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At What Age Are You Eligible For Medicare Benefits

Already Enrolled In Medicare

Are You Eligible for Medicare? | Medicare Eligibility Requirements

If you have Medicare, you can get information and services online. Find out how to .

If you are enrolled in Medicare Part A and you want to sign up for Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.

You can use one of the following options to submit your enrollment request under the Special Enrollment Period:

  • Fax or mail your CMS-40B, CMS-L564, and secondary evidence to your local Social Security office .
  • Note: When completing the forms CMS-40B and CMS-L564:

    • State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
    • If possible, your employer should complete Section B.
    • If your employer is unable to complete Section B, please complete that portion as best as you can on their behalf and submit one of the following forms of secondary evidence:
      • Income tax form that shows health insurance premiums paid.
      • W-2s reflecting pre-tax medical contributions.
      • Pay stubs that reflect health insurance premium deductions.
      • Health insurance cards with a policy effective date.
      • Explanations of benefits paid by the GHP or LGHP.
      • Statements or receipts that reflect payment of health insurance premiums.

    Some people with limited resources and income may also be able to get .

    Review Your Medicare Choices Each Year

    Whether you enroll in original Medicare or a Medicare Advantage plan, you generally do not need to renew coverage every year. That being said, plans are sometimes discontinued or their benefits and costs may change to the point that the plan no longer meets your needs. Its not unusual for pharmacy and provider networks to change, for costs to increase, or the list of covered prescription drugs to vary. Thats why its a good idea to review your plan each year and compare it against your current health care needs.

    Your health insurer is required to send you an Annual Notice of Change by September 30 each year. The notice outlines any changes in coverage and costs expected to begin the following January. If you decide to change your health care plan after reviewing those updates, you can do so during Medicares open enrollment period. The period runs from October 15 to December 7. During this time, you can switch from original Medicare to Medicare Advantage or vice versa. You can switch from one Medicare Advantage plan to another or from one Medicare Part D plan to another. You can also enroll in Medicare Part D if you have not done so already, although late enrollment penalties may apply.

    If you find that the new health care plan is not meeting your needs, you can reverse some plan decisions January 1 to March 31 of the following year. Guidance for the renewal process is offered through the U.S. governments phone line at 1-800-MEDICARE or through your local SHIP.

    When Your Coverage Starts

    The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always starts on the first of the month.

    If you qualify for Premium-free Part A: Your Part A coverage starts the month you turn 65.

    Part B : Coverage starts based on the month you sign up:

    If you sign up:

    1 month after you turn 65

    In 2022: 2 months after you sign up

    Starting January 1, 2023: the next month

    2 or 3 months after you turn 65

    In 2022: 3 months after you sign up

    Starting January 1, 2023: the next month

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    How Might Lowering The Medicare Age Affect State And Federal Costs And Provider Payments

    What is current policy? Medicare is a federal program primarily financed by a combination of payroll taxes, general revenue, and premiums. In traditional Medicare, the federal government establishes the methodology for making payments to hospitals, physicians and other health care providers under the traditional Medicare program and uses a formula to establish capitated payments to Medicare Advantage plans. In contrast, Medicaid is financed jointly by states and the federal government, and states determine provider payment rates within broad federal standards.

    What are the key policy choices and implications? The precise impact of lowering the Medicare age on federal and state costs depends on how the policy is structured. Transitioning current Medicaid enrollees to Medicare would be likely to increase federal spending and reduce state costs as states would no longer share in the costs of covering these individuals. If individuals 60-64 are permitted to retain their current Medicaid eligibility, states would continue to fund a share of these individuals Medicaid costs, though Medicare would be the primary payer for the benefits it covers. If enrollees move to Medicare and do not retain full Medicaid eligibility, the federal government would no longer pay for a share of benefits that are only available through Medicaid .

    Other Medicare Eligibility Requirements

    What Age Are You Eligible For Medicare Part B

    There are a few other Medicare eligibility criteria in addition to the age requirement.

    • You must be a U.S. citizen or a legal permanent resident who has lived in the United States for at least 5 years.
    • You or your spouse mustve paid into Social Security for what amounts to 10 years or more , OR you mustve paid Medicare tax while you or your spouse was an employee of the federal government.

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    What Is The Minimum Age To Qualify For Medicaid

    This Medicaid coverage group is for individuals who are disabled and are between ages 16 and 65. Individuals who meet the Social Security disability requirement and who are employed may qualify when total gross income is at or below 250% FPL and when unearned income is at or below the current SSI Payment Level.

