Am I Eligible for Medicare?

Most people qualify for Medicare at age 65. You may be eligible earlier if you have certain disabilities or conditions such as End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease).

You may qualify for Part A at no cost if you or your spouse worked and paid Medicare taxes for at least 10 years. Others may be eligible through Social Security or Railroad Retirement Board (RRB) benefits.

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Medicare Eligibility Before 65

You may qualify before age 65 if:

You have received Social Security Disability Insurance (SSDI) for 24 months.

You receive a disability pension from the RRB and meet certain conditions.

You have ALS (Lou Gehrig’s disease).

You have ESRD and meet federal work or dependent requirements.

Costs Associated With Part A

- Deductible: A deductible must be met before Medicare Part A begins to cover eligible services.

- Premiums: Many individuals do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. Those who do not meet this requirement may be able to purchase Part A coverage.

- Copayments and Coinsurance: Cost-sharing may apply for extended hospital or skilled nursing facility stays.

- Inpatient hospital care: coinsurance applies after day 60 of a benefit period.

- Skilled nursing facility care: coinsurance applies after day 20 of a benefit period.

-Inpatient mental health care: coinsurance applies after day 60 of a benefit period.

Note: Medicare coverage is generally accepted nationwide, as most hospitals in the United States participate in the program.

Enrollment in Medicare Parts A & B

Initial Enrollment Period (IEP): Begins 3 months before the month you turn 65 and lasts until 3 months after (7 months total).

Open Enrollment Period (October 15 – December 7): You can review and change Medicare Advantage or Part D coverage.

General Enrollment Period (January 1 – March 31): Allows enrollment in Part A and/or Part B if you missed your IEP. Coverage starts July 1.

Special Enrollment Periods: Available in certain situations, such as losing employer coverage.

Costs Associated With Part B

- Premiums: Part B requires a monthly premium, which is based on income and enrollment timing. Most enrollees have their premium deducted from Social Security benefits.

- Deductible: A deductible must be met each year before Part B coverage begins.

- Coinsurance and Copayments: Typically, beneficiaries are responsible for 20% of the Medicare-approved amount for covered services if the provider accepts assignment.
- Preventive Care: Many preventive services, such as screenings and annual wellness visits, are covered at no cost to the beneficiary.

Additional Information:

- Coverage is generally available throughout the United States with any doctor or provider who accepts Medicare.

- Part B premiums, deductibles, and coinsurance amounts may change annually, with updates typically effective on January 1.

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Frequently Asked Questions

Will I be automatically enrolled in Medicare?

In some cases, yes. For example, if you are 65 and already receiving Social Security or RRB benefits, or if you are under 65 with certain disabilities, you may be enrolled automatically.

How do I manually enroll?

If you are not receiving Social Security, you must apply for Medicare during your Initial Enrollment Period. You can sign up at ssa.gov/medicare/sign-up.

How We Help?

Our licensed insurance agents provide clear information about the Medicare options we represent. We help you compare plans and understand your choices so you can make an informed decision.

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Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to the plans we represent. For information on all options, please visit Medicare.gov or call 1-800-MEDICARE.

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NPN:

Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to the plans we represent. For information on all options, please visit Medicare.gov or call 1-800-MEDICARE.