first day of the fourth month of your dialysis treatments. The 4-month waiting period begins even if you have not signed up for Medicare yet.

Medicare can start in the first month of regular dialysis treatment if you participate in a Medicare-approved home dialysis training program during the first 3 months of your treatments, and your doctor expects you to complete training and do your own dialysis treatment.

ALS (Lou Gehrig's Disease)

Benefits can begin when you start receiving Social Security Disability benefits.

Typically, Social Security Disability begins 5 months after you apply for it.

How Do I Enroll?

In many cases, Medicare automatically enrolls you when you turn 65 or collect Social Security/RRB benefits.

You receive:

Medicare Part A is hospitalization, hospice, home health, skilled nursing services, and surgery. It does not cover doctor's services in the hospital.

Medicare Part B is medical insurance for doctor's services (inpatient and outpatient), lab work, durable medical equipment, preventative services, and more.

Otherwise, you must enroll in Medicare during one of the several Enrollment Periods they provide.

You can opt for Medicare Part D (prescription drug coverage) since neither Part A nor Part B include most medications.

How Much Does Medicare Cost?

Medicare Part A

For most people, Medicare Part A has a $0 premium. If you worked and paid taxes for at least 10 years, or receive Social Security/RRB retirement benefits, then you qualify.

You still must pay copays, deductibles and 20% coinsurance for services.

Medicare Part B

Everyone pays an additional premium for Medicare Part B. For most people, the amount is $144.60, but it might be more if you earn a higher income.

Typically, Medicare deducts it automatically from your Social Security, Railroad Retirement, or Civil Service Retirement check.

Otherwise, you receive a quarterly bill from Medicare.

If you enroll late, you will pay a late enrollment penalty to Medicare. They charge the penalty for as long as you qualify for Medicare Part B.

Part B also requires that you share some of the costs. It has copays, deductibles, and a 20% coinsurance you must cover.

Medicare Part D

You must opt-in for Medicare Part D when you become eligible or during your Initial Enrollment Period, the Annual Enrollment Period, or the General Enrollment Period.

Unlike Medicare Part A and B, private insurers sell drug plans. Premiums vary between policies and states. Learn more about Prescription Drug plans here.

Medicare Supplement

Medicare Supplements charge an additional premium beyond what you pay for Medicare Part B and Part D.

Rates are based on which plan you choose, your age, sex, location, and the insurance company.

Medicare Advantage

Medicare Advantage costs depend on which plan you choose. Some have a $0 premium. You are responsible for copays, deductibles, and coinsurance.

Working After 65?

If you plan to work after you turn 65, you still want to enroll in Medicare Part A as soon as you are eligible. Chances are you won't have to pay any premium.

Check with your employer about whether you should also enroll in Medicare Part B.

Make sure to sign up during your Initial Enrollment Period to avoid paying a late enrollment fee.

AARDY Can Help You Enroll in Medicare

AARDY is the nation's fastest Medicare insurance marketplace. You can compare Medicare supplements and Medicare Advantage plans to find the one that best fits your needs.



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