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    Social Security And Medicare Basics

    For most of us, Social Security is the bedrock of retirement income. And Medicare is likely to be your primary source of health coverage. But when can you claim Social Security? And exactly what is Medicare? Understanding how and when to start taking advantage of these programs can help you maximize your benefitsand positively impact your retirement lifestyle.

    Though the two programs are separate, Social Security works closely with Medicare to enroll people who are 65 and older, provide information and collect premiums.

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    Explore Your Other Medicare Coverage Options

    Once you are enrolled in Original Medicare, you can explore additional coverage options.

    You can decide to:

    • Add a Medigap supplement insurance policy.
    • Add a Part D prescription drug plan.
    • Switch to a Medicare Advantage plan also known as Part C to replace your Original Medicare coverage.

    Medicare Part D, Medigap and Medicare Advantage are all administered by private insurance companies that contract with CMS.

    You can apply for these benefits online.

    Use the Medicare Plan Finder tool to explore and compare plans in your area.

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    If My Spouse Is 65 And Im 62 How Will That Affect My Spouses Medicare Costs

    What Are Dual Special Needs Plans (D-SNP)?

    Your spouseâs costs will depend on the type of Medicare plan they choose â Original Medicare from the government or Medicare Advantage from a private insurer. And it will depend on the number of years youâve both worked.

    Hereâs the lowdown: At the age of 65, your spouse will qualify for traditional Medicare, also called Original Medicare. That includes Medicare Part A, which covers hospital costs, and Medicare Part B, which covers doctor visits, among other things. If they need additional benefits, like coverage for prescription drugs, vision, hearing, or dental care, they must buy either additional Medicare Supplement plans or enroll in a Medicare Advantage plan that bundles those benefits in one policy.

    Chances are that your spouse will have to pay a monthly premium for Part B . But they probably wonât have to pay for Part A. The reason: If your spouse has worked for at least 10 years , theyâve paid taxes to Medicare, so they wonât have to pay a premium for Part A.

    And if your spouse hasnât worked for at least 10 years? They can still qualify for premium-free Part A if youâve worked for that amount of time and have paid taxes to Medicare.

    If, on the other hand, neither you nor your spouse has worked for at least 10 years, you both may need to pay a premium for Part A. That cost can be as much as $499 a month. Part B is at least $170.10.

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    Medicare Advantage Plan Eligibility For 2023

    Heres what you need to know about eligibility for Parts C and D:

    If you
    Qualify for Medicare because youre turning 65 Sign up for Medicare Advantage or Part D during your 7-month initial enrollment period
    Qualify for Medicare because of a disability but arent 65 Sign up for Medicare Advantage or Part D during the 7-month period that starts 3 months before your 25th month of disability payments, includes that 25th month, and ends 3 months after the 25th month of disability payments
    Qualify for Medicare because of a disability and youre 65 Sign up for Medicare Advantage or Part D during the 7-month period that starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after your birthday month
    Dont have Medicare Part A, and you enrolled in Part B during general enrollment Sign up for Medicare Part D only, from April 1 to June 30
    Have Medicare Part A, and you enrolled in Part B during general enrollment Sign up for Medicare Advantage only, from April 1 to June 30

    You can also switch to Medicare Advantage or join a Part D drug plan during the Medicare annual open enrollment period, which runs from October 15 through December 7 each year. And if you already have an Advantage plan, you can use the Medicare Advantage Open Enrollment Period to make a one-time change to your coverage.

    • A Part D drug plan
    • A Medicare Advantage plan with drug coverage
    • Another Medicare health plan that covers prescription drugs
    • A plan from an employer or union

    Do You Pay Taxes On Social Security

    Some people who get Social Security must pay federal income taxes on their benefits. However, no one pays taxes on more than 85% percent of their Social Security benefits. You must pay taxes on your benefits if you file a federal tax return as an individual and your combined income exceeds $25,000.

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    When Are You Eligible To Enroll In Medicare

    You can apply for Medicare during several enrollment periods.

    The first, Initial Enrollment Period , includes the three months before your 65th birthday, the month of your 65th birthday and the three months after your 65th birthday.4

    If you didnt apply for Medicare within the seven months surrounding your 65th birthday, the window to apply opens again at the beginning of each year, from January 1 to March 31 . But keep in mind that if you enroll during the GEP, your actual Medicare coverage wont begin until July of that year.5

    If you or your spouse paid Medicare taxes for 10 years or more, youre eligible for premium-free Medicare Part A . If, though, you or your spouse worked for less than a decade, you will still qualify for Medicare but you may need to pay a monthly premium for Part A, which will be based on how long you or your spouse worked.

    Everyone who enrolls in Medicare Part B is required to pay a monthly premium. The standard premium for 2021 is $148.50, those who are considered higher-income beneficiaries will pay more.

    And if you opt for Medicare Part D , you may pay a premium, depending on how you get the coverage. This can be through a standalone drug plan or as part of a Medicare Advantage that includes drug coverage.

    Whos Eligible For Medigap

    How Early To Join Medicare

    If youre enrolled in both Medicare Part A and Part B, and dont have Medicare Advantage or Medicaid benefits, then youre eligible to apply for a Medigap policy. These plans are standardized, and are designed to cover some or all of the out-of-pocket costs that are incurred when you have a Medicare-covered claim .

    You have a federal right to buy a Medigap plan during the six months beginning when youre at least 65 years old and have enrolled in Part B. This is known as your Medigap open enrollment period. After this time runs out, you will have only limited chances to purchase one down the road.

    Some states allow people of any age or health status to purchase Medigap coverage at any time without medical underwriting, but most dont. In many states, Medigap plans may not be available for people who have Medicare before age 65. There are 33 states that require Medigap plans to be guaranteed issue in at least some circumstances when an applicant is under age 65, but the rules vary from one state to another you can click on a state on this map to see details about state-based Medigap rules.

    If youre enrolling in Medicare due to your age, the primary factor that will affect your ability to purchase a Medigap policy regardless of your health will be whether you enroll during your Medigap Open Enrollment Period.

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    What Is The Eligibility Age For Medicare

    The eligibility age for Medicare is 65 years old. This applies whether or not youre still working at the time of your 65th birthday. You dont need to be retired to apply for Medicare.

    If you have insurance through your employer at the time you apply for Medicare, Medicare will become your secondary insurance.

    You can apply for Medicare:

    • as early as 3 months before the month you turn age 65
    • during the month you turn age 65
    • up to 3 months after the month you turn age 65

    This time frame around your 65th birthday provides a total of 7 months to get enrolled.

    How Do Beneficiaries Out

    Out-of-pocket spending

    Although total Medicare per capita spending is higher for Medicare beneficiaries under age 65 with disabilities than for older beneficiaries, younger beneficiaries in traditional Medicare spend significantly less out of pocket, on average. This is likely due to the fact that a greater share of younger beneficiaries with disabilities than older beneficiaries have Medicaid coverage , as well as Part D Low-Income Subsidies , that help cover their premiums and cost sharing. Overall, out-of-pocket spending by younger beneficiaries with disabilities is 40% less than that of older beneficiaries . Younger beneficiaries have lower average out-of-pocket spending than older beneficiaries for insurance premiums and for medical and long-term care services combined .

    On average, in 2012 beneficiaries in traditional Medicare with disabilities spent the largest share of their total non-premium out-of-pocket costs on medical providers , followed by prescription drugs and long-term care facility costs . These services also were the top three in terms of out-of-pocket costs for older beneficiaries, but in a different order: older beneficiaries spent the largest share of their out-of-pocket costs on facility costs , followed by medical providers and prescription drugs .

    Access to care and cost-related problems

    Figure 6: Selected Measures of Access to Health Care for Medicare Beneficiaries Under Age 65 Compared to Those Age 65 or Older

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    Medicare Benefit Period Explained

    The Medicare benefit period is simply the way Original Medicare measures your use of inpatient hospital and skilled nursing facility services. Your benefit period begins the day youre admitted as an inpatient into a hospital or SNF and ends when you have gone 60 days in a row with no inpatient hospital or SNF care.

    The benefit period has nothing to do with the calendar year, but is based on your medical care needs. It begins on the first day you are admitted into the hospital or SNF and ends 60 days after the last day you received treatment. For example, if you are admitted into the hospital on May 1 and receive 15 days of treatment, your benefit period would begin on May 1 and end on July 15. If you need to return to the hospital before the 60 days has expired, you will still be in the same benefit period. However, as soon as 60 days has passed with no care, if you return to the hospital, you will start a new benefit period.

    While there is no limit to the number of benefit periods you can have or how long each benefit period can last, you must pay the inpatient hospital deductible for each benefit period.

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    Medicare Is Health Insurance For Individuals 65 Years Of Age Or Older Or Individuals Under The Age Of 65 With Certain Disabilities

    Who Is Eligible for Medicare?

    You may qualify under the following conditions:

    • You are turning 65
    • You are under 65 and have been receiving disability benefits from Social Security for 24 months
    • You are under 65 and have been receiving certain disability benefits from the Railroad Retirement Board
    • You have End Stage Renal Disease
    • You have Amyotrophic Lateral Sclerosis

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